A preliminary study on the diagnostic value of iterative model reconstruction technique combined with low-dose coronary CTA in patients with suspected coronary heart disease
LIU Xin, YANG Lin-lin, WANG Yi-jing, GAO Si-zhe, MA Yue, HOU Yang
Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
Abstract Objective: To evaluate the image quality of low-dose coronary CTA combined with iterative model reconstruction(IMR) in coronary arteries and its diagnostic value for coronary stenosis in patients with suspected coronary heart disease. Methods: Eighty patients with suspected coronary heart disease who underwent coronary CTA and the catheter coronary angiography(CAG) in our hospital were analyzed retrospectively. The image quality of each coronary artery was divided into 4 grades. Coronary angiography showing coronary artery luminal diameter reduction>50% as positive standard, the sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and accuracy of coronary CTA in the diagnosis of coronary artery stenosis were analyzed at the level of coronary artery segment and main artery. Patients were divided into two groups according to the Agaston score(group A <400, group B≥400). The difference in diagnostic efficacy between the two groups was compared. Results: At the segment level, 98.1% of the coronary images were qualified, and the sensitivity, specificity, PPV, NPV and accuracy of CTA were 93.2%, 98.0%, 91.3%, 98.4% and 97.1% respectively. At the level of main artery, 96.6% of coronary images were qualified, and the sensitivity, specificity, PPV, NPV and accuracy of CTA were 84.6%, 93.0%, 88.9%, 90.1% and 89.6%, respectively. There were significant differences in specificity, PPV and accuracy between groups A and B(99.2% & 91.8%, 95.7% & 84.2%, 97.9% & 93.7%, P<0.05). Conclusions: Low-dose coronary CTA combined with IMR can obtain satisfactory image quality and has high diagnostic accuracy for coronary artery stenosis. However, the diagnosis of severely calcified segments is still limited.
LIU Xin,YANG Lin-lin,WANG Yi-jing, et al. A preliminary study on the diagnostic value of iterative model reconstruction technique combined with low-dose coronary CTA in patients with suspected coronary heart disease[J]. JOURNAL OF CHINA MEDICAL IMAGING, 2020, 31(4): 252-257.
[1]Rani S, Lakshmi R, Pillai AAK, et al. The risk factors associated with complications of coronary angiogram: A cross-sectional observational study[J]. Int J Adv Med Health Res, 2016, 3(1): 11-15.
[2]Azzalini L, Candilio L, Mccullough PA, et al. Current Risk of Contrast-Induced Acute Kidney Injury After Coronary Angiography and Intervention: A Reappraisal of the Literature[J]. Can J Cardiol, 2017, 33(10): 1225-1228.
[3]Joshi H, Shah R, Prajapati J, et al. Diagnostic Accuracy of Computed Tomography Angiography as Compared to Conventional Angiography in Patients Undergoing Noncoronary Cardiac Surgery[J]. Heart Views, 2016, 17(3): 88-91.
[4]Wang SY, Gao W, Zhong YM, et al. Prospective ECG-triggering cardiac CT for infants with complex congenital heart disease using low-dose contrast medium, low tube voltage, and adaptive statistical iterative reconstruction[J]. Clin Radiol, 2017, 72(6): 502-507.
[5]Bu G, Miao Y, Bin J, et al. Comparison of 128-Slice Low-Dose Prospective ECG-Gated CT Scanning and Trans-Thoracic Echocardiography for the Diagnosis of Complex Congenital Heart Disease[J]. PloS One, 2016, 11(10): e0165617.
[6]Goodenberger MH, Wagner-Bartak NA, Gupta S, et al. Computed Tomography Image Quality Evaluation of a New Iterative Reconstruction Algorithm in the Abdomen(Adaptive Statistical Iterative Reconstruction-V) a Comparison With Model-Based Iterative Reconstruction, Adaptive Statistical Iterative Reconstruction, and Filtered Back Projection Reconstructions[J]. J Comput Assist Tomogr, 2018, 42(2): 184-190.
[7]Funama Y, Utsunomiya D, Hirata K, et al. Improved Estimation of Coronary Plaque and Luminal Attenuation Using a Vendor-specific Model-based Iterative Reconstruction Algorithm in Contrast-enhanced CT Coronary Angiography[J]. Acad Radiol, 2017, 24(9): 1070-1078.
[8]André F, Fortner P, Vembar M, et al. Improved image quality with simultaneously reduced radiation exposure: Knowledge-based iterative model reconstruction algorithms for coronary CT angiography in a clinical setting[J]. J Cardiovasc Comput Tomogr, 2017, 11(3): 213-220.
[9]Károlyi M, Szilveszter B, Kolossváry M, et al. Iterative model reconstruction reduces calcified plaque volume in coronary CT angiography[J]. Eur J Radiol, 2017, 87: 83-89.
