不同心率CCTA最佳采集时相和扫描时间窗的优化

刘子岩; 丁玮; 马泽鹏; 张天乐; 赵永霞

doi:10.15953/j.ctta.2024.202

不同心率CCTA最佳采集时相和扫描时间窗的优化

河北大学附属医院放射科，河北保定 071000

基金项目: 保定市科技计划项目（基于不同心率CT冠状动脉造影优化研究（2141ZF307））；河北省2020年度医学科学研究课题计划项目（基于宽体探测器能谱CT在CT造影中影像质量和辐射剂量的优化研究（20200572））；2023河北省医学适用技术跟踪项目（基于宽体探测器CT造影的相关因素优化研究（2023093））；河北大学医学学科培育项目（基于宽体探测器CT在CT血管造影中影像质量和辐射剂量的优化研究（2021A10））。

详细信息

作者简介:
刘子岩，女，研究生，E-mail：liuziyan000304@163.com

通讯作者:
赵永霞✉，男，博士，教授、博士生导师，研究方向为CT和MRI的基础和临床研究，E-mail：zyx_zyx999@163.com。

中图分类号: R 816.2
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出版历程
- 收稿日期: 2024-09-18
- 网络出版日期: 2025-01-24

Optimization of Acquisition Phase and Acquisition Time Window of Coronary Artery CT Angiography with Different Heart Rates

Department of Radiology, the Affiliated Hospital of Hebei University, Baoding 071000, China

摘要

摘要:
探讨冠状动脉CT血管造影（CCTA）不同心率的最佳采集时相及最佳扫描时间窗，探究优化扫描时间窗对CCTA图像质量和辐射剂量的影响。将1000例行CCTA检查的患者分为A、B两组，根据患者CCTA扫描时的心率分为9个亚组。A组行全心动周期CCTA扫描，根据图像质量确定不同心率CCTA的最佳心电图采集时相和扫描时间窗；B组采用A组优化的扫描时间窗进行扫描。部分患者行数字减影血管造影（DSA），以DSA结果作为金标准，比较两组的图像质量、辐射剂量和诊断效能。A1~A9亚组CCTA的最佳扫描时间窗分别是：61%~85% RR间期，68%~84% RR间期，70%~82% RR间期及34%~46% RR间期，70%~82% RR间期及34%~46% RR间期，70%~82% RR间期及36%~48% RR间期，65%~89% RR间期及38%~50% RR间期，68%~84% RR间期及36%~56% RR间期，38%~54% RR间期，38%~58% RR间期。A、B两组主观评价及CCTA检查评估冠脉节段狭窄的敏感性和特异性无明显差异；B组的有效剂量较A组下降40.17%；在保证图像质量前提下，缩窄扫描时间窗可显著降低CCTA检查的辐射剂量。
- 冠状动脉CT血管造影 /
- 最佳采集时相 /
- 扫描时间窗 /
- 辐射剂量
Abstract:
This study aimed to determine the optimal reconstruction phase and acquisition time window for coronary computed tomography angiography (CCTA) in patients with different heart rates, by exploring the effect of the optimized scanning time window on image quality and radiation dose. One thousand patients who underwent CCTA were divided into groups A and B and were divided into nine subgroups based on their heart rate at the time of CCTA. Group A individuals underwent CCTA within a single cardiac cycle, and the optimal reconstruction phase at each heart rate was identified based on image quality. The individuals in group B were examined using the optimized scanning window in group A. Some patients underwent digital subtraction angiography (DSA) and the results were used as the gold standard. The image quality, radiation dose, and diagnostic efficiency were compared between the two groups. The findings indicated that the A1~A9 subgroups' optimal reconstruction phases were: 61%~85% RR interval; 68%~84% RR interval; 70%~82% RR interval and 34%~46% RR interval; 70%~82% RR interval and 34%~46% RR interval; 70%~82% and 36%~48% RR interval; 65%~89% and 38%~50% RR interval; 68%~84% RR interval and 36%~56% RR interval; 38%~54% RR interval; and 38%~58% RR interval. There were no significant differences in the subjective score and sensitivity and specificity of CCTA in the assessment of coronary artery stenosis between the two groups. The average effective dose (ED) in Group B was 40.17% lower than that in Group A. Narrowing the acquisition time window can lower the radiation dose of CCTA inspection while maintaining image quality.
- coronary artery CT angiography /
- optimal acquisition phase /
- optimal acquisition time window /
- radiation dose

