Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
Eur Radiol. 2018 Jul;28(7):3097-3104. doi: 10.1007/s00330-017-5249-2. Epub 2018 Feb 5.
To investigate diagnostic accuracy and radiation dose of high-pitch CT coronary artery calcium scoring (CACS) with tin filtration (Sn100kVp) versus standard 120kVp high-pitch acquisition.
78 patients (58% male, 61.5±9.1 years) were prospectively enrolled. Subjects underwent clinical 120kVp high-pitch CACS using third-generation dual-source CT followed by additional high-pitch Sn100kVp acquisition. Agatston scores, calcium volume scores, Agatston score categories, percentile-based risk categorization and radiation metrics were compared.
61/78 patients showed coronary calcifications. Median Agatston scores were 34.9 [0.7-197.1] and 41.7 [0.7-207.2] and calcium volume scores were 34.1 [0.7-218.0] for Sn100kVp and 35.7 [1.1-221.0] for 120kVp acquisitions, respectively (both p<0.0001). Bland-Altman analysis revealed underestimated Agatston scores and calcium volume scores with Sn100kVp versus 120kVp acquisitions (mean difference: 16.4 and 11.5). However, Agatston score categories and percentile-based risk categories showed excellent agreement (ĸ=0.98 and ĸ=0.99). Image noise was 25.8±4.4HU and 16.6±2.9HU in Sn100kVp and 120kVp scans, respectively (p<0.0001). Dose-length-product was 9.9±4.8mGycm and 40.9±14.4mGycm with Sn100kVp and 120kVp scans, respectively (p<0.0001). This resulted in significant effective radiation dose reduction (0.13±0.07mSv vs. 0.57±0.2mSv, p<0.0001) for Sn100kVp acquisitions.
CACS using high-pitch low-voltage tin-filtered acquisitions demonstrates excellent agreement in Agatston score and percentile-based cardiac risk categorization with standard 120kVp high-pitch acquisitions. Furthermore, radiation dose was significantly reduced by 78% while maintaining accurate risk prediction.
• Coronary artery calcium scoring with tin filtration reduces radiation dose by 78%. • There is excellent correlation between high-pitch Sn100kVp and standard 120kVp acquisitions. • Excellent agreement regarding Agatston score categories and percentile-based risk categorization was achieved. • No cardiac risk reclassifications were observed using Sn100kVp coronary artery calcium scoring.
研究使用锡滤器（Sn100kVp）的高分辨率 CT 冠状动脉钙评分（CACS）与标准 120kVp 高分辨率采集的诊断准确性和辐射剂量。
前瞻性纳入 78 例患者（58%为男性，61.5±9.1 岁）。受试者均接受第三代双源 CT 进行临床 120kVp 高分辨率 CACS 检查，随后进行额外的高分辨率 Sn100kVp 采集。比较了 Agatston 评分、钙体积评分、Agatston 评分类别、基于百分位的风险分类和辐射指标。
78 例患者中有 61 例显示有冠状动脉钙化。Sn100kVp 和 120kVp 采集的中位数 Agatston 评分分别为 34.9[0.7-197.1]和 35.7[1.1-221.0]，钙体积评分分别为 34.1[0.7-218.0]和 34.5[1.1-221.0]（均 P<0.0001）。Bland-Altman 分析显示，与 120kVp 采集相比，Sn100kVp 采集的 Agatston 评分和钙体积评分存在低估（平均差值：16.4 和 11.5）。然而，Agatston 评分类别和基于百分位的风险类别具有极好的一致性（κ=0.98 和 κ=0.99）。Sn100kVp 和 120kVp 扫描的图像噪声分别为 25.8±4.4HU 和 16.6±2.9HU（P<0.0001）。Sn100kVp 和 120kVp 扫描的剂量长度乘积分别为 9.9±4.8mGycm 和 40.9±14.4mGycm（P<0.0001）。这导致 Sn100kVp 采集的有效辐射剂量显著降低（0.13±0.07mSv 与 0.57±0.2mSv，P<0.0001）。
使用高分辨率低电压锡滤器采集的 CACS 在与标准 120kVp 高分辨率采集的 Agatston 评分和基于百分位的心脏风险分类方面具有极好的一致性。此外，在保持准确风险预测的同时，辐射剂量降低了 78%。
锡滤器冠状动脉钙评分可将辐射剂量降低 78%。
使用 Sn100kVp 高分辨率采集与标准 120kVp 采集具有极好的相关性。
实现了 Agatston 评分类别和基于百分位的风险分类的极好一致性。
使用 Sn100kVp 冠状动脉钙评分未观察到心脏风险再分类。
