University of Groningen, University Medical Center Groningen, Center for Medical Imaging North-East Netherlands (CMI-NEN), Groningen, The Netherlands.
University Medical Center Utrecht, Department of Radiology, Utrecht, The Netherlands.
J Cardiovasc Comput Tomogr. 2018 Sep-Oct;12(5):352-363. doi: 10.1016/j.jcct.2018.06.001. Epub 2018 Jun 15.
Multiple dose reduction techniques have been introduced for coronary artery calcium (CAC) computed tomography (CT), but few have emerged into clinical practice while an increasing number of patients undergo CAC scanning. We sought to determine to what extend the radiation dose in CAC CT can be safely reduced without a significant impact on cardiovascular disease (CVD) risk stratification. A systematic database-review of articles published from 2002 until February 2018 was performed in Pubmed, WebOfScience, and Embase. Eligible studies reported radiation dose reduction for CAC CT, calcium scores and/or risk stratification for phantom or patient studies. Twenty-eight studies were included, under which 17 patient studies, 10 phantom/ex-vivo studies, and 1 study evaluated both phantom and patients. Dose was reduced with tube voltage reduction and tube current reduction with and without iterative reconstruction (IR), and tin-filter spectral shaping. The different dose reduction techniques resulted in varying final radiation doses and had varying impact on CAC scores and CVD risk stratification. In 78% of the studies the radiation dose was reduced by ≥ 50% ranging from (CTDI) 0.6-5.5 mGy, leading to reclassification rates ranging between 3% and 21%, depending on the acquisition technique. Specific dose reduced protocols, including either tube current reduction and IR or spectral shaping with tin filtration, that showed low reclassification rates may potentially be used in CAC scanning and in future population-based screening for CVD risk stratification.
已经提出了多种冠状动脉钙化（CAC）计算机断层扫描（CT）的剂量减少技术，但只有少数技术在临床实践中得到应用，而越来越多的患者接受 CAC 扫描。我们旨在确定 CAC CT 的辐射剂量在多大程度上可以安全降低，而不会对心血管疾病（CVD）风险分层产生重大影响。在 Pubmed、WebOfScience 和 Embase 中对 2002 年至 2018 年 2 月发表的文章进行了系统的数据库综述。符合条件的研究报告了 CAC CT、钙评分和/或风险分层的辐射剂量减少，这些研究是在体模或患者研究中进行的。共纳入 28 项研究，其中包括 17 项患者研究、10 项体模/离体研究和 1 项同时评估体模和患者的研究。通过管电压降低和管电流降低（包括使用和不使用迭代重建（IR）以及锡滤光片光谱整形）来降低剂量。不同的剂量减少技术导致最终辐射剂量不同，并对 CAC 评分和 CVD 风险分层产生不同的影响。在 78%的研究中，辐射剂量降低了≥50%，范围从（CTDI）0.6-5.5 mGy，导致重新分类率在 3%-21%之间，具体取决于采集技术。特定的剂量降低方案，包括管电流降低和 IR 或带锡滤光片的光谱整形，显示出较低的重新分类率，可能在 CAC 扫描和未来的 CVD 风险分层人群筛查中使用。
