ISSN 1004-4140
CN 11-3017/P

基于扩展视野重建技术的冠状动脉CTA与肺静脉成像一站式方案：可行性与辐射、对比剂双低剂量评估

One-stop Solution for Coronary CTA and Pulmonary Vein Imaging Based on Extended Field-of-View Reconstruction Technology: Feasibility and Evaluation of Dual Low Radiation and Contrast Agent Doses

    摘要
  • 摘要: 目的：心房颤动（AF）和冠状动脉疾病（CAD）具有许多共同的发病危险因素，因此在进行射频导管消融术（RFCA）前进行全面的影像学评估有利于对心脏整体状况的了解和对AF病因的探索。本研究旨在评估利用冠状动脉CT血管成像（CCTA）通过扩展视野（extDFOV）重建技术获得衍生的肺静脉CT（PVCT）图像，实现对CCTA和PVCT的单次扫描成像，旨在减少对比剂用量和辐射剂量的同时保持PVCT诊断图像质量的可行性。方法：前瞻性招募了44名计划接受射频消融术的冠状动脉疾病合并心房颤动的患者，最终36名患者符合纳入标准。所有患者均进行了CCTA和PVCT检查：实验组（第1组）使用CCTA图像通过extDFOV扩展视野重建获得的PVCT图像；对照组（第2组）使用常规的螺旋扫描获得的PVCT图像。通过盲法分析并比较两组图像的的主观图像质量、运动伪影、信噪比（SNR）、对比噪声比（CNR）、对比剂用量及辐射剂量。结果：CCTA扩展视野重建的PVCT图像（第1组）表现出更优的主观图像质量评分（4.44±0.61 vs. 3.97±0.74，P < 0.05），并且相比于传统的PVCT（第2组）图像显著减少了运动伪影（EMA：1.73±0.47 mm vs. 4.55±1.35 mm，P < 0.05）。第1组的对比剂用量也低于第2组（33.19±3.82 mL vs. 45 mL，P < 0.05）。辐射剂量方面，由于CCTA采用多期相采集的原因，第1组的辐射剂量略高于第2组（2.44±0.89 mSv vs. 1.87±0.07 mSv，P < 0.05）。CCTA扩展视野重建的PVCT图像（第1组）总体的CT衰减值略低于传统的PVCT（第2组），但仍提供了足够的增强效果以满足诊断需求。结论：利用CCTA衍生的PVCT图像与extDFOV重建技术对CAD合并AF患者的术前评估是可行且有效的。该方法显著减少了对比剂用量，同时减少了运动伪影，优化了影像工作流程而不影响诊断准确性。

     

    Abstract: Purpose: Atrial fibrillation (AF) and coronary artery disease (CAD) share multiple risk factors. Comprehensive imaging evaluation before radiofrequency catheter ablation (RFCA) is beneficial for assessing overall cardiac condition and exploring the underlying causes of AF. This study aimed to evaluate the feasibility of using coronary computed tomography angiography (CCTA)-derived pulmonary vein CT (PVCT) images obtained via extended field-of-view (extDFOV) reconstruction to achieve single-scan imaging for both CCTA and PVCT, with the goal of reducing contrast agent dosage and radiation exposure while maintaining diagnostic image quality. Methods: A total of 44 CAD patients with AF scheduled for RFCA were prospectively enrolled, with 36 meeting the inclusion criteria. All patients underwent both CCTA and PVCT examinations: the experimental group (Group 1) used extDFOV reconstruction from CCTA images to derive PVCT images, while the control group (Group 2) underwent separate helical PVCT scans. Image quality, motion artifacts, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), contrast agent dosage, and radiation dose were analyzed and compared between the two groups. Results: CCTA-derived PVCT images (Group 1) demonstrated superior image quality scores (4.44±0.61 vs. 3.97±0.74, P < 0.05) and significantly reduced motion artifacts (EMA: 1.73±0.47 mm vs. 4.55±1.35 mm, P < 0.05) compared to conventional PVCT images (Group 2). The contrast agent dosage was also lower in Group 1 (33.19±3.82 mL vs. 45 mL, P < 0.05). Due to multiphase acquisition in CCTA, the radiation dose in Group 1 was slightly higher than in Group 2 (2.44±0.89 mSv vs. 1.87±0.07 mSv, P < 0.05). Although the CT attenuation values of CCTA-derived PVCT images were lower than those of conventional PVCT, they still provided sufficient enhancement for diagnostic purposes. Conclusion: The use of CCTA-derived PVCT images with extDFOV reconstruction is a feasible and effective method for pre-procedural assessment in CAD patients with AF. This approach significantly reduces contrast agent dosage, minimizes motion artifacts, and optimizes imaging workflow without compromising diagnostic accuracy.

     

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