Di Cesare Ernesto, Gennarelli Antonio, Di Sibio Alessandra, Felli Valentina, Splendiani Alessandra, Gravina Giovanni Luca, Masciocchi Carlo
Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, Italy.
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, Laboratory of Radiobiology, University of L'Aquila, Italy.
Eur J Radiol. 2015 Apr;84(4):631-6. doi: 10.1016/j.ejrad.2014.11.035. Epub 2015 Jan 2.
To evaluate image quality and radiation dose of single heartbeat 640-slice coronary CT angiography (CCTA) in patients with chronic Atrial Fibrillation (cAF) in comparison with subjects in normal sinus rhythm.
A cohort of 71 patients with cAF was matched with 71 subjects in normal sinus rhythm (NSR) and HR≤65 bpm using a matched by propensity analysis. All subjects underwent a single heartbeat CCTA with prospective gating. In subjects with cAF, we manually established the acquisition of data only from a single heartbeat. Mean effective dose and image quality, with both objective and subjective measures, were assessed.
96.4% of all segments in the cAF group had diagnostic image quality. The rate of subjects with at least one non-diagnostic segment was 14% and 2.8% (p=0.031) in the cAF and NRS groups, respectively. In the cAF group, the percentage of patients with at least one non-diagnostic segment for acquisition HR≤72 was 1.8% (1/55), and it did not significantly differ from the NSR group (2.8%; 2/71) (p=1.0). Objective quality parameters did not show a statistically significant difference between the two groups. The mean effective dose was 4.24±1.24 mSv in the cAF group and 2.67±0.5 mSv in the sinus rhythm group (p<0.0001) with an increase by 59% in the cAF group with respect to the SNR group.
A single heartbeat acquisition protocol with a 640-slice prospectively ECG-triggered CT angiography may be feasible in patients with cAF and HR below 72 bpm at the CT acquisition, although mean effective dose of this protocol in cAF group was 59% higher than in sinus rhythm one. In patients with cAF and a heart rate higher than 72 bpm, CCTA tends to have more movement-associated artefacts.
与正常窦性心律的受试者相比，评估慢性心房颤动（cAF）患者单心跳640层冠状动脉CT血管造影（CCTA）的图像质量和辐射剂量。
采用倾向分析匹配的方法，将71例cAF患者与71例正常窦性心律（NSR）且心率≤65次/分的受试者进行匹配。所有受试者均接受前瞻性门控的单心跳CCTA检查。对于cAF患者，我们仅手动从单心跳中获取数据。评估平均有效剂量和图像质量，包括客观和主观测量指标。
cAF组所有节段中96.4%具有诊断性图像质量。cAF组和NRS组中至少有一个非诊断性节段的受试者比例分别为14%和2.8%（p=0.031）。在cAF组中，采集心率≤72时至少有一个非诊断性节段的患者比例为1.8%（1/55），与NSR组（2.8%；2/71）无显著差异（p=1.0）。两组间客观质量参数无统计学显著差异。cAF组平均有效剂量为4.24±1.24 mSv，窦性心律组为2.67±0.5 mSv（p<0.0001），cAF组相对于SNR组增加了59%。
对于CT采集时cAF且心率低于72次/分的患者，采用640层前瞻性心电图触发的CT血管造影单心跳采集方案可能是可行的，尽管该方案在cAF组的平均有效剂量比窦性心律组高59%。对于cAF且心率高于72次/分的患者，CCTA往往有更多与运动相关的伪影。
