• 【急性冠状动脉综合征伴ST抬高型心肌梗死和慢性稳定性心绞痛患者队列中冠状动脉罪犯病变的18F-NaF PET摄取特征: 一项氟化物PET/CTCA杂交研究。】 复制标题 收藏 收藏
    DOI:10.1007/s12350-020-02284-0 复制DOI
    作者列表:Ashwathanarayana AG,Singhal M,Satapathy S,Sood A,Mittal BR,Kumar RM,Parmar M,Krishnappa D,Rana N
    BACKGROUND & AIMS: BACKGROUND:18F-NaF PET/CT identifies high-risk plaques due to active calcification in coronary arteries with potential to characterize plaques in ST-elevation myocardial infarction (MI) and chronic stable angina (CSA) patients. METHODS:Twenty-four MI and 17 CSA patients were evaluated with 18F-NaF PET/CTCA for SUVmax and TBR values of culprit and non-culprit plaques in both groups (inter-group and intra-group comparison), and pre- and post-interventional MI plaques sub-analysis. RESULTS:Culprit plaques in MI patients had significantly higher SUVmax (1.6; IQR 0.6 vs 1.3; IQR 0.3, P = 0.03) and TBR (1.4; IQR 0.6 vs 1.1; IQR 0.4, P = 0.006) than culprit plaques of CSA. Pre-interventional culprit plaques of MI group (n = 11) revealed higher SUVmax (P = 0.007) and TBR (P = 0.008) values than culprit CSA plaques. Culprit plaques showed significantly higher SUVmax (P = 0.006) and TBR (P = 0.0003) than non-culprit plaques in MI group, but without significant difference between culprit and non-culprit plaques in CSA group. With median TBR cutoff value of 1.4 in MI culprit plaques, 6/7 plaques (85.7%) among the event prone non-culprit lesions had TBR values > 1.4 in CSA group. CONCLUSION:The study shows higher SUVmax and TBR values in MI culprit plaques and comparable TBR values for event prone plaques of CSA group in identifying high-risk plaques.
    背景与目标:
  • 【RAPID-CTCA试验 (使用CTCA快速评估潜在的缺血性心脏病)-一项多中心平行组随机试验,用于比较疑似患者的早期计算机断层扫描冠状动脉造影术与标准护理】 复制标题 收藏 收藏
    DOI:10.1186/s13063-016-1717-2 复制DOI
    作者列表:Gray AJ,Roobottom C,Smith JE,Goodacre S,Oatey K,O'Brien R,Storey RF,Na L,Lewis SC,Thokala P,Newby DE
    BACKGROUND & AIMS: BACKGROUND:Emergency department attendances with chest pain requiring assessment for acute coronary syndrome (ACS) are a major global health issue. Standard assessment includes history, examination, electrocardiogram (ECG) and serial troponin testing. Computerised tomography coronary angiography (CTCA) enables additional anatomical assessment of patients for coronary artery disease (CAD) but has only been studied in very low-risk patients. This trial aims to investigate the effect of early CTCA upon interventions, event rates and health care costs in patients with suspected/confirmed ACS who are at intermediate risk. METHODS/DESIGN:Participants will be recruited in about 35 tertiary and district general hospitals in the UK. Patients ≥18 years old with symptoms with suspected/confirmed ACS with at least one of the following will be included: (1) ECG abnormalities, e.g. ST-segment depression >0.5 mm; (2) history of ischaemic heart disease; (3) troponin elevation above the 99th centile of the normal reference range or increase in high-sensitivity troponin meeting European Society of Cardiology criteria for 'rule-in' of myocardial infarction (MI). The early use of ≥64-slice CTCA as part of routine assessment will be compared to standard care. The primary endpoint will be 1-year all-cause death or recurrent type 1 or type 4b MI at 1 year, measured as the time to such event. A number of secondary clinical, process and safety endpoints will be collected and analysed. Cost effectiveness will be estimated in terms of the lifetime incremental cost per quality-adjusted life year gained. We plan to recruit 2424 (2500 with ~3% drop-out) evaluable patients (1212 per arm) to have 90% power to detect a 20% versus 15% difference in 1-year death or recurrent type 1 MI or type 4b MI, two-sided p < 0.05. Analysis will be on an intention-to-treat basis. The relationship between intervention and the primary outcome will be analysed using Cox proportional hazard regression adjusted for study site (used to stratify the randomisation), age, baseline Global Registry of Acute Coronary Events score, previous CAD and baseline troponin level. The results will be expressed as a hazard ratio with the corresponding 95% confidence intervals and p value. DISCUSSION:The Rapid Assessment of Potential Ischaemic Heart Disease with CTCA (RAPID-CTCA) trial will recruit 2500 participants across about 35 hospital sites. It will be the first study to investigate the role of CTCA in the early assessment of patients with suspected or confirmed ACS who are at intermediate risk and including patients who have raised troponin measurements during initial assessment. TRIAL REGISTRATION:ISRCTN19102565 . Registered on 3 October 2014. ClinicalTrials.gov: NCT02284191.
