Analysis of Accuracy, Image Quality, and Effective Dose of Coronary CT Angiography Using Dual-Source CT with Turbo-Flash Mode to Evaluate Coronary Artery Stenosis
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摘要:
目的：分析双源CT Turbo-Flash扫描模式冠状动脉CT血管成像（CCTA）评价冠状动脉狭窄的价值。方法：选取2023年10月至2024年12月我院接受CCTA检查患者150例，依据所采用的扫描模式分为观察组（行双源CT Turbo-Flash扫描模式，n=75）、对照组（采用回顾性心电门控扫描模式，n=75），分析两组扫描参数[CT-血流储备分数（CT-FFR）、管腔内CT强化密度值、Agatston钙化积分、钙化体积]、图像质量[CT值、信噪比（SNR）]、辐射剂量[剂量长度乘积（DLP）、容积CT剂量指数（CTDIvol）、有效辐射剂量（ED）]。结果：观察组CT-FFR、管腔内CT强化密度值、Agatston钙化积分高于对照组（P＜0.05）；双源CT Turbo-Flash扫描模式下，随冠状动脉狭窄程度增加，获得的CT-FFR、管腔内CT强化密度值、Agatston钙化积分增加；以DSA为金标准，观察组诊断冠状动脉中重度狭窄的敏感度、特异度、准确度分别为96.43%、87.23%、90.67%，与对照组差异均无统计学意义；两组CT值、SNR、图像质量比较差异无统计学意义；观察组DLP、CTDIvol、ED均低于对照组。结论：双源CT Turbo-Flash扫描模式下行CCTA检查，评估冠状动脉狭窄的准确性、图像质量较好，可通过定量参数对狭窄程度予以评估，同时其DLP、CTDIvol、ED均较少，值得在临床推广实践。
Abstract:Objective: To analyze the value of coronary CT angiography (CCTA) using dual-source CT with Turbo-Flash mode to evaluate coronary artery stenosis. Methods: A total of 150 patients who underwent CCTA in hospital between January 2023 and December 2024 were selected and divided into an observation group (dual-source CT with Turbo-Flash mode, n=75) and control group (retrospective electrocardiographic-gating mode, n=75) according to the scan mode used. The scan parameters [CT-derived fractional flow reserve (CT-FFR), intraluminal contrast density, Agatston scores for calcification, and calcification volume], image quality [CT value and signal-to-noise ratio (SNR)], and radiation doses [dose length product (DLP), volume CT dose index (CTDIvol), and ED] of the two groups were analyzed. Results: CT-FFR, intraluminal contrast density, and Agatston score for calcification were greater in the observation group than in the control group (P<0.05). Under dual-source CT with Turbo-Flash mode, as the degree of coronary artery stenosis increased, the CT-FFR, intraluminal contrast density, and Agatston score for calcification increased (P<0.05). Taking DSA as the gold standard, the diagnostic sensitivity, specificity, and accuracy for moderate-severe coronary artery stenosis in the observation group were 96.43%, 87.23%, and 90.67%, respectively. No statistically significant difference was observed compared with the control group (P<0.05). The differences in CT values, SNR, and image quality between the two groups were not statistically significant (P>0.05). DLP, CTDIvol, and ED were lower in the observation group than in the control group (P<0.05). Conclusion: Dual-source CT with Turbo-Flash mode for CCTA can achieve high accuracy and image quality when evaluating coronary artery stenosis. The degree of stenosis can be evaluated through quantitative parameters. Moreover, the DLP, CTDIvol, and ED are relatively low. These findings are worthy of clinical promotion and application.
