深度学习重建辅助四低 Coronary CTA 在高 BMI 患者中的图像质量与诊断性能评估
前瞻性随机对照研究纳入 180 例 BMI≥25 kg/m² 患者，比较标准剂量与三低、四低 CCTA 方案；三低和四低组图像噪声更低，SNR、CNR 及主观图像质量优于标准组，四低组保持狭窄诊断性能，可有效降低辐射剂量和对比剂用量。
要点
- 高 BMI 患者采用 80 kVp 联合 DLIR-H 的三低/四低 CCTA 方案图像质量不劣于或优于标准方案。
- 四低方案在降低辐射剂量、对比剂用量、注射速率和碘浓度同时保持狭窄诊断性能。
- 日常阅片遇高 BMI 患者可关注低管电压联合深度学习重建方案的图像噪声与对比度表现。
核心结论
- 三低和四低 CCTA 方案在高 BMI 患者中图像质量和诊断准确性与标准剂量方案相当或更优，可作为减少辐射剂量和对比剂用量的有效替代方案。
研究设计与样本
- 前瞻性随机对照研究纳入 180 例 BMI≥25 kg/m² 的参与者，随机分为标准剂量组、三低组和四低组。
- 标准剂量组采用 100 kVp、ASIR-V 50% 重建、碘负荷 245 mgI/kg（Iohexol 350 mgI/mL）、注射时间 10 s。
- 三低组采用 80 kVp、DLIR-H 重建、碘负荷 128 mgI/kg（Iohexol 350 mgI/mL）、注射时间 7 s。
- 四低组采用 80 kVp、DLIR-H 重建、碘负荷 128 mgI/kg（Iodixanol 320 mgI/mL）、注射时间 7 s。
关键影像表现/征象
- 四低组和三低组图像噪声显著低于标准剂量组（均 p < 0.001）。
- 三低组和四低组 SNR、CNR 及主观图像质量优于标准剂量组（p < 0.05）。
诊断标准与关键数值
- 与标准剂量组相比，三低组辐射剂量降低 29.4%、对比剂用量降低 47.5%、注射速率降低 23.5%。
- 与标准剂量组相比，四低组辐射剂量降低 32.5%、对比剂用量降低 41.5%、注射速率降低 14.5%、对比剂浓度降低 9%。
- 四低组保持狭窄诊断性能（均 p > 0.05）。
临床应用与阅片要点
- 对高 BMI 患者行 CCTA 时，可考虑采用 80 kVp 联合 DLIR-H 的低剂量方案以降低辐射和对比剂用量。
- 四低方案使用较低碘浓度对比剂仍可维持诊断性能，阅片时注意结合 DLIR-H 图像特征评估狭窄。
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
RATIONALE AND OBJECTIVES: To examine the feasibility of a quadruple-low protocol in coronary computed tomography angiography (CCTA) assisted by the deep learning image reconstruction (DLIR) for participants with high body mass index (BMI).
MATERIALS AND METHODS: This prospective study involved 180 participants (BMI of ≥ 25 kg/m2). Participants were randomly assigned to three groups: the standard-dose (SD) group in 100 kVp with adaptive statistical iterative reconstruction (ASIR-V 50%) using contrast media (CM) administration at an iodine load of 245 mgI/kg (Iohexol, 350 mgI/mL) with a 10 s injection time; the experimental group underwent imaging with 80 kVp and DLIR-H, using an iodine load of 128 mgI/kg with a 7 s injection time, representing the triple-low (TL) with 350 mgI/mL Iohexol and quadruple-low (QL) groups with 320 mgI/mL Iodixanol. Quantitative image quality evaluations included vascular attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR), while qualitative image quality and diagnostic performance were also assessed.
RESULTS: Compared to the SD group, the TL group achieved reductions of 29.4% in radiation dose, 47.5% in CM volume, and 23.5% in CM injection rate, while the QL group achieved reductions of 32.5% in radiation dose, 41.5% in CM volume, 14.5% in CM injection rate, and 9% in CM concentration. The image noise in the QL and TL groups were significantly lower than in the SD group (all p < 0.001). Overall, the SNR, CNR, and qualitative image quality of the TL and QL groups were superior to those of the SD group (p < 0.05). The QL group maintained the stenosis diagnostic performance (all p > 0.05).
CONCLUSION: TL and QL CCTA protocols showed equivalent or superior image quality and diagnostic accuracy compared to the SD protocol and may serve as effective alternatives for reducing radiation dose and contrast media use in patients with high BMI.
引用
- Qi K, Li S, Wang L, et al. Assessing Image Quality and Diagnostic Performance of Quadruple-Low Coronary CT Angiography with Deep Learning in High-BMI Patients. Acad Radiol. 2026. PMID: 42218081. doi:10.1016/j.acra.2026.04.048
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。