Abhijith S, Jaseemudheen M M
Department of Medical Radiology and Diagnostic Imaging, REVA University, Bangalore, Karnataka, India.
Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Heart Views. 2024 Apr-Jun;25(2):74-79. doi: 10.4103/heartviews.heartviews_24_24. Epub 2024 Oct 10.
Computed tomographic (CT) coronary artery angiography with calcium scoring is crucial in suspecting coronary artery disease (CAD). The routine protocol for CAD radiological investigation involves a precontrast series for calcium scoring and a postcontrast series for investigating structural changes in coronary arteries. This review intends to investigate the feasibility of virtual noncontrast images to replace the true noncontrast (TNC) images in coronary artery calcium scoring to decrease the radiation dose. The current review included articles found in the PubMed database. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the further evaluation of the articles for inclusion criteria, 25 articles were finally shortlisted for the final review. It is found that the calcium score of coronary arteries estimated by virtual unenhanced images generated by dual-energy CT (DECT) is comparable with that of TNC images. The virtual unehncanced images has the potential to eliminate the need for the TNC series acquisition, thereby reducing the radiation dose. Especially, photon-counting detector-based DECT has excellent potential in the estimation of calcium scores and the reduction in radiation dose. In addition, contrast dose also can be significantly reduced, which is crucial in patients with renal insufficiency. In conclusion, using DECT for CAD investigations significantly reduces both radiation and contrast doses compared to conventional CT scans. This reduction is particularly crucial for patients who require repeated follow-up scans, as it enhances their safety and minimizes potential risks.
计算机断层扫描（CT）冠状动脉造影结合钙化积分在疑似冠状动脉疾病（CAD）的诊断中至关重要。CAD放射学检查的常规方案包括用于钙化积分的非增强扫描系列和用于研究冠状动脉结构变化的增强扫描系列。本综述旨在探讨虚拟非增强图像替代真实非增强（TNC）图像进行冠状动脉钙化积分以降低辐射剂量的可行性。本综述纳入了在PubMed数据库中检索到的文章。根据系统评价和Meta分析的首选报告项目指南进一步评估文章的纳入标准，最终筛选出25篇文章进行最终评审。结果发现，双能CT（DECT）生成的虚拟非增强图像估计的冠状动脉钙化积分与TNC图像相当。虚拟非增强图像有可能无需采集TNC系列图像，从而降低辐射剂量。特别是，基于光子计数探测器的DECT在钙化积分估计和降低辐射剂量方面具有巨大潜力。此外，对比剂剂量也可显著降低，这对肾功能不全患者至关重要。总之，与传统CT扫描相比，使用DECT进行CAD检查可显著降低辐射剂量和对比剂剂量。这种降低对于需要重复随访扫描的患者尤为关键，因为它提高了患者的安全性并将潜在风险降至最低。
