单源双能量CT的单色冠状动脉计算机断层扫描血管造影对冠状动脉狭窄定量的影响。

Impact of monochromatic coronary computed tomography angiography from single-source dual-energy CT on coronary stenosis quantification.

作者信息

Stehli Julia, Clerc Olivier F, Fuchs Tobias A, Possner Mathias, Gräni Christoph, Benz Dominik C, Buechel Ronny R, Kaufmann Philipp A

机构信息

Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.

出版信息

J Cardiovasc Comput Tomogr. 2016 Mar-Apr;10(2):135-40. doi: 10.1016/j.jcct.2015.12.008. Epub 2015 Dec 17.

DOI:10.1016/j.jcct.2015.12.008

PMID:26754621

Abstract

BACKGROUND

In coronary CT angiography (CTA), stenosis evaluation is limited by artifacts such as blooming. Monochromatic reconstructions from single-source dual-energy coronary CTA have shown to reduce image noise and improve image quality.

OBJECTIVE

The aim of this study was to analyze the impact of monochromatic coronary CTA reconstructions on stenosis quantification using invasive coronary angiography (ICA) as standard of reference.

METHODS

Patients who were referred for clinically indicated assessment of coronary artery disease underwent coronary CTA and ICA within 4 months. In standard polychromatic coronary CTA images as well as 8 monochromatic series (50 keV-140 keV) luminal narrowing of coronary lesions was measured and compared to ICA with quantitative coronary angiography (QCA).

RESULTS

In 37 patients with a mean age of 63.4 ± 8.2 years and a broad range of BMI (19.9-45.5 kg/m(2)), 124 lesions were studied. Throughout all the reconstructions, CT measurements showed a significant correlation with QCA (P < 0.001), except for reconstructions with 50 keV. Luminal narrowing of calcified and partly calcified lesions was generally overestimated, and underestimated in noncalcified plaques. After stepwise regression, reconstructions with 90 keV showed the best relation to QCA (P < 0.001, R2 = 0.9). Analysis by plaque composition suggested a superior performance of reconstructions at 90 keV for calcified and partly calcified plaques and at 140 keV for noncalcified plaques.

CONCLUSION

The use of monochromatic reconstructions improves the overall accuracy of lesion assessment. Combining reconstructions at 90 keV for calcified and partly calcified lesions and at 140 keV for noncalcified lesions yielded optimal results. Thus monochromatic reconstruction bears the potential to improve accuracy of coronary CTA.

摘要

背景

在冠状动脉CT血管造影（CTA）中，狭窄评估受到诸如伪影（如光晕）的限制。单源双能量冠状动脉CTA的单色重建已显示可减少图像噪声并提高图像质量。

目的

本研究旨在以有创冠状动脉造影（ICA）作为参考标准，分析单色冠状动脉CTA重建对狭窄定量的影响。

方法

因临床需要评估冠状动脉疾病而转诊的患者在4个月内接受了冠状动脉CTA和ICA检查。在标准多色冠状动脉CTA图像以及8个单色系列（50 keV - 140 keV）中，测量冠状动脉病变的管腔狭窄情况，并与采用定量冠状动脉造影（QCA）的ICA结果进行比较。

结果

对37例平均年龄为63.4 ± 8.2岁且BMI范围较广（19.9 - 45.5 kg/m²）的患者的124个病变进行了研究。在所有重建中，CT测量结果与QCA均显示出显著相关性（P < 0.001），50 keV重建除外。钙化和部分钙化病变的管腔狭窄通常被高估，非钙化斑块则被低估。逐步回归分析后，90 keV重建与QCA的关系最佳（P < 0.001，R² = 0.9）。按斑块成分分析表明，90 keV重建对钙化和部分钙化斑块表现更佳，140 keV重建对非钙化斑块表现更佳。