Wang Shaochuan, Sun Zhengwen, Zeng Yihong, Xu Xinyu, Wang Yan, Liu Xueqin, Yang Yonggui
The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China.
Sci Rep. 2024 Dec 30;14(1):32110. doi: 10.1038/s41598-024-83884-5.
This study aims to explore the feasibility of applying the "Three-Low" technique (low injection rate, low iodine contrast volume, low radiation dose) in coronary CT angiography (CCTA). We prospectively collected data from 90 patients who underwent CCTA at our hospital between 2021 and 2024. The patients were randomly assigned to either the experimental group (n = 45) or the control group (n = 45). The experimental group parameters were as follows: injection rate of 3.5-4.0 ml/s, iodine contrast volume of 35-40 ml, tube voltage of 100 kVp, and tube current of 250 mA. The control group parameters were: injection rate of 4.5-5.0 ml/s, iodine contrast volume of 45-50 ml, tube voltage of 120 kVp, and tube current of 450 mA. Both groups received a high-concentration, non-ionic, water-soluble contrast agent (Iomeprol, 40 gl/100 ml). The heart rate of all patients was ≤ 70 bpm, and breath-hold scanning was performed after breathing training. The study compared the CT values of the left anterior descending artery, left circumflex artery, right coronary artery, and aorta, as well as background noise, signal-to-noise ratio (SNR), volumetric CT dose index, dose-length product, effective radiation dose, and total iodine dose between the two groups. In the control group, no cases of contrast extravasation occurred, while 6 cases of extravasation were observed in the experimental group (p = 0.026). There was no significant difference between the groups in terms of vascular image quality (mean vascular image quality score: experimental group 4.27 ± 0.62 vs. control group 4.24 ± 0.57, p > 0.05) or vascular motion artifact score (mean vascular motion artifact score: experimental group 4.20 ± 0.59 vs. control group 4.13 ± 0.55, p > 0.05). However, significant differences were found between the experimental and control groups in the CT values of the left anterior descending artery (experimental group: 571.31 ± 49.66 HU vs. control group: 449.20 ± 36.80 HU, p < 0.05), left circumflex artery (experimental group: 570.41 ± 49.98 HU vs. control group: 450.95 ± 39.27 HU, p < 0.05), right coronary artery (experimental group: 584.52 ± 53.70 HU vs. control group: 452.66 ± 40.67 HU, p < 0.05), aorta (experimental group: 624.91 ± 48.99 HU vs. control group: 465.36 ± 34.37 HU, p < 0.05), background noise (experimental group: 24.76 ± 1.97 vs. control group: 19.09 ± 1.69, p < 0.05), SNR (experimental group: 25.30 ± 1.81 vs. control group: 24.47 ± 1.75, p < 0.05), volumetric CT dose index (experimental group: 22.97 ± 1.47 mGy vs. control group: 50.53 ± 4.89 mGy, p < 0.05), dose-length product (experimental group: 363.68 ± 21.45 mGy·cm vs. control group: 782.41 ± 58.20 mGy·cm, p < 0.05), and effective radiation dose (experimental group: 5.09 ± 0.30 mSv vs. control group: 10.95 ± 0.81 mSv, p < 0.05).The results of the Fisher test indicated that the extravasation rate was significantly higher in the high injection rate group compared to the low injection rate group (P = 0.024). The "Three-Low" technique in CCTA imaging effectively reduces the incidence of contrast extravasation caused by high injection rates and decreases the radiation dose, making it a highly feasible option for clinical application and worthy of broader adoption.
本研究旨在探讨在冠状动脉CT血管造影（CCTA）中应用“三低”技术（低注射速率、低碘对比剂用量、低辐射剂量）的可行性。我们前瞻性收集了2021年至2024年在我院接受CCTA检查的90例患者的数据。患者被随机分为实验组（n = 45）和对照组（n = 45）。实验组参数如下：注射速率3.5 - 4.0 ml/s，碘对比剂用量35 - 40 ml，管电压100 kVp，管电流250 mA。对照组参数为：注射速率4.5 - 5.0 ml/s，碘对比剂用量45 - 50 ml，管电压120 kVp，管电流450 mA。两组均使用高浓度、非离子型、水溶性对比剂（碘美普尔，40 gl/100 ml）。所有患者心率≤70次/分钟，经呼吸训练后进行屏气扫描。本研究比较了两组患者左前降支、左旋支、右冠状动脉及主动脉的CT值，以及背景噪声、信噪比（SNR）、容积CT剂量指数、剂量长度乘积、有效辐射剂量和总碘用量。对照组未发生对比剂外渗病例，而实验组观察到6例对比剂外渗（p = 0.026）。两组在血管图像质量（平均血管图像质量评分：实验组4.27±0.62 vs.对照组4.24±0.57，p＞0.05）或血管运动伪影评分（平均血管运动伪影评分：实验组4.20±0.59 vs.对照组4.13±0.55，p＞0.05）方面无显著差异。然而，实验组与对照组在左前降支CT值（实验组：571.31±49.66 HU vs.对照组：449.20±36.80 HU，p＜0.05）、左旋支CT值（实验组：570.41±49.98 HU vs.对照组：450.95±39.27 HU，p＜0.05）、右冠状动脉CT值（实验组：584.52±53.70 HU vs.对照组：452.66±40.67 HU，p＜0.05）、主动脉CT值（实验组：624.91±48.99 HU vs.对照组：465.36±34.37 HU，p＜0.05）、背景噪声（实验组：24.76±1.97 vs.对照组：19.09±1.69，p＜0.05）、SNR（实验组：25.30±1.81 vs.对照组：24.47±1.75，p＜0.05）、容积CT剂量指数（实验组：22.97±1.47 mGy vs.对照组：50.53±4.89 mGy，p＜0.05）、剂量长度乘积（实验组：363.68±21.45 mGy·cm vs.对照组：782.41±58.20 mGy·cm，p＜0.05）和有效辐射剂量（实验组：5.09±0.30 mSv vs.对照组：10.95±0.81 mSv，p＜0.05）方面存在显著差异。Fisher检验结果表明，高注射速率组的对比剂外渗率显著高于低注射速率组（P = 0.024）。CCTA成像中的“三低”技术有效降低了高注射速率导致的对比剂外渗发生率，并降低了辐射剂量，使其成为临床应用中高度可行的选择，值得更广泛地采用。