    背景与目标:
  • 【在CT冠状动脉造影 (CTCA) 和CT肺血管造影 (CTPA) 的测试推注阶段,管电位可降低至80 kVp,以节省剂量而不影响诊断质量。】 复制标题 收藏 收藏
    DOI:10.1007/s00330-014-3281-z 复制DOI
    作者列表:Rodrigues JC,Joshi D,Lyen SM,Negus IS,Manghat NE,Hamilton MC
    BACKGROUND & AIMS: OBJECTIVES:The purpose of this study was to determine whether performing the test bolus (TB) of computed tomography coronary angiography (CTCA) and computed tomography pulmonary angiography (CTPA) at 80 kVp reduces dose without compromising diagnostic quality. METHODS:An 80 kVp TB protocol for CTCA and CTPA was retrospectively compared to standard TB protocol (non-obese: 100 kVp, obese: 120 kVp). CT angiogram parameters were unchanged between cohorts. Thirty-seven consecutive 80 kVp TB CTCA images were compared to 53 standard CTCA images. Fifty consecutive CTPAs from each protocol were analysed. Diagnostic quality of the CT angiogram was assessed by: mean attenuation, signal-to-noise ratio (SNR) in the ascending aorta (AA) in CTCA and in the main pulmonary artery (MPA) in CTPA, diagnostic rate, and number of repeated monitoring scans. Mean effective dose was estimated using the dose-length product. RESULTS:Mean TB effective doses were significantly lower (P < 0.0001) for 80 kVp scans compared to the standard in non-obese CTCA (0.15 ± 0.04 mSv Vs 0.33 ± 0.09 mSv), obese CTCA (0.17 ± 0.06 mSv Vs 0.57 ± 0.12 mSv), and CTPA patients (0.07 ± 0.03 mSv Vs 0.15 ± 0.06 mSv). No difference was demonstrated in mean attenuation, SNR (AA), SNR (MPA), diagnostic rates, or number of repeated monitoring scans between protocols. CONCLUSIONS:Routinely performing TB at 80 kVp, regardless of body habitus, in CTCA and CTPA results in a small but significant dose reduction, without compromising CT angiogram diagnostic quality. KEY POINTS:• CT coronary angiography is performed to exclude the presence of significant coronary atherosclerosis. • CT pulmonary angiography is performed to diagnose pulmonary thromboembolism. • This retrospective study showed dose reduction by performing test bolus at 80 kVp. • Diagnosis can be made with reduced exposure to ionising radiation.
