消融术前单延迟期对比计算机断层扫描以减少辐射暴露且不影响肺静脉诊断准确性

The Single-Delayed-Phase Contrast Computed Tomography Before Ablation to Reduce Radiation Exposure Without Compromising Diagnostic Pulmonary Vein Accuracy.

作者信息

Yagyu Keishiro, Oginosawa Yasushi, Kobayashi Takahiro, Nakamura Yuki, Ishii Nozomu, Miyamoto Taro, Hayashi Katsuhide, Ohe Hisaharu, Kataoka Masaharu

机构信息

The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.

Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Japan.

出版信息

J Cardiovasc Electrophysiol. 2025 Sep;36(9):2341-2352. doi: 10.1111/jce.70002. Epub 2025 Jul 18.

DOI:10.1111/jce.70002

PMID:40678915

Abstract

INTRODUCTION

Early-phase contrast-enhanced CT (CCT) is often used to plan and guide catheter ablation for atrial fibrillation (AF), and delayed-phase images can be used to detect or exclude left atrial appendage (LAA) thrombosis. However, dual-phase CCT is associated with concerns about radiation exposure; hence, this study aimed to evaluate whether single-delayed-phase images can provide sufficient preoperative information while minimizing radiation exposure.

METHODS AND RESULTS

A total of 102 patients who underwent dual-phase CCT were analyzed for pulmonary vein (PV) anatomy and LAA thrombus detection. The decrease in image quality due to the difference between early and delayed phases in 3D reconstruction did not pose a problem regarding anatomical evaluation. The PV anatomy was classified as typical or atypical, and 399 PVs were analyzed. Atypical PVs included 17 cases, with consistent anatomical details across the early and delayed phases. The mean discrepancy in PV diameter between the two phases and the correlation coefficient for the coronal view was 0.78 ± 0.16 mm, r = 0.91, and for the axial view, 0.79 ± 0.15 mm, r = 0.93. The LAA thrombi were observed in three patients, and no thrombus was overestimated in the delayed phase. The total exposure dose was 2320.1 ± 1031.0 mGy-cm in the dual-phase, 1443.3 ± 578.5 mGy-cm in the single early phase, and 876.8 ± 526.6 mGy-cm in the single delayed phase. Radiation doses were significantly lower in single-phase imaging than in dual-phase.

CONCLUSIONS

The single-delayed-phase CCT provides accurate anatomical and thrombus evaluations while significantly reducing radiation exposure. This approach could be a safer alternative for pre-ablation assessment without compromising diagnostic reliability.

TRIAL REGISTRATION

The University of Occupational and Environmental Health ethics committee approved the study (UOEHCRB22-067).

摘要

引言

早期增强CT（CCT）常用于规划和指导心房颤动（AF）的导管消融，延迟期图像可用于检测或排除左心耳（LAA）血栓形成。然而，双期CCT存在辐射暴露问题；因此，本研究旨在评估单延迟期图像能否在将辐射暴露降至最低的同时提供足够的术前信息。

方法与结果

对102例行双期CCT的患者进行肺静脉（PV）解剖结构及LAA血栓检测分析。三维重建中早期与延迟期差异导致的图像质量下降在解剖评估方面并无问题。PV解剖结构分为典型或非典型，共分析399支PV。非典型PV有17例，早期与延迟期的解剖细节一致。两期PV直径的平均差异及冠状位的相关系数为0.78±0.16mm，r = 0.91，轴位为0.79±0.15mm，r = 0.93。3例患者观察到LAA血栓，延迟期无血栓被高估。双期总暴露剂量为2320.1±1031.0mGy-cm，单早期为1443.3±578.5mGy-cm，单延迟期为876.8±526.6mGy-cm。单相成像的辐射剂量显著低于双期。