光子计数探测器CT低剂量胸部扫描评估冠状动脉钙化积分的可行性研究  

Photon-counting detector CT for low-dose chest scans in the evaluation of coronary artery calcium scoring:a feasibility study

作　　者：赵艳娥 金东生 孙美荣 陈骥梁 田地 罗松 胡秋菊 卢光明 ZHAO Yan’e;JIN Dongsheng;SUN Meirong;CHEN Jiliang;TIAN Di;LUO Song;HU Qiuju;LU Guangming(Department of Radiology,Geriatric Hospital of Nanjing Medical University,Nanjing 210024,China;CT Collaboration,Siemens Healthiness Digital Technology(Shanghai)Co.,Ltd.;Department of Radiology,Eastern Theater Command General Hospital)

机构地区：[1]南京医科大学附属老年医院放射科,南京210024 [2]西门子数字医疗科技(上海)有限公司CT科研合作部 [3]东部战区总医院放射科

出　　处：《国际医学放射学杂志》2024年第6期647-653,共7页International Journal of Medical Radiology

基　　金：江苏省干部保健科研项目(BJ23017)。

摘　　要：目的 评估光子计数探测器CT(PCD-CT)胸部低剂量CT(LD-CT)对冠状动脉钙化的检测、定量和危险分层的可行性。方法 回顾性收集采用PCD-CT同时行心电门控CT(ECG-CT)和LD-CT扫描的冠状动脉钙化病人63例(共189支血管),其中高心率组(心率>75次/min)29例、低心率组(心率≤75次/min)34例。ECG-CT采用前瞻性心电门控120 kVp扫描,LD-CT采用非心电门控大螺距联合锡滤过100 kVp(Sn100 kVp)扫描。冠状动脉钙化定量采用Agatston评分(AS)。以ECG-CT为参考标准,基于病人和血管水平、心率亚组计算LD-CT检测冠状动脉钙化的敏感度、特异度和准确度;并采用Spearman相关系数(r)和Bland-Altman方法(偏倚:95%一致性下限/上限值)分析LD-CT和ECG-CT评估AS的相关性和一致性。采用加权Kappa方法分析冠状动脉钙化风险分层的一致性。采用配对t检验比较LD-CT和ECG-CT的有效辐射剂量。结果 ECG-CT在63例病人和130支血管中检测出冠状动脉钙化。以病人为单位,LD-CT对冠状动脉钙化检测准确度100%,LD-CT和ECG-CT获得的AS评分相关性极强(r=0.95~0.99,均P<0.05),一致性较好(-9.7:-125/105.7);以血管为单位,前降支(LAD)的AS偏倚(0.1:-102.8/102.9)小于左回旋支(LCX)(-11.5:-86.9/63.9)和右冠状动脉(RCA)(-8.1:-81.2/65.1);低心率组的AS偏倚(-3.3:-73.4/66.5)小于高心率组(-18.3:-175.3/138.6)。LD-CT和ECG-CT基于AS的危险分层一致性强(kappa=0.963)。LD-CT的有效辐射剂量(0.48±0.9 mSv)比ECG-CT(0.77±0.16 mSv)降低了37%(P<0.001)。结论 基于PCD-CT胸部LD-CT扫描不仅对冠状动脉钙化检测、定量和风险分层具有较好的准确性,而且可以降低有效辐射剂量。Objective This study aims to evaluate the feasibility of low-dose chest CT(LD-CT)using photon-counting detector CT(PCD-CT)for the detection,quantification,and risk stratification of coronary artery calcium.Methods A retrospective analysis was conducted on 63 patients with coronary artery calcium who underwent standard calcium scoring CT(ECG-CT)and LD-CT with PCD-CT,a total of 189 vessels involved.Twenty-nine patients were divided into high heart rate group(heart rate>75 beats/min)and 34 patients into low heart rate group(heart rate<75 beats/min).ECG-CT was performed using a prospective ECG-gated 120 kVp scan,while LD-CT utilized non-ECG-gated high-pitch combined with tin filtration at 100 kVp(Sn100 kVp)settings.The Agatston score was used for quantifying coronary artery calcium.Using ECG-CT as the reference standard,the sensitivity,specificity,and accuracy of LD-CT in detecting coronary artery calcification were calculated at both patient and vessel levels,as well as at high and low heart rates.The correlation and agreement between LD-CT and ECG-CT in assessing AS were analyzed by the Spearman correlation coefficient(r)and Bland-Altman method(bias:95%limits of agreement).The agreement of coronary artery calcification risk stratification was assessed by the Weighted Kappa analysis.The difference in effective radiation doses between LD-CT and ECG-CT was compared using the paired t-test. Results ECG-CT detected coronary artery calcification in 130 vessels across all 63 patients. For all patients, LD-CT showed high accuracy(100%) in detecting coronary artery calcification. A strong correlation (r=0.95~0.99,P<0.05) and consistency (-9.7:-125/105.7) were observed between the Agatston scores obtained from both methods. The bias in the left anterior descending artery (LAD) (0.1:-102.8/102.9) was smaller than the left circumflex artery (LCX) (-11.5:-86.9/63.9) and the right coronary artery(RCA) (-8.1:-81.2/65.1). The bias in the low heart rate group (-3.3: -73.4/66.5) was smaller than in the high heart rate group(-18.3:-1

关 键 词：光子计数探测器CT 冠状动脉钙化 钙化积分 辐射剂量 

分 类 号：R814.42[医药卫生—影像医学与核医学]