    背景与目标:
  • 【回顾性心电图触发的螺旋扫描中256排CT冠状动脉造影 (CTCA) 的个体化辐射剂量控制: 使用体型测量来调整管电流选择。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejrad.2012.04.017 复制DOI
    作者列表:Li JL,Huang MP,Liang CH,Zhao ZJ,Liu H,Cui YH,Liu QS,Zhang JE,Yang L,Ivanc TB,Yanof JH
    BACKGROUND & AIMS:
    背景与目标:
  • 【CTCA的亚毫西弗时代: 新辐射剂量方法的技术基础。】 复制标题 收藏 收藏
    DOI:10.1007/s11547-020-01280-1 复制DOI
    作者列表:Schicchi N,Fogante M,Palumbo P,Agliata G,Esposto Pirani P,Di Cesare E,Giovagnoni A
    BACKGROUND & AIMS: :Computed tomography coronary angiography (CTCA) has become a cornerstone in the diagnostic process of the heart disease. Although the cardiac imaging with interventional procedures is responsible for approximately 40% of the cumulative effective dose in medical imaging, a relevant radiation dose reduction over the last decade was obtained, with the beginning of the sub-mSv era in CTCA. The main technical basis to obtain a radiation dose reduction in CTCA is the use of a low tube voltage, the adoption of a prospective electrocardiogram-triggering spiral protocol and the application of the tube current modulation with the iterative reconstruction technique. Nevertheless, CTCA examinations are characterized by a wide range of radiation doses between different radiology departments. Moreover, the dose exposure in CTCA is extremely important because the benefit-risk calculus in comparison with other modalities also depends on it. Finally, because anatomical evaluation not adequately predicts the hemodynamic relevance of coronary stenosis, a low radiation dose in routine CTCA would allow the greatest use of the myocardial CT perfusion, fractional flow reserve-CT, dual-energy CT and artificial intelligence, to shift focus from morphological assessment to a comprehensive morphological and functional evaluation of the stenosis. Therefore, the aim of this work is to summarize the correct use of the technical basis in order that CTCA becomes an established examination for assessment of the coronary artery disease with low radiation dose.
    背景与目标: : 计算机断层扫描冠状动脉造影 (CTCA) 已成为心脏病诊断过程中的基石。尽管具有介入程序的心脏成像负责医学成像中累积有效剂量的大约40%,但随着CTCA亚mSv时代的开始,在过去十年中获得了相关的辐射剂量减少。在CTCA中获得辐射剂量降低的主要技术基础是使用低管电压,采用前瞻性心电图触发螺旋协议以及应用具有迭代重建技术的管电流调制。尽管如此,CTCA检查的特点是不同放射科之间的辐射剂量范围很广。此外,CTCA中的剂量暴露非常重要,因为与其他方式相比,获益-风险演算也取决于它。最后,由于解剖学评估不能充分预测冠状动脉狭窄的血液动力学相关性,因此常规CTCA中的低辐射剂量将允许最大程度地使用心肌CT灌注,血流储备分数CT,双能CT和人工智能,将重点从形态学评估转移到对狭窄的全面形态学和功能评估。因此,这项工作的目的是总结技术基础的正确使用,以便CTCA成为评估低辐射剂量冠状动脉疾病的既定检查。
  • 【在前瞻性和回顾性心电图门控下使用快照冻结技术改善CTCA图像质量。】 复制标题 收藏 收藏
    DOI:10.1097/RCT.0000000000000193 复制DOI
    作者列表:Fan L,Zhang J,Xu D,Dong Z,Li X,Zhang L
    BACKGROUND & AIMS: BACKGROUND:Although coronary computed tomography angiography (CCTA) can detect coronary artery disease, limited temporal resolution of computed tomographic scanners may allow for motion artifacts, which may result in nonevaluable coronary segments. OBJECTIVE:This study aimed to assess Snapshot Freeze (SSF) Motion Correction algorithm for its effect on image quality of CCTA. METHODS AND RESULTS:Thirty patients underwent prospective electrocardiographic (ECG)-gating CCTA and 30 patients underwent retrospective ECG gating. In prospective ECG-gating group, SSF showed higher interpretability than standard (STD) on per-artery [97.8% (88/90) vs 87.8% (79/90), P = 0.004] and per-segment level [99.1% (427/431) vs 96.1% (414/431), P = 0.000]. Image quality was higher with SSF than STD on per-patient [3.5 (0.9) vs 2.9 (1.2), P = 0.004], per-artery [3.5 (0.8) vs 3.1 (1.0), P = 0.000], and per-segment levels [3.7 (0.8) vs 3.4 (1.0), P = 0.000]. In retrospective ECG-gating group, SSF showed higher interpretability than STD on per-patient [80.0% (24/30) vs 53.3% (16/30), P = 0.039], per-artery [90.0% (81/90) vs 71.1% (64/90), P = 0.000], and per-segment levels [98.1% (413/421) vs 90.7% (382/421), P = 0.000] of 45% R-R interval images. Snapshot freeze showed higher interpretability than STD on per-artery [70.0% (63/90) vs 55.6% (50/90), P = 0.02] and per-segment levels [82.7% (348/421) vs 78.4% (330/421), P = 0.018]. Image quality was higher with SSF than STD on per-patient [2.8 (1.0) vs 2.1 (1.2), P = 0.013] [2.1 (1.2) vs 1.6 (1.0), P = 0.026], per-artery [3.0 (0.9) vs 2.4 (1.0), P = 0.000] [2.6 (1.2) vs 2.2 (1.2), P = 0.000], and per-segment levels [3.3 (0.9) vs 2.9 (1.0), P = 0.000] [2.9 (1.2) vs 2.7 (1.1), P = 0.000] of 45% and 75% R-R interval images. CONCLUSIONS:Snapshot freeze could improve the image quality and interpretability of CCTA with prospective and retrospective ECG gating. Especially, SSF could improve the image quality on right coronary artery by using the 45% R-R interval as the central phase with retrospective ECG gating.
