Óriás Viktor I, Szöllősi Dávid, Gyánó Marcell, Veres Dániel S, Nardai Sándor, Csobay-Novák Csaba, Nemes Balázs, Kiss János P, Szigeti Krisztián, Osváth Szabolcs, Sótonyi Péter, Ruzsa Zoltán
Kinepict Health Ltd, 1026, Júlia u 11, Budapest, Hungary.
Bács-Kiskun County Hospital, 6000, Nyíri út 38, Kecskemét, Hungary.
Eur J Radiol Open. 2020 Nov 17;7:100288. doi: 10.1016/j.ejro.2020.100288. eCollection 2020.
In previous clinical studies Digital Variance Angiography (DVA) provided higher signal-to-noise ratio (SNR) and better image quality than Digital Subtraction Angiography (DSA). Our aim was to investigate whether this quality reserve of DVA provides an opportunity for the reduction of iodinated contrast media (ICM) in carotid X-ray angiography (CXA).
Our prospective study enrolled 26 patients (67.0 ± 8.1 years) undergoing carotid percutaneous transluminal angioplasty. The SNR of DSA and DVA image pairs obtained by a standard (100 %, 6 mL ICM) or a low-dose (50 %, 3 mL ICM) protocol were compared. Visual evaluation of all images was performed by five specialists using a 5-grade rating scale. The quality of DSA and DVA videos was also compared.
DVA provided more than two-fold SNR, the median SNR/SNR ratio was 2.06 (100 %) and 2.25 (50 %). In the visual evaluation, the DVA score (3.73 ± 0.06) was significantly higher than the DSA score (3.52 ± 0.07, Wilcoxon p < 0.001), and the DVA score (3.64 ± 0.13) was also significantly higher than the DSA score (3.01 ± 0.17, Wilcoxon p < 0.001). While the low-dose protocol significantly decreased the DSA score (Mann-Whitney p < 0.01, DSA vs DSA), it had no effect on the DVA score (DVA vs DVA). There was no statistical difference between the DSA and DVA scores. Evaluators preferred the diagnostic value of DVA to DSA videos in 61% of comparisons, the interrater agreement was 69 % (Fleiss' kappa 0.35, p < 0.001).
Our data show that DVA allows a substantial (50 %) ICM reduction in CXA without affecting the quality and diagnostic value of angiograms.
在先前的临床研究中，数字方差血管造影（DVA）比数字减影血管造影（DSA）具有更高的信噪比（SNR）和更好的图像质量。我们的目的是研究DVA的这种质量储备是否为减少颈动脉X射线血管造影（CXA）中碘化造影剂（ICM）的使用提供了机会。
我们的前瞻性研究纳入了26例接受颈动脉经皮腔内血管成形术的患者（67.0±8.1岁）。比较了通过标准方案（100%，6 mL ICM）或低剂量方案（50%，3 mL ICM）获得的DSA和DVA图像对的SNR。由五名专家使用5级评分量表对所有图像进行视觉评估。还比较了DSA和DVA视频的质量。
DVA的SNR提高了两倍多，SNR/SNR比值的中位数在标准剂量组为2.06，低剂量组为2.25。在视觉评估中，DVA评分（3.73±0.06）显著高于DSA评分（3.52±0.07，Wilcoxon检验p<0.001），低剂量组的DVA评分（3.64±0.13）也显著高于DSA评分（3.01±0.17，Wilcoxon检验p<0.001）。虽然低剂量方案显著降低了DSA评分（Mann-Whitney检验p<0.01，标准剂量DSA与低剂量DSA比较），但对DVA评分没有影响（低剂量DVA与标准剂量DVA比较）。DSA和DVA评分之间没有统计学差异。在61%的比较中，评估者更喜欢DVA视频的诊断价值，评估者间的一致性为69%（Fleiss'kappa系数0.35，p<0.001）。
我们的数据表明，DVA可使CXA中的ICM用量大幅减少（50%），而不影响血管造影的质量和诊断价值。
