低对比剂量双能 CT 在经导管主动脉瓣置换术患者肾功能不全中的诊断效能和安全性。

Diagnostic Efficacy and Safety of Low-Contrast-Dose Dual-Energy CT in Patients With Renal Impairment Undergoing Transcatheter Aortic Valve Replacement.

机构信息

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

Korean J Radiol. 2024 Jul;25(7):634-643. doi: 10.3348/kjr.2023.1207.

DOI:10.3348/kjr.2023.1207

PMID:38942457

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11214918/

Abstract

OBJECTIVE

This study aimed to evaluate the diagnostic efficacy and safety of low-contrast-dose, dual-source dual-energy CT before transcatheter aortic valve replacement (TAVR) in patients with compromised renal function.

MATERIALS AND METHODS

A total of 54 consecutive patients (female:male, 26:38; 81.9 ± 7.3 years) with reduced renal function underwent pre-TAVR dual-energy CT with a 30-mL contrast agent between June 2022 and March 2023. Monochromatic (40- and 50-keV) and conventional (120-kVp) images were reconstructed and analyzed. The subjective quality score, vascular attenuation, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were compared among the imaging techniques using the Friedman test and post-hoc analysis. Interobserver reliability for aortic annular measurement was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. The procedural outcomes and incidence of post-contrast acute kidney injury (AKI) were assessed.

RESULTS

Monochromatic images achieved diagnostic quality in all patients. The 50-keV images achieved superior vascular attenuation and CNR ( < 0.001 in all) while maintaining a similar SNR compared to conventional CT. For aortic annular measurement, the 50-keV images showed higher interobserver reliability compared to conventional CT: ICC, 0.98 vs. 0.90 for area and 0.97 vs. 0.95 for perimeter; 95% limits of agreement width, 0.63 cm² vs. 0.92 cm² for area and 5.78 mm vs. 8.50 mm for perimeter. The size of the implanted device matched CT-measured values in all patients, achieving a procedural success rate of 92.6%. No patient experienced a serum creatinine increase of ≥ 1.5 times baseline in the 48-72 hours following CT. However, one patient had a procedural delay due to gradual renal function deterioration.

CONCLUSION

Low-contrast-dose imaging with 50-keV reconstruction enables precise pre-TAVR evaluation with improved image quality and minimal risk of post-contrast AKI. This approach may be an effective and safe option for pre-TAVR evaluation in patients with compromised renal function.

摘要

目的

本研究旨在评估低对比剂量双源双能 CT 在肾功能受损患者行经导管主动脉瓣置换术（TAVR）前的诊断效能和安全性。

材料与方法

2022 年 6 月至 2023 年 3 月，共 54 例连续肾功能受损患者（女：男，26：38；81.9±7.3 岁）接受了 TAVR 前双能 CT 检查，使用 30ml 造影剂。重建并分析单色（40keV 和 50keV）和常规（120kVp）图像。采用 Friedman 检验和事后分析比较不同成像技术的主观质量评分、血管衰减、对比噪声比（CNR）和信噪比（SNR）。采用组内相关系数（ICC）和 Bland-Altman 分析评估主动脉瓣环测量的观察者间可靠性。评估手术结果和对比后急性肾损伤（AKI）的发生率。

结果

单色图像在所有患者中均获得诊断质量。50keV 图像在保持与常规 CT 相似 SNR 的同时，实现了更好的血管衰减和 CNR（所有比较均<0.001）。对于主动脉瓣环测量，50keV 图像与常规 CT 相比具有更高的观察者间可靠性：面积的 ICC 为 0.98 比 0.90，周长的 ICC 为 0.97 比 0.95；面积的 95%一致性界限宽度为 0.63cm² 比 0.92cm²，周长的 95%一致性界限宽度为 5.78mm 比 8.50mm。所有患者植入的器械大小均与 CT 测量值匹配，手术成功率为 92.6%。在 CT 后 48-72 小时内，没有患者的血清肌酐增加≥1.5 倍基线值。然而，有 1 例患者因肾功能逐渐恶化而导致手术延迟。