    背景与目标:
  • 【在前瞻性和回顾性心电图门控下使用快照冻结技术改善CTCA图像质量: 勘误表。】 复制标题 收藏 收藏
    DOI:10.1097/RCT.0000000000000768 复制DOI
    作者列表:
    BACKGROUND & AIMS:
    背景与目标:
  • 【CTCA-PRORECAD (冠状动脉疾病的计算机断层扫描冠状动脉血管造影预后注册) 的原理,设计和方法: 多中心和多供应商注册。】 复制标题 收藏 收藏
    DOI:10.1007/s11547-012-0912-9 复制DOI
    作者列表:Maffei E,Midiri M,Russo V,Rengo M,Tedeschi C,Spagnolo P,Seitun S,Francone M,Guaricci AI,Carrabba N,Malagò R,Cuocolo A,Arcadi T,Catalano OA,Cademartiri F
    BACKGROUND & AIMS: PURPOSE:This study was done to assess the prognostic value of computed tomography coronary angiography (CTCA) in a large multicentre population of patients with suspected coronary artery disease (CAD) and, in particular, its incremental value compared with traditional methods for risk stratification. MATERIALS AND METHODS:This is a retrospective observational study that began in January 2003 conducted on patients with suspected CAD assessed with CTCA on the basis of symptoms (chest pain, dyspnoea) and/or abnormal or equivocal stress test and/or a high cardiovascular risk profile. The participating centres will provide data obtained with CTCA performed with 16-slice or higher equipment. Exclusion criteria are renal insufficiency, allergy to iodinated contrast material, pregnancy and previous myocardial infarction or revascularisation (percutaneous coronary intervention and/or coronary artery bypass graft). All patients are stratified by means of clinical assessment and/or data retrieved from a clinical database. Risk factors considered are hypertension, dyslipidaemia, diabetes mellitus, smoking, family history and obesity. Symptoms are classified as absent, typical chest pain, atypical chest pain and dyspnoea. Primary endpoints are death, major adverse cardiovascular events (cardiac death, unstable angina requiring hospitalisation, acute myocardial infarction) and shifting of cardiovascular risk category on the basis of coronary plaque burden. The secondary endpoint is coronary revascularisation. Telephone interviews and/or clinical databases are used for the follow-up. The study will be conducted on a population >1,000 patients. CONCLUSIONS:The information collected from the Prognostic Registry for Coronary Artery Disease (PRORECAD) will provide insight into the prognostic value of CTCA in addition to demographic and clinical features. The results will allow for better use and interpretation of CTCA for prognostic purposes.
    背景与目标:
  • 【CT冠状动脉造影: 与滤波反投影相比,正弦图确定的迭代重建图像质量。】 复制标题 收藏 收藏
    DOI:10.1016/j.crad.2012.08.007 复制DOI
    作者列表:Wang R,Schoepf UJ,Wu R,Gibbs KP,Yu W,Li M,Zhang Z
    BACKGROUND & AIMS: AIM:To investigate image quality and potential for radiation dose reduction using sinogram-affirmed iterative reconstruction (SAFIRE) at computed tomography (CT) coronary angiography (CTCA) compared with filtered back-projection (FBP) reconstruction. MATERIALS AND METHODS:A water phantom and 49 consecutive patients were scanned using a retrospectively electrocardiography (ECG)-gated CTCA protocol on a dual-source CT system. Image reconstructions were performed with both conventional FBP and SAFIRE. The SAFIRE series were reconstructed image data from only one tube, simulating a 50% radiation dose reduction. Two blinded observers independently assessed the image quality of each coronary segment using a four-point scale and measured image noise (the standard deviation of Hounsfield values, SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Radiation dose estimates were calculated. RESULTS:In the water phantom, image noise decreased at the same ratio as the tube current increased for both reconstruction algorithms. Despite an estimated radiation dose reduction from 7.9 ± 2.8 to 4 ± 1.4 mSv, there was no significant difference in the SD and SNR within the aortic root and left ventricular chamber between the two reconstruction methods. There was also no significant difference in the image quality between the FBP and SAFIRE series. CONCLUSION:Compared with traditional FBP, there is potential for substantial radiation dose reduction at CTCA with use of SAFIRE, while maintaining similar diagnostic image quality.
