From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
Radiology. 2013 Dec;269(3):722-9. doi: 10.1148/radiol.13130408. Epub 2013 Oct 28.
To analyze the effect of automatic tube potential selection with tube current modulation (APSCM) and iterative reconstruction on image quality, diagnostic accuracy, and radiation dose at computed tomographic (CT) angiography and compare it with APSCM-only and body mass index (BMI)-based examination protocols.
This study was approved by the institutional review board, and informed consent was obtained from all patients. Images from 185 patients who underwent a BMI-based protocol and 197 patients who underwent an APSCM protocol with filtered back projection (FBP) and an APSCM protocol with sinogram-affirmed iterative reconstruction (SAFIRE) were retrospectively evaluated. Diagnostic performance was compared with that of conventional coronary angiography in a subgroup of 51 patients. Statistical analysis was performed by using the independent or paired t test, Mann-Whitney U test, Wilcoxon signed rank test, χ(2) statistics, linear weighted κ statistics, and generalized estimating equation.
The APSCM group with SAFIRE had a significant reduction in image noise and a significant increase in CT number, contrast enhancement, signal-to-noise ratio, and contrast-to-noise ratio compared with the APSCM group with FBP (P < .0001) and the BMI-based group (P < .001, except P = .002 for image noise). Image quality and diagnostic accuracy showed no significant difference between the three groups. The use of APSCM resulted in a significant reduction in radiation dose compared with the BMI-based protocol.
The combination of SAFIRE and APSCM at coronary CT angiography significantly improves objective image quality while maintaining diagnostic accuracy and reduced radiation dose. Online supplemental material is available for this article.
分析管电流调制自动管电压选择（APSCM）和迭代重建对 CT 血管造影图像质量、诊断准确性和辐射剂量的影响，并将其与仅 APSCM 和基于体质量指数（BMI）的检查方案进行比较。
本研究经机构审查委员会批准，并获得所有患者的知情同意。回顾性分析了 185 例行 BMI 方案和 197 例行 APSCM 方案（滤波反投影[FBP]和正弦图确认迭代重建[SAFIRE]）的患者的图像。在 51 例患者的亚组中比较了诊断性能与常规冠状动脉造影的比较。使用独立或配对 t 检验、Mann-Whitney U 检验、Wilcoxon 符号秩检验、χ(2)检验、线性加权κ检验和广义估计方程进行统计分析。
与 FBP 组（P<0.0001）和 BMI 组（P<0.001，除 P=0.002 为噪声外）相比，APSCM 组联合 SAFIRE 组的图像噪声显著降低，CT 值、对比增强、信噪比和对比噪声比显著增加（P<0.0001）。三组之间的图像质量和诊断准确性无显著差异。与 BMI 方案相比，APSCM 的应用显著降低了辐射剂量。
在冠状动脉 CT 血管造影中，SAFIRE 与 APSCM 的联合使用可显著改善客观图像质量，同时保持诊断准确性和降低辐射剂量。本研究提供了在线补充材料。
