Andre Florian, Seitz Sebastian, Fortner Philipp, Allmendinger Thomas, Sommer André, Brado Matthias, Sokiranski Roman, Fink Joana, Kauczor Hans-Ulrich, Heussel Claus P, Herth Felix, Frey Norbert, Görich Johannes, Buss Sebastian J
University of Heidelberg, Department of Cardiology, Angiology and Pneumology, Heidelberg, Germany.
MVZ-DRZ Heidelberg, Heidelberg, Germany.
Eur J Radiol Open. 2023 Feb 15;10:100481. doi: 10.1016/j.ejro.2023.100481. eCollection 2023.
The combined testing for coronary artery and pulmonary diseases is of clinical interest as risk factors are shared. In this study, a novel ECG-gated tin-filtered ultra-low dose chest CT protocol (GCCT) for integrated heart and lung acquisition and the applicability of artificial intelligence (AI)-based coronary artery calcium scoring were assessed.
In a clinical registry of 10481 patients undergoing heart and lung CT, GCCT was applied in 44 patients on a dual-source CT. Coronary calcium scans (CCS) with 120 kVp, 100 kVp, and tin-filtered 100 kVp (Sn100) of controls, matched with regard to age, sex, and body-mass index, were retrieved from the registry (n=176, 66.5 (59.4-74.0) years, 52 men). Automatic tube current modulation was used in all scans. In 20 patients undergoing GCCT and Sn100 CCS, Agatston scores were measured both semi-automatically by experts and by AI, and classified into six groups (0, <10, <100, <400, <1000, ≥1000).
Effective dose decreased significantly from 120 kVp CCS (0.50 (0.41-0.61) mSv) to 100 kVp CCS (0.34 (0.26-0.37) mSv) to Sn100 CCS (0.14 (0.11-0.17) mSv). GCCT showed higher values (0.28 (0.21-0.32) mSv) than Sn100 CCS but lower than 120 kVp and 100 kVp CCS (all p < 0.05) despite greater scan length. Agatston scores correlated strongly between GCCT and Sn100 CCS in semi-automatic and AI-based measurements (both ρ = 0.98, p < 0.001) resulting in high agreement in Agatston score classification (κ = 0.97, 95% CI 0.92-1.00; κ = 0.89, 95% CI 0.79-0.99). Regarding chest findings, further diagnostic steps were recommended in 28 patients.
GCCT allows for reliable coronary artery disease and lung cancer screening with ultra-low radiation exposure. GCCT-derived Agatston score shows excellent agreement with standard CCS, resulting in equivalent risk stratification.
由于冠状动脉疾病和肺部疾病存在共同的风险因素，因此对这两种疾病进行联合检测具有临床意义。在本研究中，我们评估了一种用于心脏和肺部联合采集的新型心电图门控锡过滤超低剂量胸部CT协议（GCCT）以及基于人工智能（AI）的冠状动脉钙化评分的适用性。
在一项对10481例接受心肺CT检查的患者的临床登记研究中，44例患者在双源CT上接受了GCCT检查。从登记研究中检索出年龄、性别和体重指数相匹配的对照组患者的冠状动脉钙化扫描（CCS）数据，扫描条件分别为120 kVp、100 kVp和锡过滤100 kVp（Sn100）（n = 176，年龄66.5（59.4 - 74.0）岁，男性52例）。所有扫描均采用自动管电流调制。在20例接受GCCT和Sn100 CCS检查的患者中，由专家和AI半自动测量阿加斯顿评分，并将其分为六组（0、<10、<100、<400、<1000、≥1000）。
有效剂量从120 kVp CCS（0.50（0.41 - 0.61）mSv）显著降低至100 kVp CCS（0.34（0.26 - 0.37）mSv），再降至Sn100 CCS（0.14（0.11 - 0.17）mSv）。尽管GCCT扫描长度更长，但其有效剂量（0.28（0.21 - 0.32）mSv）高于Sn100 CCS，但低于120 kVp和100 kVp CCS（所有p < 0.05）。在半自动和基于AI的测量中，GCCT和Sn100 CCS的阿加斯顿评分之间具有很强的相关性（两者ρ = 0.98，p < 0.001），导致阿加斯顿评分分类具有高度一致性（κ = 0.97，95%CI 0.92 - 1.00；κ = 0.89，95%CI 0.79 - 0.99）。关于胸部检查结果，建议28例患者采取进一步的诊断措施。
GCCT能够在超低辐射暴露下可靠地筛查冠状动脉疾病和肺癌。GCCT得出的阿加斯顿评分与标准CCS具有极好的一致性，从而实现等效的风险分层。