    背景与目标:
  • 【计算机断层扫描冠状动脉造影中口服伊伐布雷定的心率控制: 7.5 mg与5 mg方案的随机比较。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijcard.2012.09.041 复制DOI
    作者列表:Guaricci AI,Maffei E,Brunetti ND,Montrone D,Di Biase L,Tedeschi C,Gentile G,Macarini L,Midiri M,Cademartiri F,Di Biase M
    BACKGROUND & AIMS: BACKGROUND:Heart rate (HR) reduction is essential to achieve optimal image quality and diagnostic accuracy with computed tomography coronary angiography (CTCA). Administration of oral ivabradine seems to be more effective than beta-blockade in reducing HR in patients referred for CTCA. METHODS:Two-hundred-fifty-nine consecutive patients referred for CTCA were prospectively enrolled. Patients not receiving beta-blocker at baseline (group 1) and those with beta-blocker therapy (group 2) were enrolled in the study. Each group was randomized into 3 parallel arms with 1:1:1 allocation. Patients who did not receive beta-blocker at baseline: underwent CTCA without beta blocker (n=49), and received ivabradine 5mg (n=48), or 7.5mg ivabradine (n=48). Patients with beta-blocker therapy: continued with the prior beta-blocker without any dose modification (n=38), and received ivabradine 5mg (n=38), or ivabradine 7.5mg (n=38). RESULTS:HR and blood pressure were assessed at admission (T0), immediately before CTCA (T1) and during CTCA (T2). Administration of ivabradine 7.5mg significantly reduced mean relative HR at T1 and T2 (p<0.01), the rate of patients not achieving target HR at T1 (p<0.001) and T2 (p<0.01), and the percentage of patients needing additional IV beta-blockade prior to CTCA (p<0.01). Results remained statistically significant even after correction for age, gender, ejection fraction, risk factors and HR at T0, in a multivariable analysis. CONCLUSIONS:Ivabradine 7.5mg is more effective than ivabradine 5mg in increasing the rate of patients at target HR in patients referred for CTCA.
    背景与目标:
  • 【心外膜脂肪组织体积和衰减的自然史: 一项长期前瞻性队列随访研究。】 复制标题 收藏 收藏
    DOI:10.1038/s41598-020-63135-z 复制DOI
    作者列表:Nerlekar N,Thakur U,Lin A,Koh JQS,Potter E,Liu D,Muthalaly RG,Rashid HN,Cameron JD,Dey D,Wong DTL
    BACKGROUND & AIMS: :Epicardial adipose tissue (EAT) is associated with cardiovascular risk. The longitudinal change in EAT volume (EATv) and density (EATd), and potential modulators of these parameters, has not been described. We prospectively recruited 90 patients with non-obstructive coronary atherosclerosis on baseline computed tomography coronary angiography (CTCA) performed for suspected coronary artery disease to undergo a repeat research CTCA. EATv in millilitres (mL) and EATd in Hounsfield units (HU) were analysed and multivariable regression analysis controlling for traditional cardiovascular risk factors (CVRF) performed to assess for any predictors of change. Secondary analysis was performed based on statin therapy. The median duration between CTCA was 4.3years. Mean EATv increased at follow-up (72 ± 33 mL to 89 ± 43 mL, p < 0.001) and mean EATd decreased (baseline -76 ± 6 HU vs. -86 ± 5 HU, p < 0.001). There were no associations between baseline variables of body mass index, age, sex, hypertension, hyperlipidaemia, diabetes or smoking on change in EATv or EATd. No difference in baseline, follow-up or delta EATv or EATd was seen in patients with (60%) or without baseline statin therapy. In this select group of patients, EATv consistently increased and EATd consistently decreased at long-term follow-up and these changes were independent of CVRF, age and statin use. Together with the knowledge of strong associations between EAT and cardiac disease, these findings may suggest that EAT is an independent parameter rather than a surrogate for cardiovascular risk.
