Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Department of Cardiology and Angiology, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Clin Res Cardiol. 2017 Jul;106(7):485-492. doi: 10.1007/s00392-017-1077-2. Epub 2017 Feb 6.
The usage of coronary CT angiography (CTA) is appropriate in patients with acute or chronic chest pain; however the diagnostic accuracy may be challenged with increased Agatston score (AS), increased heart rate, arrhythmia and severe obesity. Thus, we aim to determine the potential of the recently introduced third-generation dual-source CT (DSCT) for CTA in a 'real-life' clinical setting.
Two hundred and sixty-eight consecutive patients (age: 67 ± 10 years; BMI: 27 ± 5 kg/m²; 61% male) undergoing clinically indicated CTA with DSCT were included in the retrospective single-center analysis. A contrast-enhanced volume dataset was acquired in sequential (SSM) (n = 151) or helical scan mode (HSM) (n = 117). Coronary segments were classified in diagnostic or non-diagnostic image quality. A subset underwent invasive angiography to determine the diagnostic accuracy of CTA.
SSM (96.8 ± 6%) and HSM (97.5 ± 8%) provided no significant differences in the overall diagnostic image quality. However, AS had significant influence on diagnostic image quality exclusively in SSM (B = 0.003; p = 0.0001), but not in HSM. Diagnostic image quality significantly decreased in SSM in patients with AS ≥2,000 (p = 0.03). SSM (sensitivity: 93.9%; specificity: 96.7%; PPV: 88.6%; NPV: 98.3%) and HSM (sensitivity: 97.4%; specificity: 94.3%; PPV: 86.0%; NPV: 99.0%) provided comparable diagnostic accuracy (p = n.s.). SSM yielded significantly lower radiation doses as compared to HSM (2.1 ± 2.0 vs. 5.1 ± 3.3 mSv; p = 0.0001) in age and BMI-matched cohorts.
SSM in third-generation DSCT enables significant dose savings and provides robust diagnostic image quality in patients with AS ≤2000 independent of heart rate, heart rhythm or obesity.
冠状动脉 CT 血管造影（CTA）适用于急性或慢性胸痛患者；然而，随着 积分（AS）增加、心率增加、心律失常和严重肥胖等因素，诊断准确性可能受到挑战。因此，我们旨在确定第三代双源 CT（DSCT）在“真实”临床环境中用于 CTA 的潜力。
回顾性分析了 268 例连续接受临床指征 CTA 的患者（年龄：67±10 岁；BMI：27±5kg/m²；61%为男性）。使用连续（SSM）（n=151）或螺旋扫描模式（HSM）（n=117）采集增强容积数据集。将冠状动脉节段分为诊断或非诊断图像质量。部分患者接受有创血管造影以确定 CTA 的诊断准确性。
SSM（96.8±6%）和 HSM（97.5±8%）在整体诊断图像质量方面无显著差异。然而，AS 仅在 SSM 中对诊断图像质量有显著影响（B=0.003；p=0.0001），而在 HSM 中无影响。在 AS≥2000 的患者中，SSM 中诊断图像质量显著降低（p=0.03）。SSM（敏感性：93.9%；特异性：96.7%；PPV：88.6%；NPV：98.3%）和 HSM（敏感性：97.4%；特异性：94.3%；PPV：86.0%；NPV：99.0%）提供了可比的诊断准确性（p=n.s.）。在年龄和 BMI 匹配的队列中，SSM 与 HSM 相比，辐射剂量显著降低（2.1±2.0 与 5.1±3.3mSv；p=0.0001）。
第三代 DSCT 的 SSM 可显著降低剂量，并为 AS≤2000 的患者提供稳健的诊断图像质量，而不受心率、心律或肥胖的影响。
