采用 X 射线管电压适配对比剂注射方案的低管电压和高管电压冠状动脉 CT 血管造影的诊断准确性。
Diagnostic accuracy of low and high tube voltage coronary CT angiography using an X-ray tube potential-tailored contrast medium injection protocol.
机构信息
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
出版信息
Eur Radiol. 2018 May;28(5):2134-2142. doi: 10.1007/s00330-017-5150-z. Epub 2017 Nov 27.
OBJECTIVES
To compare the diagnostic accuracy between low-kilovolt peak (kVp) (≤ 100) and high-kVp (> 100) third-generation dual-source coronary CT angiography (CCTA) using a kVp-tailored contrast media injection protocol.
METHODS
One hundred twenty patients (mean age = 62.6 years, BMI = 29.0 kg/m) who underwent catheter angiography and CCTA with automated kVp selection were separated into two cohorts (each n = 60, mean kVp = 84 and 117). Contrast media dose was tailored to the kVp level: 70 = 40 ml, 80 = 50 ml, 90 = 60 ml, 100 = 70 ml, 110 = 80 ml, and 120 = 90 ml. Contrast-to-noise ratio (CNR) was measured. Two observers evaluated image quality and the presence of significant coronary stenosis (> 50% luminal narrowing).
RESULTS
Diagnostic accuracy (sensitivity/specificity) with ≤ 100 vs. > 100 kVp CCTA was comparable: per patient = 93.9/92.6% vs. 90.9/92.6%, per vessel = 91.5/97.8% vs. 94.0/96.8%, and per segment = 90.0/96.7% vs. 90.7/95.2% (all P > 0.64). CNR was similar (P > 0.18) in the low-kVp vs. high-kVp group (12.0 vs. 11.1), as ws subjective image quality (P = 0.38). Contrast media requirements were reduced by 38.1% in the low- vs. high-kVp cohort (53.6 vs. 86.6 ml, P < 0.001) and radiation dose by 59.6% (4.3 vs. 10.6 mSv, P < 0.001).
CONCLUSIONS
Automated tube voltage selection with a tailored contrast media injection protocol allows CCTA to be performed at ≤ 100 kVp with substantial dose reductions and equivalent diagnostic accuracy for coronary stenosis detection compared to acquisitions at > 100 kVp.
KEY POINTS
• Low-kVp coronary CT angiography (CCTA) enables reduced contrast and radiation dose. • Diagnostic accuracy is comparable between ≤ 100 and > 100 kVp CCTA. • Image quality is similar for low- and high-kVp CCTA. • Low-kVp image acquisition is facilitated by automated tube voltage selection. • Tailoring contrast injection protocols to the automatically selected kVp-level is feasible.
目的
比较使用基于千伏峰（kVp）量身定制的对比剂注射方案的低千伏峰（≤100）和高千伏峰（>100）第三代双源冠状动脉 CT 血管造影（CCTA）的诊断准确性。
方法
将 120 例接受导管血管造影和自动选择 kVp 的 CCTA 检查的患者（平均年龄=62.6 岁，BMI=29.0 kg/m²）分为两组（每组 n=60，平均 kVp=84 和 117）。对比剂剂量根据 kVp 水平进行调整：70=40ml，80=50ml，90=60ml，100=70ml，110=80ml，120=90ml。测量对比噪声比（CNR）。两名观察者评估图像质量和是否存在明显的冠状动脉狭窄（>50%管腔狭窄）。
结果
≤100 与>100 kVp CCTA 的诊断准确性（敏感性/特异性）相当：每位患者为 93.9/92.6%与 90.9/92.6%，每条血管为 91.5/97.8%与 94.0/96.8%，每段血管为 90.0/96.7%与 90.7/95.2%（均 P>0.64）。低 kVp 组与高 kVp 组的 CNR 相似（P>0.18）（12.0 与 11.1），主观图像质量也相似（P=0.38）。低 kVp 组的对比剂用量比高 kVp 组减少了 38.1%（53.6 与 86.6ml，P<0.001），辐射剂量减少了 59.6%（4.3 与 10.6mSv，P<0.001）。
结论
使用基于千伏峰量身定制的对比剂注射方案的自动管电压选择允许在≤100 kVp 时进行 CCTA，与>100 kVp 时相比，可显著减少对比剂和辐射剂量，并且对冠状动脉狭窄的检测具有相同的诊断准确性。
关键点
冠状动脉 CT 血管造影（CCTA）中的低千伏峰可降低对比剂和辐射剂量。
≤100 与>100 kVp CCTA 的诊断准确性相当。
低千伏峰和高千伏峰 CCTA 的图像质量相似。
自动管电压选择有助于进行低千伏峰图像采集。
根据自动选择的 kVp 水平定制对比剂注射方案是可行的。
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