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图 1 有狭窄者CCTA图像
注：患者女，53岁，DSA证实有狭窄。（a）容积再现图像，（b）血管树图像，（c）左冠状动脉前降支曲面重建图像，（d）左回旋支曲面重建图像。
Figure 1. CCTA images of a patient with stenosis
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图 2 无狭窄者CCTA图像
注：患者男，59岁，DSA证实无狭窄。（a）容积再现图像，（b）血管树图像，（c）右冠状动脉曲面重建图像，（d）左冠状动脉前降支曲面重建图像。
Figure 2. CCTA images of a patient without stenosis
表 1 两组一般资料比较
Table 1 Comparison of general information between the two groups
项目 组别 统计检验 观察组（n=75） 对照组（n=75） $\chi^2 $/t P 性别 男 39（52.00） 42（56.00） 0.242 0.623 女 36（48.00） 33（44.00） 年龄/岁 71.42±7.29 72.07±7.38 0.543 0.588 体质指数/（kg/m2） 24.19±2.56 24.83±2.48 1.555 0.122 扫描时心率/（次/min） 69.48±7.23 68.97±7.46 0.425 0.671 心率变化值/（次/min） 3.12±0.33 3.07±0.38 0.860 0.391 
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表 2 两组CCTA扫描参数比较（
$ \bar x \pm s $ ）Table 2 Comparison of CCTA parameters between the two groups (
$ \bar x \pm s $ )扫描参数 组别 统计检验 观察组（n=75） 对照组（n=75） t P CT-FFR 0.66±0.12 0.62±0.06 2.582 0.011 管腔内CT强化密度值/HU 0.11±0.05 0.09±0.04 2.705 0.008 Agatston钙化积分/分 37.53±6.34 34.99±3.83 2.970 0.003 钙化体积/mm3 36.60±6.77 35.27±3.25 1.534 0.127
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表 3 不同狭窄程度患者CCTA扫描参数比较（
$ \bar x \pm s $ ）Table 3 Comparison of CCTA parameters among patients with different degrees of stenosis (
$ \bar x \pm s $ )扫描参数 冠状动脉狭窄程度 统计检验 正常（n=21） 轻度狭窄（n=26） 中度狭窄（n=16） 重度狭窄（n=12） F P CT-FFR 0.53±0.06 0.67±0.08* 0.72±0.09* 0.81±0.09*#△ 36.574 ＜0.001 管腔内CT强化密度值/HU 0.07±0.01 0.10±0.02* 0.14±0.03*# 0.18±0.04*#△ 59.718 ＜0.001 Agatston钙化积分/分 31.59±3.26 36.44±3.75* 40.28±4.37*# 46.59±4.73*#△ 40.525 ＜0.001 注：与正常比较，*为P＜0.05；与轻度狭窄比较，#为P＜0.05；与中度狭窄比较，△为P＜0.05。
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表 4 CCTA诊断冠状动脉中重度狭窄结果
Table 4 CCTA diagnosis results of moderate-severe coronary artery stenosis
组别 类型 DSA 中重度 正常+轻度 合计 观察组 中重度 27 6 33 正常+轻度 1 41 42 对照组 中重度 24 5 29 正常+轻度 4 42 46
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表 5 CCTA诊断冠状动脉中重度狭窄的价值
Table 5 Value of CCTA in diagnosing moderate-severe coronary artery stenosis
预测价值 组别 统计检验 观察组（n=75） 对照组（n=75） $\chi^2 $ P 敏感度 96.43（27/28） 85.71（24/28） 0.878 0.349* 特异度 87.23（41/47） 74.47（42/47） 0.103 0.748 准确度 90.67（68/75） 88.00（66/75） 0.280 0.597 阳性预测值 81.82（27/33） 82.76（24/29） 0.009 0.923 阴性预测值 97.62（41/42） 91.30（42/46） 0.668 0.414* 注：*为采用连续校正$\chi^2 $检验。
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表 6 两组图像质量比较
Table 6 Comparison of image quality between the two groups
评分等级 组别 统计检验 观察组（n=75） 对照组（n=75） t/Z P CT值/HU 590.75±60.08 584.72±59.07 0.620 0.536 SNR 12.79±1.34 12.41±1.56 1.600 0.112 图像质量分级[n(%)] 1分 33（44.00） 30（40.00） 0.050 0.823 2分 30（40.00） 35（46.67） 3分 10（13.33） 8（10.67） 4分 2（2.67） 2（2.67）
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表 7 两组辐射剂量参数比较
Table 7 Comparison of radiation dose between the two groups
剂量参数 组别 统计检验 观察组（n=75） 对照组（n=75） t P DLP/（mGy·cm） 28.44±2.96 400.48±45.25 71.052 ＜0.001 CTDIvol/mGy 2.53±0.29 4.37±0.46 29.304 ＜0.001 ED/mSv 0.36±0.04 5.29±0.58 73.438 ＜0.001
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