The research advancements on the advantages and limitations of coronary computed tomography angiography at low tube voltage: a literature review.

BACKGROUND AND OBJECTIVE

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.

METHODS

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).

KEY CONTENT AND FINDINGS

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.

CONCLUSIONS

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.