Jadczyk Tomasz, Wolf Jiri, Pesl Martin, Soucek Filip, Lehar Frantisek, Jez Jiri, Kulik Tomas, Tyshchenko Bohdan, Belaskova Silvie, Ourednicek Petr, Caluori Guido, Novak Miroslav, Starek Zdenek
Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital Brno, 656 91 Brno, Czech Republic.
Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland.
Diagnostics (Basel). 2022 Mar 1;12(3):612. doi: 10.3390/diagnostics12030612.
(1) Background: Computer tomography (CT) is an imaging modality used in the pre-planning of radiofrequency catheter ablation (RFA) procedure in patients with cardiac arrhythmias. However, it is associated with a considerable ionizing radiation dose for patients. This study aims to develop and validate low-dose CT scanning protocols of the left atrium (LA) for RFA guidance. (2) Methods: 68 patients scheduled for RFA of atrial fibrillation were sequentially assigned to four groups of ECG-gated scanning protocols, based on the set tube current (TC): Group A (n = 20, TC = 33 mAs), Group B (n = 18, TC = 67 mAs), Group C (n = 10, TC = 135 mAs), and control Group D (n = 20, TC = 600 mAs). We used a 256-row multidetector CT with body weight-dependent tube voltage of 80 kVp (<70 kg), 100 kVp (70−90 kg), and 120 kVp (>90 kg). We evaluated scanning parameters including radiation dose, total scanning procedure time and signal-to-noise ratio (SNR). (3) Results: The average effective radiation dose (ED) was lower in Group A in comparison to Group B, C and D (0.83 (0.76−1.10), 1.55 (1.36−1.67), 2.91 (2.32−2.96) and 9.35 (8.00−10.04) mSv, p < 0.05). The total amount of contrast media was not significantly different between groups. The mean SNR was 6.5 (5.8−7.3), 7.1 (5.7−8.2), 10.8 (10.1−11.3), and 12.2 (9.9−15.7) for Group A, B, C and D, respectively. The comparisons of SNR in group A vs. B and C vs. D were without significant differences. (4) Conclusions: Optimized pre-ablation CT scanning protocols of the LA can reduce an average ED by 88.7%. Three dimensional (3D) models created with the lowest radiation protocol are useful for the integration of electro-anatomic-guided RFA procedures.
(1) 背景：计算机断层扫描（CT）是一种用于心律失常患者射频导管消融（RFA）术前规划的成像方式。然而，它会给患者带来相当大的电离辐射剂量。本研究旨在开发并验证用于RFA引导的左心房（LA）低剂量CT扫描方案。(2) 方法：将68例计划进行房颤RFA的患者根据设定的管电流（TC）依次分为四组心电图门控扫描方案：A组（n = 20，TC = 33 mAs）、B组（n = 18，TC = 67 mAs）、C组（n = 10，TC = 135 mAs）和对照组D组（n = 20，TC = 600 mAs）。我们使用一台256排多层螺旋CT，管电压根据体重而定，分别为80 kVp（<70 kg）、100 kVp（70 - 90 kg）和120 kVp（>90 kg）。我们评估了包括辐射剂量、总扫描程序时间和信噪比（SNR）在内的扫描参数。(3) 结果：与B组、C组和D组相比，A组的平均有效辐射剂量（ED）更低（分别为0.83（0.76 - 1.10）、1.55（1.36 - 1.67）、2.91（2.32 - 2.96）和9.35（8.00 - 10.04）mSv，p < 0.05）。各组之间造影剂总量无显著差异。A组、B组、C组和D组的平均SNR分别为6.5（5.8 - 7.3）、7.1（5.7 - 8.2）、10.8（10.1 - 11.3）和12.2（9.9 - 15.7）。A组与B组以及C组与D组之间SNR的比较无显著差异。(4) 结论：优化后的LA消融前CT扫描方案可使平均ED降低88.7%。采用最低辐射方案创建的三维（3D）模型有助于整合电解剖引导的RFA手术。
