Matuleviciute-Stojanoska Aiste, Sautier Julia, Bauer Verena, Nuessel Martin, Nizhnikava Volha, Stumpf Christian, Klink Thorsten
Institute of Diagnostic and Interventional Radiology, Klinikum Bayreuth, Medical Campus Oberfranken, Friedrich Alexander University Erlangen, Bayreuth, Germany.
Department of Cardiology, Klinikum Bayreuth, Medical Campus Oberfranken, Friedrich Alexander University Erlangen, Bayreuth, Germany.
Eur J Radiol Open. 2024 Nov 20;13:100612. doi: 10.1016/j.ejro.2024.100612. eCollection 2024 Dec.
The purpose of this study was to compare CCTA images generated using HIR and IMR algorithm with the reference standard ICA, and to determine to what extend further improvements of IMR over HIR can be expected.
This retrospective study included 60 patients with low to intermediate CAD risk, who underwent coronary CTA (with HIR and IMR) and ICA. ICA was used as reference standard. Two independent and blinded readers evaluated 2226 segments, classifying stenosis with CAD-RADS (significant stenosis ≥3). Image quality was assessed with a 5-point scale, SNR in the ascending aorta, and FWHM of proximal LCA calibers. The impact of image noise, radiation dose, and BMI on diagnostic accuracy was evaluated using ROC curves and Fisher's Exact Test. Quantitative plaque analysis was performed on 28 plaques.
IMR showed higher image quality than HIR (IMR 4.4, HIR 3.97, p<0.001) with better SNR (21.4 vs. 13.28, p<0.001) and FWHM (4.44 vs. 4.55, p=0.003). IMR had better diagnostic accuracy (ROC AUC 0.967 vs. 0.948, p=0.16, performed better at higher radiation doses (p=0.02) and showed a larger minimum lumen area (p=0.022 and p=0.046).
IMR offers significantly superior image quality of CCTA, more precise measurements, and a stronger positive correlation with ICA. The overall diagnostic accuracy may be superior with IMR, although the differences were not statistically significant. However, in patients who are exposed to higher radiation doses during CCTA due to their constitution, IMR enables significantly better diagnostic accuracy than HIR thus providing a specific benefit for obese patients.
本研究的目的是将使用HIR和IMR算法生成的CCTA图像与参考标准ICA进行比较，并确定IMR相对于HIR有望在多大程度上得到进一步改进。
这项回顾性研究纳入了60例低至中度CAD风险的患者，这些患者接受了冠状动脉CTA（使用HIR和IMR）和ICA检查。ICA被用作参考标准。两名独立且不知情的阅片者对2226个节段进行评估，使用CAD-RADS对狭窄进行分类（显著狭窄≥3级）。图像质量采用5分制进行评估，测量升主动脉的信噪比以及左冠状动脉近端管径的半高宽。使用ROC曲线和Fisher精确检验评估图像噪声、辐射剂量和BMI对诊断准确性的影响。对28个斑块进行了定量斑块分析。
IMR显示出比HIR更高的图像质量（IMR为4.4，HIR为3.97，p<0.001），具有更好的信噪比（21.4对13.28，p<0.001）和半高宽（4.44对4.55，p=0.003）。IMR具有更好的诊断准确性（ROC曲线下面积0.967对0.948，p=0.16），在较高辐射剂量下表现更好（p=0.02），并且显示出更大的最小管腔面积（p=0.022和p=0.046）。
IMR提供了显著更优的CCTA图像质量、更精确的测量结果，并且与ICA具有更强的正相关性。尽管差异无统计学意义，但IMR的总体诊断准确性可能更高。然而，对于在CCTA检查期间由于体质原因接受较高辐射剂量的患者，IMR比HIR能显著提高诊断准确性，从而为肥胖患者带来特定益处。
