Coronary CT angiography in the emergency department utilizing second and third generation dual source CT
Coronary CT angiography in the emergency department utilizing second and third generation dual source CT
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DOI：
10.1016/j.jcct.2017.03.002
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发表时间：
2017-07-01
影响因子：
5.4
通讯作者：
Ghoshhajra, Brian B.
中科院分区：
文献类型：
--
作者：
Meyersohn, Nandini M.;Szilveszter, Balint vi;Ghoshhajra, Brian B.
背景：冠状动脉计算机断层扫描血管造影（冠状动脉 CTA）可以对急诊科（ED）疑似急性冠脉综合征（ACS）的低至中危患者进行有效分类。随着标准化扫描协议的建立和新一代 CT 硬件的引入，急诊室中冠状动脉 CTA 采集技术不断发展。 目标：使用专为 ED 设计的标准化机构扫描协议，评估第二代与第三代双源 CT (DSCT) 扫描仪上采集的冠状动脉 CTA 的定性和定量图像质量和辐射剂量暴露。方法：对 246 名转诊至冠状动脉 CIA 怀疑患有 ACS 的 ED 患者进行了一项回顾性观察性病例对照研究。 2013 年 10 月至 2015 年 8 月期间（56.5% 为男性；平均年龄 533 +/- 11.6 岁）。对 123 名连续患者进行了第三代 DSCT 扫描，并确定了一组按年龄、BMI 和心率匹配的 123 名患者，他们使用相同的标准临床方案进行了第二代 DSCT 成像。对定性和定量图像质量参数以及辐射暴露进行了评估。结果：与第二代相比，使用第三代 DSCT 的定性图像质量显着更高 (p < 0.001)。第三代 DSCT 的近端冠状动脉平均衰减也显着高于第二代（左主冠状动脉 (LM) 为 586 HU 对比 426 HU，p < 0.001）。然而，第三代 DSCT 的信噪比 (SNR) 和对比噪声比 (CNR) 值低于第二代（LM 中的 SNR 11.2 [9.9-13.4] vs 13.5 [11.0-15.5]，CNR 12.4 [10.9-14.8] vs 15.2 [12.8-17.9]， p < 0.001）。第三代 DSCT 的中位有效剂量也低于第二代（分别为 2.9 [2.3-5.0] mSv 和 3.7 mSv [2.5-5.7]），尽管这一趋势未达到统计学显着性 (p = 0.065)。结论：使用第三代 DSCT 评估的冠状动脉节段的定性图像质量和平均 CT 衰减值显着更高。第三代 DSCT 的 SNR 和 CNR 较低，但这伴随着使用相同标准机构方案时辐射剂量暴露较低的趋势。 (C) 2017 年心血管计算机断层扫描学会。由爱思唯尔公司出版。保留所有权利。
Background: Coronary computed tomography angiography (coronary CTA) allows efficient triage of low to intermediate risk patients with suspected acute coronary syndrome (ACS) in the emergency department (ED). Techniques for coronary CTA acquisition in the ED continue to evolve with the establishment of standardized scan protocols and the introduction of newer generations of CT hardware.Objectives: To evaluate qualitative and quantitative image quality and radiation dose exposure of coronary CTA acquired on 2nd versus 3rd generation dual source CT (DSCT) scanners using a standardized institutional scan protocol designed for the ED.Methods: A retrospective observational case-control study was performed of 246 ED patients referred to coronary CIA with suspicion of ACS (56.5% male; mean age 533 +/- 11.6 years) between October 2013 and August 2015.123 consecutive patients were scanned on 3rd generation DSCT, and a cohort of 123 patients matched by age, BMI and heart rate were identified who had undergone 2nd generation DSCT imaging utilizing the same standard clinical protocol. Qualitative and quantitative image quality parameters and radiation exposures were evaluated.Results: Qualitative image quality was significantly higher using 3rd generation DSCT as compared to 2nd generation (p < 0.001). Mean attenuation in the proximal coronary arteries was also significantly higher on 3rd generation DSCT than for 2nd generation (586 HU vs. 426 HU in the left main coronary artery (LM), p < 0.001). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) values, however, were lower in 3rd generation DSCT than 2nd generation (SNR 11.2 [9.9-13.4] vs 13.5 [11.0-15.5] and CNR 12.4 [10.9-14.8] vs 15.2 [12.8-17.9] in the LM, p < 0.001). Median effective dose was also lower for 3rd generation DSCT than for 2nd generation (2.9 [2.3-5.0] mSv and 3.7 mSv [2.5-5.7], respectively) although this trend did not reach statistical significance (p = 0.065).Conclusion: Qualitative image quality and mean CT attenuation values of the assessed coronary segments were significantly higher using 3rd generation DSCT. SNR and CNR were lower on 3rd generation DSCT, however this was accompanied by a trend toward lower radiation dose exposure when using the same standard institutional protocol. (C) 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.