Szablics Fanni Éva, Bérczi Ákos, Csőre Judit, Borzsák Sarolta, Szentiványi András, Kiss Máté, Juhász Georgina, Papp Dóra, Suhai Ferenc Imre, Csobay-Novák Csaba
Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Városmajor utca 68, 1122 Budapest, Hungary.
Siemens Healthcare, 1143 Budapest, Hungary.
J Clin Med. 2025 Aug 7;14(15):5571. doi: 10.3390/jcm14155571.
: Virtual non-contrast (VNC) images derived from dual-energy CTA (DE-CTA) could potentially replace true non-contrast (TNC) scans while reducing radiation exposure. This study evaluated the image quality of VNC compared to TNC for assessing native arteries and bypass grafts in patients with peripheral arterial disease (PAD). : We retrospectively analyzed 175 patients (111 men, 64 women, mean age: 69.3 ± 9.5 years) with PAD who underwent lower extremity DE-CTA. Mean attenuation and image noise values of TNC and VNC images were measured in native arteries and bypass grafts at six arterial levels, from the aorta to the popliteal arteries, using circular regions of interest (ROI). Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were calculated. Three independent radiologists evaluated the subjective image quality of VNC images compared to baseline TNC scans for overall quality (4-point Likert scale), and for residual contrast medium (CM), calcium subtractions, and bypass graft visualization (3-point Likert scales). Radiation dose parameters (DLP, CTDIvol) were recorded to estimate effective dose values (ED) and the potential radiation dose reduction. Differences between TNC and VNC measurements and radiation dose parameters were compared using a paired -test. Interobserver agreement was assessed with Gwet's AC2. : VNC attenuation and noise values were significantly lower across all native arterial levels ( < 0.05, mean difference: 4.7 HU-10.8 HU) and generally lower at all bypass regions (mean difference: 2.2 HU-13.8 HU). Mean image quality scores were 3.03 (overall quality), 2.99 (residual contrast), 2.04 (subtracted calcifications), and 3.0 (graft visualization). Inter-reader agreement was excellent for each assessment (AC2 ≥ 0.81). The estimated radiation dose reduction was 36.8% ( < 0.0001). : VNC reconstructions demonstrated comparable image quality to TNC in a PAD assessment and offer substantial radiation dose reduction, supporting their potential as a promising alternative in clinical practice. Further prospective studies and optimization of reconstruction algorithms remain essential to confirm diagnostic accuracy and address remaining technical limitations.
双能量CT血管造影（DE-CTA）生成的虚拟非增强（VNC）图像有可能替代真正的非增强（TNC）扫描，同时减少辐射暴露。本研究评估了VNC与TNC在评估外周动脉疾病（PAD）患者的天然动脉和旁路移植物方面的图像质量。我们回顾性分析了175例接受下肢DE-CTA检查的PAD患者（111例男性，64例女性，平均年龄：69.3±9.5岁）。使用圆形感兴趣区域（ROI），在从主动脉到腘动脉的六个动脉水平的天然动脉和旁路移植物中测量TNC和VNC图像的平均衰减和图像噪声值。计算信噪比（SNR）和对比噪声比（CNR）。三名独立的放射科医生将VNC图像的主观图像质量与基线TNC扫描的整体质量（4点李克特量表）以及残留造影剂（CM）、钙减影和旁路移植物可视化（3点李克特量表）进行比较评估。记录辐射剂量参数（DLP、CTDIvol）以估计有效剂量值（ED）和潜在的辐射剂量降低。使用配对t检验比较TNC和VNC测量值以及辐射剂量参数之间的差异。观察者间一致性用Gwet's AC2进行评估。VNC的衰减和噪声值在所有天然动脉水平均显著较低（P<0.05，平均差异：4.7 HU - 10.8 HU），在所有旁路区域通常也较低（平均差异：2.2 HU - 13.8 HU）。平均图像质量得分分别为3.03（整体质量）。
