Department of Radiology, Ningbo First Hospital, Ningbo, 305010, Zhejiang Province, People's Republic of China.
Diabetes Research Center, School of Medicine, Ningbo University, 818 Fenghua Road, Jiangbei District, Ningbo, 315211, Zhejiang Province, People's Republic of China.
Int J Cardiovasc Imaging. 2019 Dec;35(12):2239-2248. doi: 10.1007/s10554-019-01678-7. Epub 2019 Jul 30.
This prospective study evaluated the image quality and accuracy of coronary computed tomography angiography (CCTA) for diagnosing coronary artery disease (CAD) in patients with atrial fibrillation (AF), in which CCTA used adaptive iterative dose reduction (AIDR) with a low tube voltage and low concentration of isotonic contrast agent. Sixty-eight consecutive patients with AF and suspected CAD were equally and randomly apportioned to two groups and underwent CCTA. In the experimental group, the contrast agent was iodixanol (270 mg I/mL), patients were scanned with 100 kV, and reconstruction was by AIDR. In the conventional scanning (control) group, the contrast agent was iopromide (370 mg I/mL), patients were scanned with 120 kV, and reconstruction was by filtered back projection. The image quality, effective radiation dose (E), and total iodine intake of the groups were compared. Thirty-nine patients with coronary artery stenosis later were given invasive coronary angiography (ICA). The groups were similar with regard to mean CT value, noise, and signal-to-noise and contrast-to-noise ratios. The figure of merit of the experimental group was significantly higher than that of the control group, while the E and total iodine were significantly lower. Using ICA as the diagnostic reference, the groups shared similar sensitivity, specificity, and false positive and false negative rates for diagnosing coronary artery stenosis. For determining CAD in patients with AF, CCTA with isotonic low-concentration contrast agent and low-voltage scanning is a feasible alternative that improves accuracy and reduces radiation dose and iodine intake.
本前瞻性研究评估了在心房颤动（AF）患者中使用自适应迭代剂量降低（AIDR）的低管电压和低浓度等渗对比剂进行冠状动脉计算机断层血管造影（CCTA）诊断冠状动脉疾病（CAD）的图像质量和准确性。68 例连续的 AF 合并疑似 CAD 患者被平均随机分为两组并接受 CCTA 检查。在实验组中，造影剂为碘克沙醇（270mgI/mL），管电压为 100kV，重建方法为 AIDR。在常规扫描（对照组）组中，造影剂为碘普罗胺（370mgI/mL），管电压为 120kV，重建方法为滤波反投影。比较了两组的图像质量、有效辐射剂量（E）和总碘摄入量。39 例冠状动脉狭窄患者进一步接受了有创冠状动脉造影（ICA）检查。两组的平均 CT 值、噪声、信噪比和对比噪声比相似。实验组的符合度明显高于对照组，而 E 和总碘则明显降低。以 ICA 作为诊断参考，两组在诊断冠状动脉狭窄方面具有相似的敏感性、特异性、假阳性和假阴性率。对于 AF 患者的 CAD 诊断，使用等渗低浓度对比剂和低电压扫描的 CCTA 是一种可行的替代方法，可以提高准确性，降低辐射剂量和碘摄入量。
