Lessick Jonathan, Klass Oliver, Wuchenauer Sabine, Walker Matthew J, Schmitt Holger, Peters Jochen, Weese Juergen, Brunner Horst, Vembar Mani, Grass Michael, Aronson Doron, Hoffmann Martin H K
Cardiology Department, Rambam Health Care Campus and Technion, Israel Institute of Technology, Haalita Street, Haifa 3109601, Israel.
Klinik für Diagnostische und Interventionelle Radiologie, Ulm, Germany.
Acad Radiol. 2015 Jun;22(6):697-703. doi: 10.1016/j.acra.2015.01.013. Epub 2015 Mar 7.
Selecting the optimal phase for coronary artery evaluation can be challenging, especially at higher heart rates, given that the optimal phase may differ for each of the coronary arteries. This study aimed to evaluate a novel vessel-specific algorithm which automatically outputs the minimum motion phase per coronary artery.
The study included 44 patients who underwent 256-slice cardiac computed tomography for evaluation of chest pain. End-systolic and mid-diastolic minimal motion phases were automatically calculated by a previously validated global motion algorithm and by a new vessel-specific algorithm which calculates the minimum motion for each of the three main coronary arteries, separately. Two readers blindly evaluated all coronary segments for image quality. Median scores per coronary artery were compared by the Wilcoxon signed rank test.
The variation, per patient, between the optimal phases of the three coronary arteries was 5.0 ± 4.5% (1%-22%) for end systole and 4.8 ± 4.1% (0%-19%) for mid diastole. The mean image quality scores per coronary artery were 4.0 ± 0.61 for the vessel-specific approach and 3.80 ± 0.69 for the global phase selection (P < .001). Overall, 46 of 122 arteries had a better score with the vessel-specific approach and five with the standard global approach. Interreader agreement was substantial (k = 0.72).
This study has shown that multiple phases are required to ensure optimal image quality for all three coronary arteries and that a vessel-specific phase selection algorithm achieves superior results to the standard global approach.
鉴于每条冠状动脉的最佳相位可能不同，选择用于冠状动脉评估的最佳相位可能具有挑战性，尤其是在心率较高时。本研究旨在评估一种新型的血管特异性算法，该算法可自动输出每条冠状动脉的最小运动相位。
本研究纳入了44例因胸痛接受256层心脏计算机断层扫描的患者。通过先前验证的整体运动算法以及一种新的血管特异性算法自动计算出收缩末期和舒张中期的最小运动相位，该血管特异性算法分别计算三条主要冠状动脉各自的最小运动。两名阅片者对所有冠状动脉节段的图像质量进行盲法评估。采用Wilcoxon符号秩检验比较每条冠状动脉的中位数评分。
每位患者三条冠状动脉最佳相位之间的差异，收缩末期为5.0±4.5%（1%-22%），舒张中期为4.8±4.1%（0%-19%）。血管特异性方法下每条冠状动脉的平均图像质量评分为4.0±0.61，整体相位选择法为3.80±0.69（P<.001）。总体而言，122条动脉中有46条采用血管特异性方法时评分更高，5条采用标准整体方法时评分更高。阅片者间一致性较高（k=0.72）。
本研究表明，需要多个相位来确保三条冠状动脉均获得最佳图像质量，并且血管特异性相位选择算法比标准整体方法能取得更好的结果。
