Mantini Cesare, Cademartiri Filippo, Procaccini Luca, Tana Claudio, Mastrodicasa Domenico, Saba Luca, Gallina Sabina, Tana Marco, Caulo Massimo, Ricci Fabrizio
Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
Institute of Radiology, "G. d'Annunzio" University of Chieti-Pescara , SS Annunziata Polyclinic University Hospital, Via dei Vestini, 31, 66013, Chieti, Italy.
Radiol Med. 2025 Jun 7. doi: 10.1007/s11547-025-02027-6.
CT acquisition parameters and reconstruction techniques may affect the accuracy of calcium scoring measurements with a potential impact on clinical decision making. We evaluated the agreement of half- versus standard-dose protocols for assessment of aortic valve (AVCS HD and AVCS SD protocols) and coronary artery calcium scoring (CACS HD and CACS SD protocols) with and without the application of iterative reconstruction.
We enrolled 144 consecutive patients (mean age 83 ± 9 years) with known aortic stenosis undergoing 128-row prospective sequential CT with standard (120 kVp/20 mAs) and half-dose (120 kVp/10 mAs) protocols for both AVCS and CACS evaluation. The half-dose dataset was processed with and without iterative reconstruction. Agreement and precision of different protocols were evaluated using linear regression and Bland-Altman analysis. Additionally, we assessed the reclassification of cardiovascular risk based on the Mayo Clinic system and the likelihood of severe aortic stenosis using sex-specific categories.
Compared with the standard dose, the half-dose protocol with or without iterative reconstruction demonstrated optimum agreement for the evaluation of AVCS (r = 0.99; R = 0.97) and CACS (r = 0.96; R = 0.93). The half-dose iterative reconstruction protocol yielded a very low rate of reclassification aortic stenosis severity (1.4%) and cardiovascular risk (6.2%). The half-dose protocol resulted in 47.5% radiation dose reduction compared to standard dose (dose-length product: 8.5 ± 1.1 vs. 17.9 ± 2.7; p < 0.001).
Our findings suggest that the half-dose protocol with iterative reconstruction provides reliable and accurate results for both AVCS and CACS assessment. This evidence underscores the potential to optimize radiation dose while preserving the precision of diagnostic outcomes, thereby minimally impacting clinical management.
CT采集参数和重建技术可能会影响钙化积分测量的准确性，进而可能影响临床决策。我们评估了在应用和未应用迭代重建的情况下，半剂量与标准剂量方案用于评估主动脉瓣（AVCS HD和AVCS SD方案）和冠状动脉钙化积分（CACS HD和CACS SD方案）的一致性。
我们连续纳入了144例已知主动脉瓣狭窄的患者（平均年龄83±9岁），对其进行128排前瞻性序列CT检查，采用标准（120 kVp/20 mAs）和半剂量（120 kVp/10 mAs）方案评估AVCS和CACS。半剂量数据集在应用和未应用迭代重建的情况下进行处理。使用线性回归和Bland-Altman分析评估不同方案的一致性和精密度。此外，我们根据梅奥诊所系统评估心血管风险的重新分类以及使用性别特异性类别评估严重主动脉瓣狭窄的可能性。
与标准剂量相比，应用或未应用迭代重建的半剂量方案在评估AVCS（r = 0.99；R = 0.97）和CACS（r = 0.96；R = 0.93）方面显示出最佳一致性。半剂量迭代重建方案导致主动脉瓣狭窄严重程度的重新分类率（1.4%）和心血管风险的重新分类率（6.2%）非常低。与标准剂量相比，半剂量方案使辐射剂量降低了47.5%（剂量长度乘积：8.5±1.1 vs. 17.9±2.7；p < 0.001）。
我们的研究结果表明，采用迭代重建的半剂量方案为AVCS和CACS评估提供了可靠且准确的结果。这一证据强调了在保持诊断结果精度的同时优化辐射剂量的潜力，从而对临床管理产生最小影响。
