双层光谱CT虚拟平扫图像定量冠状动脉钙化的可行性研究
本研究回顾性纳入100例接受双层光谱CT冠状动脉CTA检查的患者，利用虚拟平扫（VNC）重建计算冠状动脉钙化体积并推导CAC评分。VNC-derived CAC与常规真平扫CAC无显著差异（p=0.653），ICC=0.977，Bland-Altman平均差异-1.2 AU；但16%患者按CAC-DRS风险分类被错分，主要低估风险等级。VNC有望免除专用平扫，减少辐射和采集时间。
要点
- VNC与TNC的CAC评分高度相关（ICC=0.977），平均差异仅-1.2 AU。
- 16%患者CAC-DRS风险分类被错分，多为低估，报告需警惕。
- VNC可替代平扫计算钙化积分，减少辐射与扫描时间。
局限性
- 回顾性单中心设计，样本量100例。
- VNC导致16%患者CAC-DRS风险分类错分，主要低估。
- CACVNC通过线性回归从VOLVNC推导，非直接阈值计算。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: To evaluate the feasibility of deriving coronary artery calcium (CAC) scores from Virtual-Non-Contrast (VNC) reconstructions obtained with dual-layer computed tomography (DLCT).
METHODS: A retrospective study was conducted on 100 patients who underwent coronary computed tomography angiography (CCTA) with a DLCT scanner. Conventional true non-contrast (TNC) images were reconstructed for CAC quantification (CACTNC). Post-contrast spectral datasets were processed to generate VNC reconstructions, and a 130 HU threshold was applied to calculate the volume of coronary calcified plaques (VOLVNC). CAC values from VNC images (CACVNC) were derived through linear regression analysis. Correlation and agreement between CAC measurement methods were assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Patients were assigned to risk categories according to Coronary Artery Calcium Data and Reporting System (CAC-DRS) to evaluate potential misclassifications.
RESULTS: The median CACTNC was 95 Agatston Unit (AU) [IQR:1-309], while the median CACVNC was 76 AU [IQR:0-340], with no statistically significant difference between the two methods (p = 0.653). An excellent correlation was found between CACTNC and CACVNC (ICC = 0.977), with good agreement demonstrated by Bland-Altman analysis, showing a mean difference of - 1.2 AU. CACVNC led to misclassification in 16% of patients, primarily underestimating the CAC-DRS risk category, yet maintaining strong agreement with CACTNC derived risk stratification.
CONCLUSIONS: VNC reconstructions from DLCT show excellent correlation and good agreement with conventional TNC images for CAC quantification. This approach has the potential to eliminate the need for a dedicated unenhanced scan, thereby reducing radiation exposure, and acquisition time while preserving diagnostic accuracy.
引用
- Lanzafame LRM, Ascenti G, Mazziotti S, et al. Quantification of coronary artery calcium using virtual non-contrast images derived from dual-layer spectral CT. Radiol Med. 2026. PMID: 42201643. doi:10.1007/s11547-026-02224-x
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。