    背景与目标: 心外膜脂肪组织 (EAT) 与心血管风险相关。尚未描述EAT体积 (EATv) 和密度 (EATd) 的纵向变化以及这些参数的潜在调节剂。我们前瞻性地招募了90例非阻塞性冠状动脉粥样硬化患者,对可疑冠状动脉疾病进行了基线计算机断层扫描冠状动脉造影 (CTCA),以进行重复研究CTCA。分析了毫升 (mL) 中的EATv和Hounsfield单位 (HU) 中的EATd,并进行了控制传统心血管危险因素 (CVRF) 的多变量回归分析,以评估变化的任何预测因素。在他汀类药物治疗的基础上进行了二次分析。CTCA之间的中位持续时间为4.3年。随访时平均EATv升高 (72  ±   33 ml至89  ±   43 ml,p  <  0.001),平均EATd降低 (基线-76  ±   6 HU vs. -86  ±   5 HU,p  <  0.001)。在EATv或EATd的变化中,体重指数,年龄,性别,高血压,高脂血症,糖尿病或吸烟的基线变量之间没有关联。在接受 (60%) 或不接受基线他汀类药物治疗的患者中,基线,随访或delta EATv或EATd无差异。在这个选定的患者组中,EATv在长期随访中持续升高,EATd持续降低,这些变化与CVRF,年龄和他汀类药物的使用无关。加上对EAT与心脏病之间强关联的了解,这些发现可能表明EAT是一个独立的参数,而不是心血管风险的替代参数。
  • 【计算机断层扫描诊断冠状动脉疾病: 辐射剂量的减少增加了适用性。】 复制标题 收藏 收藏
    DOI:10.1016/j.crad.2012.05.010 复制DOI
    作者列表:Gosling O,Morgan-Hughes G,Iyengar S,Strain W,Loader R,Shore A,Roobottom C
    BACKGROUND & AIMS: AIM:To assess the effects of dose-saving algorithms on the radiation dose in an established computed tomography coronary angiography (CTCA) clinical service. MATERIALS AND METHODS:A 3 year retrospective analysis of all patients attending for a clinically indicated CTCA was performed. The effective dose was calculated using a cardiac-specific conversion factor [0.028 mSv(mGy·cm)(-1)]. Patients were stratified by the advent of new scanning technology and dose-saving protocols. RESULTS:Between September 2007 and August 2010, 1736 examinations were performed. In the first 6 months, 150 examinations were performed with a mean effective dose of 29.6 mSv (99% CI 26.6-33 mSv). In March 2008 prospective electrocardiogram (ECG) gating was installed; reducing the effective dose to 13.6 mSv (99% CI 12.5-14.9 mSv). In March 2009, the scanner parameters were set to a minimal exposure time and 100 kV in patients with a body mass index (BMI) of <30. This reduced the mean dose to 7.4 mSv (99% CI 6.8-8 mSv). For the final six months the mean radiation dose for a cardiac scan was 5.9 mSv (99% CI 5.4-6.5 mSv) this figure incorporates all examinations performed irrespective of the protocol used. CONCLUSION:With the implementation of evidence-based protocols, the effective dose from cardiac CT has significantly reduced. As CTCA services develop dose-saving algorithms should be adopted to keep the radiation dose as low as reasonably practical.
