Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, 222#, Zhong Shan Road, Dalian, 116011, Liaoning, China.
Invasive Technology Department, Qingdao City Chengyang District People's Hospital, 600#, Chang Cheng Road, Qingdao, 266109, Shandong, China.
Eur Radiol. 2019 Jul;29(7):3678-3685. doi: 10.1007/s00330-019-06111-0. Epub 2019 Mar 19.
To explore the image quality (IQ) and diagnostic value of 70 kVp turbo high-pitch coronary CT angiography (THP-CCTA) using automated tube voltage selection (ATVS) and 30 mL of low-concentration contrast agent.
Patients who underwent 70 kVp THP-CCTA using ATVS with 30 mL of contrast agent (group A) were prospectively enrolled, and those who underwent conventional CCTA (100/120 kVp, prospective sequential mode with 65-75 mL of contrast agent) (group B) were retrospectively selected for study. IQ was assessed subjectively on a 5-point scale, and diagnostic value was assessed based on invasive coronary angiography as the gold standard. Heart rate (HR), HR fluctuation (HRF), body mass index (BMI), effective radiation dose (ED), and iodine uptake (IU) were recorded.
A total of 796 patients (398/398 in groups A/B) were included. Between-group differences in age, gender, BMI, HR, HRF, and IQ values were not significant. The ED/IU values were 0.3 ± 0.1 mSv/9.0 ± 0.0 g and 5.8 ± 1.8 mSv/22.9 ± 1.0 g in groups A and B, respectively (p < 0.01). The sensitivity, specificity, positive and negative predictive values, and accuracy of THP-CCTA for the diagnosis of ≥ 50% stenosis were 94.8%, 97.5%, 92.0%, 98.4%, and 96.9% respectively. The mean HR and coronary calcium score were independent predictors of diagnostic image quality, and the best cutoff values were 71.5 bpm and 444.1 respectively.
This third-generation dual-source CT imaging modality, a 70-kVp THP-CCTA system using ATVS with 30 mL of low-concentration contrast agent, produces high-quality images with high diagnostic accuracy for significant stenosis, with ultra low ED and IU. This technique was most promising in individuals with an HR < 71.5 bpm and coronary calcium score < 444.1.
• Turbo high-pitch CCTA using 70 kVp via automated tube voltage selection and 30 mL of low-concentration contrast agent is feasible. • This protocol provides high diagnostic accuracy for significant coronary stenosis and reduces radiation doses and iodine uptake significantly. • This protocol was most promising in individuals with an HR < 71.5 bpm and coronary calcium score < 444.1.
探讨采用自动管电压选择（ATVS）和 30 毫升低浓度造影剂进行 70kVp 涡轮高螺距冠状动脉 CT 血管造影（THP-CCTA）的图像质量（IQ）和诊断价值。
前瞻性纳入采用 ATVS 进行 70kVp THP-CCTA 并使用 30 毫升造影剂的患者（A 组），并回顾性选择采用常规 CCTA（100/120kVp，前瞻性连续模式，使用 65-75 毫升造影剂）的患者（B 组）进行研究。主观评估 IQ，并以冠状动脉造影作为金标准评估诊断价值。记录心率（HR）、HR 波动（HRF）、体重指数（BMI）、有效辐射剂量（ED）和碘摄取量（IU）。
共纳入 796 例患者（A/B 组各 398 例）。两组间年龄、性别、BMI、HR、HRF 和 IQ 值无显著差异。A 组和 B 组的 ED/IU 值分别为 0.3±0.1mSv/9.0±0.0g 和 5.8±1.8mSv/22.9±1.0g（p<0.01）。THP-CCTA 对≥50%狭窄的诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为 94.8%、97.5%、92.0%、98.4%和 96.9%。平均 HR 和冠状动脉钙化评分是诊断图像质量的独立预测因素，最佳截断值分别为 71.5bpm 和 444.1。
第三代双源 CT 成像方式，采用 ATVS 进行 70kVp 的 THP-CCTA 并使用 30 毫升低浓度造影剂，可生成高质量图像，对显著狭窄具有高诊断准确性，同时 ED 和 IU 极低。该技术在 HR<71.5bpm 和冠状动脉钙化评分<444.1 的个体中最有前景。
• 采用自动管电压选择和 30 毫升低浓度造影剂的 70kVp 涡轮高螺距 CCTA 是可行的。
• 该方案对显著冠状动脉狭窄具有高诊断准确性，并显著降低辐射剂量和碘摄取量。
• 该方案在 HR<71.5bpm 和冠状动脉钙化评分<444.1 的个体中最有前景。
