Abstract：Objective: To evaluate the image quality, diagnostic accuracy and radiation doses for coronary artery imaging with second-generation 128-slice dual-source CT (DSCT) using the highpitch mode. Methods: A total of 123 cases patients with suspected or known coronary artery disease were randomly divided into two groups. Group A (n=58) underwent the adaptive prospective ECG-triggered sequence scan (CorAdpSeq) and group B (n=65) underwent the prospective high-pitch mode (pitch 3.4, Flash mode). Two experienced radiologists assessed the image quality and significant coronary stenosis (≥50％) with a double blinded fashion in a five score scale. Interobserver agreement for image quality was calculated with Cohen kappa statistics. The radiation doses values were measured. The diagnostic performance presented by DSCT in detecting stenosis ≥50％ were compared with the gold standard DSA. Results: There were 1 968 segments of coronary arteries in 123 patients included in this analysis. Diagnostic image quality (score≥3) was obtained in 1920 segments(97.6％) of the coronary artery segments, which was obtained in 98.1％(910／928)of segments in group A and 97.1％(1 010／1 040)in group B respectively with no significant difference (χ2=0.030,P=0.867). The mean image quality score for the whole coronary segments was (4.7±0.8) in 123 patients.There was no statistical difference between mean image quality of group A (4.7±0.7) and group B (4.6±0.9) (t=0.603,P=0.548). The kappa value between two radiologists was 0.799(P<0.01)on image quality. The effective radiation dose in group B (1.08±0.11) mSv was significantly (t=11.642,P=0.000) lower than that in group A (2.26±0.49) mSv. Sensitivity and specificity were 97.6％ and 97.5％ pervessel in group A; 98.1％,96.5％ per-vessel in group B. Conclusion: Compared with DSA both the high-pitch and CorAdpSeq mode for CTCA provide high image quality and accuracy of significant coronary stenosis, but the high-pitch mode can significantly reduce the radiation dose in the lower heart rate and regular heart rhythm.
收稿日期: 2013-04-20
通讯作者:
潘昌杰(通讯作者),副主任医师,Email:pcj424815@sina.com
作者简介: 吴春华(1973—),男,主管技师;
引用本文:
吴春华, 薛跃君, 许轶群, 荣伟良, 潘昌杰, 钱农. 双源CT大螺距扫描技术在冠状动脉狭窄诊断中的应用[J]. 江苏大学学报:医学版, 2013, 23(4): 345-349.
WU Chun-hua, XUE Yue-jun, XU Yi-qun, RONG Wei-liang, PAN Chang-jie, QIAN Nong. Dual-source CT coronary angiography using the high-pitch mode in diagnosing the coronary artery stenosis. Journal of Jiangsu University(Medicine Edition), 2013, 23(4): 345-349.
[1]王小玲, 赵青, 佟海滨, 等. 第二代双源CT前门控大螺距冠状动脉成像中ECG“不稳定波形”对图像质量的影响［J］. 中国医学影像技术, 2011, 27(11):2335-2339.［2］张艳艳, 冯博, 李佩玲, 等. 双源CT冠状动脉成像评价冠状动脉狭窄［J］. 中国医学影像技术, 2011, 27(8):1587-1590.［3］Leber AW, Johnson T, Becker A, et a1. Diagnostic accuracy of dual-source multi-slice CT-coronary angiography in patients with an intermediate pretest likelihood for coronary artery disease［J］. Eur Heart J, 2007, 28(19):2354-2360.［4］Scheffel H,Alkadhi H, Plass A, et a1. Accuracy of dual-source CT coronary angiography: first experience in a high pre-test probability population without heart rate control［J］. Eur Radiol, 2006, 16(12):2739-2747.［5］Brenner DJ, Hall EJ. Computed tomography: an increasing source of radiation exposure［J］. N Engl J Med, 2007, 357(22):2277-2284.［6］Herzog BA, Wyss CA, Husmann L, et al. First head-to-head comparison of effective radiation dose from low-dose 64-slice CT with prospective ECG-triggering versus invasive coronary angiography［J］. Heart, 2009, 95(20):1656-1661.［7］Scheffel H, Alkadhi H, Leschka S, et al. Lowdose CT coronary angiography in the step-and-shoot mode: diagnostic performance［J］. Heart, 2008, 94(9):1132-1137.［8］Lell M, Marwan M, Schepis T, et al. Prospectively ECG-triggered high-pitch spiral acquisition for coronary CT angiography using dual source CT: technique and initial experience［J］. Eur Radiol, 2009, 19(11):2576-2583.［9］Austen WG, Edwards JE, Frye RL, et a1. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association［J］. Circulation, 1975, 51(Suppl 4):5-40.［10］Nakayama Y, Awai K, Funama Y, et a1. Low tube voltage reduces contrast material and radiation doses on 16-MDCT aortography［J］. AJR, 2006, 187(5):W490-W497.［11］Valentin J, International Commission on Radiation Protection. Managing patient dose in multidetector computed tomography(MDCT). ICRP Publication 102［J］. Ann ICRP, 2007, 37(1):1-79.［12］Deetjen A, Mollmann S, Conradi G, et a1. Use of automatic exposure control in multislice computed tomography of the coronaries: comparison of 16-slice and 64-slice scanner data with conventional coronary angiography［J］. Heart, 2007, 93(9):1040-1043.
2013, Vol. 23 
