Pan Yao, Jia Chong-Fu
The Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5859-5867. doi: 10.21037/qims-24-57. Epub 2025 May 26.
Coronary computed tomography angiography (CCTA) has become a widely used imaging tool for evaluating coronary artery disease, attracting significant attention in recent years. This article explores the advantages, limitations, and improvement strategies of low tube voltage CCTA, aiming to provide a comprehensive understanding of its clinical significance.
A systematic PubMed search combined Boolean operators with keywords: "coronary computed tomography angiography", "low tube voltage", "lumen attenuation", and "plaque composition", alongside synonyms (e.g., "low kV", "atherosclerotic plaque", "pericoronary adipose tissue"). The search spanned from 2010 to 2024, limited to English articles. Initial screening excluded irrelevant/non-English studies, prioritizing research on low tube voltage techniques, plaque characterization, lumen contrast dynamics, and peri-coronary adipose tissue (PCAT).
The primary advantage of low tube voltage CCTA lies in its ability to reduce radiation dose while preserving adequate image quality. Lower tube voltage settings enhance the attenuation of iodine contrast agents, improving the imaging contrast of coronary arteries. This heightened contrast allows for clearer visualization of atherosclerotic plaques and narrowings, thereby enhancing the accuracy of coronary artery disease detection and diagnosis. However, it is important to acknowledge inherent limitations in low tube voltage CCTA, such as potential increased image noise due to reduced photon penetration at lower energy levels. Nonetheless, advancements in image reconstruction algorithms and iterative techniques have significantly addressed this challenge, ensuring that dose reduction benefits do not compromise overall diagnostic value. To further improve the effectiveness of low tube voltage CCTA, researchers are exploring integration strategies with other imaging modalities. Combining CCTA with functional imaging techniques, like myocardial perfusion imaging or fractional flow reserve assessment, provides a more comprehensive evaluation of coronary artery conditions. This integrated approach may offer synergistic benefits, enabling comprehensive data collection for improved cardiovascular assessment.
In summary, low tube voltage CCTA shows great potential in coronary artery imaging, offering an ideal balance between reducing radiation dose and maintaining image quality for assessing coronary artery disease. Overcoming its limitations and integrating it with other imaging technologies will contribute to improved diagnostic capabilities, providing a more detailed assessment of patient care and treatment in cardiovascular medicine.
冠状动脉计算机断层扫描血管造影（CCTA）已成为评估冠状动脉疾病广泛应用的成像工具，近年来备受关注。本文探讨低管电压CCTA的优势、局限性及改进策略，旨在全面了解其临床意义。
通过PubMed系统检索，结合布尔运算符与关键词：“冠状动脉计算机断层扫描血管造影”、“低管电压”、“管腔衰减”和“斑块成分”，以及同义词（如“低千伏”、“动脉粥样硬化斑块”、“冠状动脉周围脂肪组织”）。检索时间跨度为2010年至2024年，限于英文文章。初步筛选排除不相关/非英文研究，优先选择关于低管电压技术、斑块特征、管腔对比动态及冠状动脉周围脂肪组织（PCAT）的研究。
低管电压CCTA的主要优势在于其在保持足够图像质量的同时能够降低辐射剂量。较低的管电压设置增强了碘造影剂的衰减，提高了冠状动脉的成像对比度。这种增强的对比度使动脉粥样硬化斑块和狭窄能够更清晰地显示，从而提高冠状动脉疾病检测和诊断的准确性。然而，必须认识到低管电压CCTA存在固有局限性，例如由于较低能量水平下光子穿透减少可能导致图像噪声增加。尽管如此，图像重建算法和迭代技术的进步已显著应对了这一挑战，确保剂量降低的益处不会损害整体诊断价值。为进一步提高低管电压CCTA的有效性，研究人员正在探索与其他成像模态的整合策略。将CCTA与功能成像技术（如心肌灌注成像或血流储备分数评估）相结合，可对冠状动脉状况进行更全面的评估。这种综合方法可能提供协同效益，实现全面的数据收集以改善心血管评估。
总之，低管电压CCTA在冠状动脉成像中显示出巨大潜力，在降低辐射剂量和保持评估冠状动脉疾病的图像质量之间提供了理想平衡。克服其局限性并将其与其他成像技术整合将有助于提高诊断能力，为心血管医学中患者的护理和治疗提供更详细的评估。
