Sharma Simran P, Verhemel Sarah, Hirsch Alexander, van der Bie Judith, Dijkshoorn Marcel L, Daemen Joost, van Mieghem Nicolas, Budde Ricardo P J
Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre, Nd-547, Dr. Molewaterplein 40, 3015 GD, Rotterdam, CA, 2040, 3000, The Netherlands.
Int J Cardiovasc Imaging. 2024 Nov 4. doi: 10.1007/s10554-024-03273-x.
We assessed the diagnostic performance of both ultra-high-resolution (UHR) and high-resolution (HR) modes of photon-counting detector (PCD)-CT within the confines of standard pre-TAVI CT scans, as well as the performance of UHR mode adjusted specifically for coronary imaging, using quantitative coronary angiography (QCA) as the reference. We included 60 patients undergoing pre-TAVI planning CT scans. Patients were divided into 3 groups: 20 scanned in HR mode, 20 in UHR mode, and 20 in adjusted UHR mode, on a dual-source PCD-CT. The adjusted UHR mode employed a lower tube voltage (90 kV vs. 120 kV) and a higher image quality level (65 vs. 34) to enhance coronary artery visualization. Patients underwent invasive coronary angiography as part of clinical routine. CCTA and QCA were reviewed to assess CAD presence defined as stenosis ≥ 50% in proximal and middle coronary segments. We included 60 patients (mean age 79 ± 7 years; 39(65%) men). Mean heart rate during scanning was 72 ± 13 bpm. Median coronary calcium score was 973 [379-2007]. QCA identified significant CAD in 24 patients (40%): 9 patients scanned with HR mode, 10 patients with the UHR mode, and 5 patients with the UHR adjusted mode. Per-patient area under the curves were 0.57 for HR, 0.80 for UHR, and 0.80 for adjusted UHR, with no significant differences between the scan modes, and per-vessel the area under the curves were 0.73 for HR, 0.69 for UHR, and 0.87 for adjusted UHR, with significant differences between UHR and adjusted UHR (p = 0.04). UHR and adjusted UHR modes of dual source PCD-CT show potential for improved sensitivity and negative predictive value for detecting CAD in patients undergoing pre-TAVI scans, however, no statistically significant difference from HR mode was observed.
我们在标准经导管主动脉瓣置入术（TAVI）前CT扫描的范围内，评估了光子计数探测器（PCD）-CT的超高分辨率（UHR）和高分辨率（HR）模式的诊断性能，以及专门针对冠状动脉成像调整的UHR模式的性能，以定量冠状动脉造影（QCA）作为参考。我们纳入了60例接受TAVI术前规划CT扫描的患者。患者被分为3组：20例采用HR模式扫描，20例采用UHR模式扫描，20例采用调整后的UHR模式扫描，均使用双源PCD-CT。调整后的UHR模式采用较低的管电压（90 kV对120 kV）和较高的图像质量水平（65对34）以增强冠状动脉可视化。患者接受了作为临床常规一部分的有创冠状动脉造影。对冠状动脉CT血管造影（CCTA）和QCA进行评估，以评估冠状动脉疾病（CAD）的存在，定义为冠状动脉近端和中段狭窄≥50%。我们纳入了60例患者（平均年龄79±7岁；39例（65%）为男性）。扫描期间的平均心率为72±13次/分钟。冠状动脉钙化评分中位数为973 [379 - 2007]。QCA在24例患者（40%）中发现显著CAD：9例采用HR模式扫描，10例采用UHR模式扫描，5例采用调整后的UHR模式扫描。每位患者的曲线下面积HR为0.57，UHR为0.80，调整后的UHR为0.80，扫描模式之间无显著差异，而每支血管的曲线下面积HR为0.73, UHR为0.69，调整后的UHR为0.87，UHR与调整后的UHR之间存在显著差异（p = 0.04）。双源PCD-CT的UHR和调整后的UHR模式在检测接受TAVI术前扫描患者的CAD方面显示出提高敏感性和阴性预测值的潜力，然而，未观察到与HR模式有统计学显著差异。