[10]Cha MJ, Seo JS, Yoo DS, et al. Knowledge-based iterative model reconstruction in coronary computed tomography angiography: comparison with hybrid iterative reconstruction and filtered back projection[J]. Acta Radiol, 2018, 59(3): 280-286.
[11]Ippolito D, Riva L, Franzesi CRT, et al. Diagnostic efficacy of model-based iterative reconstruction algorithm in an assessment of coronary artery in comparison with standard hybrid-Iterative reconstruction algorithm: dose reduction and image quality[J]. Radiol Med, 2018, 124(5): 350-359.
[12]Den Harder AM, Willemink MJ, van Doormaal PJ, et al. Radiation dose reduction for CT assessment of urolithiasis using iterative reconstruction: A prospective intra-individual study[J]. Eur Radiol, 2018, 28(1): 143-150.
[13]Moscariello A, Takx RA, Schoepf UJ, et al. Coronary CT angiography: image quality, diagnostic accuracy, and potential for radiation dose reduction using a novel iterative image reconstruction technique-comparison with traditional filtered back projection[J]. Eur Radiol, 2011, 21(10): 2130-2138.
[14]Hou Y, Ma Y, Fan W, et al. Diagnostic accuracy of low-dose 256-slice multi-detector coronary CT angiography using iterative reconstruction in patients with suspected coronary artery disease[J]. Eur Radiol, 2014, 24(1): 3-11.
[15]Meinel FG, De Cecco CN, Schoepf UJ, et al. First-arterial-pass dual-energy CT for assessment of myocardial blood supply: do we need rest, stress, and delayed acquisition? Comparison with SPECT[J]. Radiology, 2014, 270(3): 708-716.
[16]Hou Y, Xu S, Guo W, et al. The optimal dose reduction level using iterative reconstruction with prospective ECG-triggered coronary CTA using 256-slice MDCT[J]. Eur J Radiol, 2012, 81(12): 3905-3911.
[17]赵正凯，程绍玲，赖声远，等. 体重指数正常患者80 kVp低剂量冠状动脉CTA成像联合全模型迭代重建与iDose4、FBP重建算法图像质量的对照[J]. 中国老年学杂志，2019，39（1）：119-123.
[18]Khawaja RD, Singh S, Blake M, et al. Ultra-low dose abdominal MDCT: using a knowledge-based Iterative Model Reconstruction technique for substantial dose reduction in a prospective clinical study[J]. Eur J Radiol, 2015, 84(1): 2-10.
[19]Hansen NJ, Kaza RK, Maturen KE, et al. Evaluation of low-dose CT angiography with model-based iterative reconstruction after endovascular aneurysm repair of a thoracic or abdominal aortic aneurysm[J]. AJR, 2014, 202(3): 648-655.
[20]Zhang LJ, Wang Y, Schoepf UJ, et al. Image quality, radiation dose, and diagnostic accuracy of prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp in a clinical setting: comparison with invasive coronary angiography[J]. Eur Radiol, 2016, 26(3): 797-806.
[21]Liang J, Wang H, Xu L, et al. Diagnostic performance of 256-row detector coronary CT angiography in patients with high heart rates within a single cardiac cycle: a preliminary study[J]. Clin Radiol, 2017, 72(8): 694.e7-694.e14.
[22]肖冲冲，黄贤胜，丁振江，等. 64排螺旋CT冠状动脉成像对冠心病诊断准确性的影响因素分析[J]. 临床心血管病杂志，2016，32（3）：245-250.
[23]范依莎，侯阳，赵鹏飞，等. 低剂量前置门控冠脉CTA结合迭代重建技术在不典型胸痛患者中的应用研究[J]. 中国临床医学影像杂志，2013，24（3）：169-173.
[24]Sato S, Horii Y, Yoshimura N, et al. Coronary computed tomography angiography using 128-slice dual-source computed tomography in patients with severe calcification[J]. Jap J Radiol, 2017, 35(8): 432-439.
[25]Andreini D, Pontone G, Mushtaq S, et al. Diagnostic Accuracy of Rapid Kilovolt Peak-Switching Dual-Energy CT Coronary Angiography in Patients With a High Calcium Score[J]. JACC Cardiovasc Imaging, 2015, 8(6): 746-748.
[26]Schindler A, Vliegenthart R, Schoepf UJ, et al. Iterative image reconstruction techniques for CT coronary artery calcium quantification: comparison with traditional filtered back projection in vitro and in vivo[J]. Radiology, 2014, 270(2): 387-393.
[27]Yu M, Li Y, Li W, et al. Calcification remodeling index assessed by cardiac CT predicts severe coronary stenosis in lesions with moderate to severe calcification[J]. J Cardiovasc Comput Tomogr, 2017, 12(1): 42-49.
[28]Szilveszter B, Elzomor H, Károlyi M, et al. The effect of iterative model reconstruction on coronary artery calcium quantification[J]. Int J Cardiovasc Imaging, 2016, 32(1): 153-160.
