Jin Liang, Wang Kun, Li Ming
Radiology Department, Huadong Hospital, Affiliated to Fudan University, Shanghai, China.
Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
Quant Imaging Med Surg. 2022 Sep;12(9):4529-4537. doi: 10.21037/qims-21-1129.
Reducing radiation dose is a global concern in coronary computed tomography angiography (CCTA). We aimed to investigate whether a coronary artery calcium score (CACS) scan would lead to an overall reduction of radiation dose in CCTA examination and determine its necessity in routine CCTA imaging.
A total of 297 patients with suspected coronary heart disease were consecutively enrolled in this prospective cohort study between March 1, 2021, and September 1, 2021. All patients were scanned using a prospective electrocardiogram-triggered sequence acquisition mode on a dual-source computed tomography (CT) scanner. The first 1-150 patients (group A, n=150) were scanned with CACS using tin filtration with low voltage (Sn100 kVp) to guide the CCTA scanning range, whereas the subsequent 151-297 patients (group B, n=147) were scanned using a scout view for the CCTA range. Participant characteristics, number of scans, scan length, actual heart length, CT dose index (CTDIvol), dose-length product (DLP), effective dose (ED), and qualitative analysis were statistically analyzed between the groups.
There was no significant difference in sex, age, height, weight, body mass index (BMI), or heart rate between the 2 groups. The number of scans and scan length (149 of 3 scans at 10.35 cm, 1 of 4 scans at 13.80 cm; P<0.001), CTDIvol of CCTA (16.13 mGy; P<0.04), DLP of CCTA (166.90 mGycm; P<0.001), ED of CCTA (4.34 mSv; P<0.001), and overall ED (4.57 mSv; P<0.001) of group A showed significant differences compared with group B (36 of 3 scans at 10.35 cm, 109 of 4 scans at 13.80 cm, 2 of 5 scans at 17.25 cm; CTDIvol of CCTA at 18.30 mGy; DLP of CCTA at 235.60 mGycm; ED of CCTA at 6.13 mSv; overall ED at 6.13 mSv); meanwhile, actual heart length, qualitative analysis, and diagnostic CT reports were similar between the groups.
The CACS scan with Sn100 kVp prior to CCTA imaging on dual-source CT could reduce overall radiation dose.
降低辐射剂量是冠状动脉计算机断层扫描血管造影（CCTA）领域的全球关注焦点。我们旨在研究冠状动脉钙化积分（CACS）扫描是否会导致CCTA检查中辐射剂量的总体降低，并确定其在常规CCTA成像中的必要性。
在2021年3月1日至2021年9月1日期间，共有297例疑似冠心病患者连续纳入这项前瞻性队列研究。所有患者均在双源计算机断层扫描（CT）扫描仪上采用前瞻性心电图触发序列采集模式进行扫描。前150例患者（A组，n = 150）使用锡滤过低电压（Sn100 kVp）进行CACS扫描以指导CCTA扫描范围，而随后的151 - 297例患者（B组，n = 147）使用定位像确定CCTA扫描范围。对两组患者的人口统计学特征、扫描次数、扫描长度、实际心脏长度、CT剂量指数（CTDIvol）、剂量长度乘积（DLP）、有效剂量（ED）以及定性分析进行统计学分析。
两组患者在性别、年龄、身高、体重、体重指数（BMI）或心率方面无显著差异。A组的扫描次数和扫描长度（3次扫描中有149次为10.35 cm，4次扫描中有1次为13.80 cm；P < 0.001）、CCTA的CTDIvol（16.13 mGy；P < 0.04）、CCTA的DLP（166.90 mGycm；P < 0.001）、CCTA的ED（4.34 mSv；P < 0.001）以及总体ED（4.57 mSv；P < 0.001）与B组（3次扫描中有36次为10.35 cm，4次扫描中有109次为13.80 cm，5次扫描中有2次为17.25 cm；CCTA的CTDIvol为18.30 mGy；CCTA的DLP为235.60 mGycm；CCTA的ED为6.13 mSv；总体ED为6.13 mSv）相比存在显著差异；同时，两组间实际心脏长度、定性分析以及诊断CT报告相似。
在双源CT上进行CCTA成像前采用Sn100 kVp的CACS扫描可降低总体辐射剂量。
