Reinartz Sebastian Daniel, Winkler Markus, Diefenbach Sascha B, Allmendinger Thomas, Penzkofer Tobias, Kuhl Christiane K, Mahnken Andreas H
Department of Diagnostic and Interventional Radiology, University hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany.
Department of Diagnostic and Interventional Radiology, University hospital RWTH Aachen, Pauwelsstrasse 30, Aachen 52074, Germany.
Acad Radiol. 2017 Feb;24(2):167-174. doi: 10.1016/j.acra.2016.09.014. Epub 2016 Dec 20.
Particularly for patients with heart arrhythmias, conventional BestSystole (BS) and BestDiastole (BD) reconstruction techniques in computed tomography (CT) frequently show artifacts that hinder the readability of the coronary tree. To address this problem, this paper presents an alternative reconstruction method that combines the technique "reconstructions with identical filling" (RIF) with motion mapping: This new technique is called "RIF in motion mapping" (RIMM). This study compares the diagnostic quality of images generated with RIMM to that of the other reconstruction techniques.
Having shown major artifacts in standard reconstructions, the CT datasets of 23 patients with suspected coronary artery disease or prior to transcatheter aortic valve replacement were selected manually. Each dataset was evaluated with four reconstruction techniques: BS, BD, RIF, and RIMM. Two radiologists, blinded to the applied reconstruction type, then evaluated the entire coronary tree of each sample using the 15-segment American Heart Association model and the six-grade Likert scale.
Of the 345 analyzed coronary segments, the RIMM technique showed a significant number of images with reliable diagnostic quality (n = 228, 66%) as compared to RIF (P = 0.002) and BS/BD reconstructions (P < 0.001). Per coronary segment, vessel, and patient, the RIMM technique scored significantly better than the conventional BS/BD reconstructions (P = 0.003) and better than the RIF reconstructions with regard to the right coronary artery (P = 0.041).
This new technique works: Using RIMM on the worst CT images substantially erased many of these artifacts, thereby enabling the radiologists to clearly visualize these segments. As RIMM considerably eliminates artifacts, this new CT reconstruction technique can help make a fast reliable evaluation of a patient's coronary tree. Thus, this enhanced visualization of cardiac images by RIMM avoids the need for further invasive diagnostic procedures.
特别是对于心律失常患者，计算机断层扫描（CT）中传统的最佳收缩期（BS）和最佳舒张期（BD）重建技术经常显示出伪影，这会妨碍冠状动脉树的可读性。为了解决这个问题，本文提出了一种将“相同填充重建”（RIF）技术与运动映射相结合的替代重建方法：这种新技术被称为“运动映射中的RIF”（RIMM）。本研究比较了RIMM生成的图像与其他重建技术的诊断质量。
鉴于在标准重建中显示出主要伪影，手动选择了23例疑似冠状动脉疾病或经导管主动脉瓣置换术前患者的CT数据集。每个数据集用四种重建技术进行评估：BS、BD、RIF和RIMM。两名对应用的重建类型不知情的放射科医生，然后使用15段美国心脏协会模型和六级李克特量表评估每个样本的整个冠状动脉树。
在分析的345个冠状动脉节段中，与RIF（P = 0.002）和BS/BD重建（P < 0.001）相比，RIMM技术显示出大量具有可靠诊断质量的图像（n = 228，66%）。在每个冠状动脉节段、血管和患者中，RIMM技术的评分明显优于传统的BS/BD重建（P = 0.003），在右冠状动脉方面也优于RIF重建（P = 0.041）。
这项新技术有效：在最差的CT图像上使用RIMM基本上消除了许多这些伪影，从而使放射科医生能够清晰地可视化这些节段。由于RIMM大大消除了伪影，这种新的CT重建技术有助于对患者的冠状动脉树进行快速可靠的评估。因此，RIMM对心脏图像的这种增强可视化避免了进一步侵入性诊断程序的需要。