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图 1 4名不同心率患者使用优化后扫描时间窗得到的CCTA心电图采集时相图及图像

Figure 1. Four cases of different heart rates using the optimized acquisition window

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表 1 A组各亚组患者CCTA的最佳采集时相及扫描时间窗

Table 1 Optimal reconstruction phase and acquisition time window of CCTA for subgroups in Group A

心率/bpm	最佳采集时相	最佳扫描时间窗
＜51	73±6	61~85
51~55	76±4	68~84
56~60	76±3	70~82
56~60	40±3	34~46
61~65	76±3	70~82
61~65	40±3	34~46
66~70	76±3	70~82
66~70	42±3	36~48
71~75	77±6	65~89
71~75	44±3	38~50
76~80	46±5	36~56
76~80	76±4	68~84
81~85	46±4	38~54
＞85	48±5	38~58

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表 2 A组和B组CCTA图像客观评价及辐射剂量表

Table 2 Objective evaluation of CCTA images and radiation doses for groups A and B

		组别		统计检验
		A组	B组	F/Z	P
降主动脉	CT值^a	457.48±60.59	466.80±61.77	3.457	0.063
降主动脉	标准差^a	18.42±2.79	17.95±2.24	5.182	0.230
右冠状动脉	CT值^b	439.50（391.60，489.50）	442.85（403.00，492.43）	−0.821	0.412
右冠状动脉	标准差^a	16.24±2.25	15.58±1.79	15.912	0.593
左冠状动脉前降支	CT值	433.38±60.85	426.56±60.04	0.644	0.423
左冠状动脉前降支	标准差^b	15.75（13.13，17.40）	15.65（13.43，17.30）	−1.205	0.228
左冠状动脉回旋支	CT值^b	437.05（401.17，477.87）	426.45（383.25，472.03）	−0.433	0.665
左冠状动脉回旋支	标准差^a	14.88±3.06	15.57±2.61	3.064	0.082
SNR^b		28.88（25.81，3.163）	27.40（24.40，30.79）	−1.869	0.062
CNR^b		33.66（30.35，36.78）	31.96（29.48，35.34）	−1.640	0.101
CTDI_vol^b/mGy		30.13（27.56，32.67）	17.89（16.24，19.36）	11.952	＜0.05
DLP^b/mGy·cm		414.18（380.58，456.61）	247.52（217.20，270.18）	11.750	＜0.05
ED^b/mSv		5.80（5.33，6.39）	3.47（3.04，3.78）	11.750	＜0.05
注：a为$(\bar x\pm s )$，b为$M(Q_1,\;Q_3) $。

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表 3 A组和B组各亚组患者的辐射剂量

Table 3 Radiation doses for subgroups of groups A and B

心率/bpm	ED中位数/mSv		Z	P	人数
心率/bpm	A组	B组	Z	P	A组	B组
＜51	7.36（7.01，7.61）	3.21（2.84，4.01）	−5.945	＜0.05	31	60
51~55	6.57（6.38，6.87）	3.99（3.22，4.17）	−7.924	＜0.05	73	70
56~60	6.13（5.92，6.40）	3.79（3.61，3.88）	−10.160	＜0.05	136	103
61~65	5.68（5.49，5.87）	3.54（3.49，3.61）	−8.916	＜0.05	86	92
66~70	5.46（5.26，5.64）	3.33（3.18，3.46）	−7.440	＜0.05	76	57
71~75	5.18（5.09，5.46）	3.30（3.08，3.37）	−6.420	＜0.05	43	50
76~80	4.92（4.53，5.07）	3.11（2.77，3.19）	−4.899	＜0.05	24	30
81~85	4.64（4.55，4.81）	2.07（2.01，3.05）	−3.762	＜0.05	17	16
＞85	4.44（4.43，4.62）	1.98（1.98，1.99）	−3.606	＜0.05	14	22

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表 4 A组和B组CCTA图像主观评价表

Table 4 Subjective evaluation of CCTA images for groups A and B

分组		A	B	$\chi^2 $	P
右冠状动脉	3分	247（49.4）	236（47.2）	0.126	0.722
右冠状动脉	4分	253（50.6）	264（52.8）	0.126	0.722
左冠状动脉前降支	3分	354（70.8）	326（65.2）	0.827	0.363
左冠状动脉前降支	4分	146（29.2）	174（34.8）	0.827	0.363
左冠状动脉回旋支	3分	349（69.8）	315（63.0）	1.100	0.294
左冠状动脉回旋支	4分	151（30.2）	185（37.0）	1.100	0.294

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