Wu Wenjie, Zhan Hefeng, Wang Yiran, Ma Xueyan, Hou Jiameng, Ren Lichen, Liu Jie, Wang Luotong, Zhang Yonggao
Department of Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
CT Imaging Research Center, GE Healthcare China, Beijing, China.
Front Cardiovasc Med. 2024 Jul 23;11:1330824. doi: 10.3389/fcvm.2024.1330824. eCollection 2024.
This study aims to investigate the image quality of a high-resolution, low-dose coronary CT angiography (CCTA) with deep learning image reconstruction (DLIR) and second-generation motion correction algorithms, namely, SnapShot Freeze 2 (SSF2) algorithm, and its diagnostic accuracy for in-stent restenosis (ISR) in patients after percutaneous coronary intervention (PCI), in comparison with standard-dose CCTA with high-definition mode reconstructed by adaptive statistical iterative reconstruction Veo algorithm (ASIR-V) and the first-generation motion correction algorithm, namely, SnapShot Freeze 1 (SSF1).
Patients after PCI and suspected of having ISR scheduled for high-resolution CCTA (randomly for 100 kVp low-dose CCTA or 120 kVp standard-dose) and invasive coronary angiography (ICA) were prospectively enrolled in this study. After the basic information pairing, a total of 105 patients were divided into the LD group (60 patients underwent 100 kVp low-dose CCTA reconstructed with DLIR and SSF2) and the SD group (45 patients underwent 120 kVp standard-dose CCTA reconstructed with ASIR-V and SSF1). Radiation and contrast medium doses, objective image quality including CT value, image noise (standard deviation), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) for the aorta, left main artery (LMA), left ascending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA) of the two groups were compared. A five-point scoring system was used for the overall image quality and stent appearance evaluation. Binary ISR was defined as an in-stent neointimal proliferation with diameter stenosis ≥50% to assess the diagnostic performance between the LD group and SD group with ICA as the standard reference.
The LD group achieved better objective and subjective image quality than that of the SD group even with 39.1% radiation dose reduction and 28.0% contrast media reduction. The LD group improved the diagnostic accuracy for coronary ISR to 94.2% from the 83.8% of the SD group on the stent level and decreased the ratio of false-positive cases by 19.2%.
Compared with standard-dose CCTA with ASIR-V and SSF1, the high-resolution, low-dose CCTA with DLIR and SSF2 reconstruction algorithms further improves the image quality and diagnostic performance for coronary ISR at 39.1% radiation dose reduction and 28.0% contrast dose reduction.
本研究旨在探讨采用深度学习图像重建（DLIR）和第二代运动校正算法即快照冻结2（SSF2）算法的高分辨率、低剂量冠状动脉CT血管造影（CCTA）的图像质量，及其对经皮冠状动脉介入治疗（PCI）术后患者支架内再狭窄（ISR）的诊断准确性，并与采用自适应统计迭代重建Veo算法（ASIR-V）重建的高清模式和第一代运动校正算法即快照冻结1（SSF1）的标准剂量CCTA进行比较。
前瞻性纳入计划接受高分辨率CCTA（随机进行100 kVp低剂量CCTA或120 kVp标准剂量）和有创冠状动脉造影（ICA）的PCI术后怀疑有ISR的患者。在基本信息配对后，将105例患者分为低剂量组（60例患者接受用DLIR和SSF2重建的100 kVp低剂量CCTA）和标准剂量组（45例患者接受用ASIR-V和SSF1重建的120 kVp标准剂量CCTA）。比较两组的辐射剂量和造影剂剂量，以及包括主动脉、左主干动脉（LMA）、左前降支动脉（LAD）、左旋支动脉（LCX）和右冠状动脉（RCA）的CT值、图像噪声（标准差）、信噪比（SNR）和对比噪声比（CNR）等客观图像质量。采用五分制评分系统对整体图像质量和支架外观进行评估。将二元ISR定义为支架内新生内膜增生且直径狭窄≥50%，以ICA作为标准参考来评估低剂量组和标准剂量组之间的诊断性能。
即使辐射剂量降低39.1%、造影剂降低28.0%，低剂量组的客观和主观图像质量仍优于标准剂量组。低剂量组将冠状动脉ISR的诊断准确性从标准剂量组的83.8%提高到支架水平的94.2%，并将假阳性病例比例降低了19.2%。
与采用ASIR-V和SSF1的标准剂量CCTA相比，采用DLIR和SSF2重建算法的高分辨率、低剂量CCTA在辐射剂量降低39.1%、造影剂剂量降低28.0%的情况下，进一步提高了冠状动脉ISR的图像质量和诊断性能。