    背景与目标:
  • 【320-MDCT容积扫描仪上单心跳和双心跳CTCA的自动曝光控制: 心率、曝光相位窗口设置和重建算法的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejmp.2013.10.003 复制DOI
    作者列表:Funama Y,Utsunomiya D,Taguchi K,Oda S,Shimonobo T,Yamashita Y
    BACKGROUND & AIMS: PURPOSE:To investigate whether electrocardiogram (ECG)-gated single- and dual-heartbeat computed tomography coronary angiography (CTCA) with automatic exposure control (AEC) yields images with uniform image noise at reduced radiation doses. MATERIALS AND METHODS:Using an anthropomorphic chest CT phantom we performed prospectively ECG-gated single- and dual-heartbeat CTCA on a second-generation 320-multidetector CT volume scanner. The exposure phase window was set at 75%, 70-80%, 40-80%, and 0-100% and the heart rate at 60 or 80 or corr80 bpm; images were reconstructed with filtered back projection (FBP) or iterative reconstruction (IR, adaptive iterative dose reduction 3D). We applied AEC and set the image noise level to 20 or 25 HU. For each technique we determined the image noise and the radiation dose to the phantom center. RESULTS:With half-scan reconstruction at 60 bpm, a 70-80% phase window- and a 20-HU standard deviation (SD) setting, the imagenoise level and -variation along the z axis manifested similar curves with FBP and IR. With half-scan reconstruction, the radiation dose to the phantom center with 70-80% phase window was 18.89 and 12.34 mGy for FBP and 4.61 and 3.10 mGy for IR at an SD setting SD of 20 and 25 HU, respectively. At 80 bpm with two-segment reconstruction the dose was approximately twice that of 60 bpm at both SD settings. However, increasing radiation dose at corr80 bpm was suppressed to 1.39 times compared to 60 bpm. CONCLUSION:AEC at ECG-gated single- and dual-heartbeat CTCA controls the image noise at different radiation dose.
    背景与目标:
  • 【通过计算机断层扫描评估有和没有糖尿病的患者的冠状动脉疾病和钙化的冠状动脉斑块负荷。】 复制标题 收藏 收藏
    DOI:10.1007/s00330-010-1996-z 复制DOI
    作者列表:Maffei E,Seitun S,Nieman K,Martini C,Guaricci AI,Tedeschi C,Weustink AC,Mollet NR,Berti E,Grilli R,Messalli G,Cademartiri F
    BACKGROUND & AIMS: PURPOSE:To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA). METHODS AND MATERIALS:147 diabetic (mean age: 65 ± 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 ± 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too. RESULTS:Diabetics showed a higher number of diseased segments (4.1 ± 4.2 vs. 2.1 ± 3.0; p < 0.0001); a higher rate of CCS > 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS ≤ 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS ≤ 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic. CONCLUSIONS:Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics.
    背景与目标:
  • 【计算机断层扫描冠状动脉造影在临床实践中的阳性预测价值。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijcard.2010.11.008 复制DOI
    作者列表:Groothuis JG,Beek AM,Meijerink MR,Brinckman SL,Heymans MW,van Kuijk C,van Rossum AC
    BACKGROUND & AIMS: BACKGROUND:Several studies have investigated the diagnostic performance of computed tomography coronary angiography (CTCA) for the detection of significant coronary artery disease (CAD). These studies were performed in patients that were already referred for invasive coronary angiography (ICA) and prevalence of significant CAD was high. Although the negative predictive value of CTCA was consistently high, a wide range of positive predictive values (PPVs) was reported. Thus, the PPV of CTCA in patients that undergo CTCA as part of a clinical diagnostic evaluation remains unclear. This study investigated the PPV of CTCA for the detection of significant CAD in clinical practice. METHODS:A total of 181 patients with low to intermediate pre-test probability CAD that were referred for non-invasive evaluation of chest pain underwent 64-slice CTCA. CTCA was scored per segment as normal, non-obstructive CAD or obstructive CAD (>50% diameter stenosis). All patients with obstructive CAD according to CTCA, underwent ICA. Significant CAD was defined as >50% diameter stenosis on ICA. RESULTS:According to CTCA, 65 (35.9%) patients had obstructive CAD. In 26 (14.4%) patients, significant CAD was found by ICA. The PPV for detection of significant CAD per patient, per vessel and per segment were 40.0% (26/65, 95% CI: 30.6-50.2%), 31.3% (36/115, 95% CI: 24.7-38.8%) and 25.5% (42/165; 95% CI: 20.3-31.4%), respectively. CONCLUSIONS:The PPV of CTCA for detection of significant CAD in patients with low to intermediate probability CAD that are clinically referred for non-invasive evaluation of chest pain is markedly lower than generally reported.
    背景与目标:

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录