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Effects of low-tube voltage coronary CT angiography on plaque and pericoronary fat assessment: intraindividual comparison

  • Cardiac
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Abstract

Objectives

To investigate the effects of low tube voltage on coronary plaques and pericoronary fat assessment, and to compare their extent among various levels of low voltage.

Materials and methods

Patients were recommended for high-pitch low-tube voltage coronary computed tomography angiography (CCTA), and they were included if they had poor image quality and were referred to a conventional CCTA. The patients were classified into a low-voltage group (with 70-kV, 80-kV, and 90-kV subgroups) and a conventional group (100/120 kV). Their total plaque and subcomponent volumes and pericoronary fat attenuation index (FAI) were measured.

Results

A total of 1002 image slices (from 65 patients and 74 plaques) were included, including 21, 31, 13, 4, and 61 patients in the 70-kV, 80-kV, 90-kV, 100-kV, and 120-kV groups respectively. The CT values of noncalcified plaques in the conventional and low-voltage groups were 54.6 ± 21.3 HU and 31.5 ± 22.6 HU, respectively (p < 0.05). Compared with the conventional group, the necrotic core and calcification volume were increased, and the fibrolipid volume, periplaque, and right coronary artery FAI were decreased in the low-voltage group and its subgroups (p < 0.001). The magnitude of changes in fibrous and calcification volumes increased in the 70-kV subgroup compared with that in the 90-kV subgroup (p < 0.05).

Conclusion

Low tube voltages, particularly of 70 kV, have a significant effect on coronary plaque and FAI. The effect of low voltage on plaque composition is characterized by a polarization pattern, i.e., a decrease in fibrolipid (medium density) and an increase in necrotic core (low density) and calcification (high density).

Clinical relevance statement

Our results highlight the comparability and repeatability of plaque and pericoronary fat assessments facilitated by the same or a similar tube voltage. It is necessary to carry out studies on the specificity threshold of low tube voltage at each level.

Key Points

• Low tube voltage had a significant effect on coronary plaque and pericoronary fat, particularly 70 kV.

• The effect of low tube voltage on plaque composition shows the shift from medium-density mixed components to low- and high-density components.

• It is necessary to correct the specificity threshold or attenuation difference for low tube voltage at each level.

Graphical Abstract

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Abbreviations

BMI:

Body mass index

CCTA:

Coronary computed tomography angiography

CT:

Computed tomography

DLP:

Dose length product

ED:

Effective radiation dose

FAI:

Fat attenuation index

RCA-FAI:

Fat attenuation index of right coronary artery

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. The Department of Cardiovascular Radiology, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhong Shan Road, Dalian, Liaoning, 116011, China

    Yao Pan, Yaqi Gao, Zhaoqian Wang, Xixia Sun, Zhiqiang Yang, Shuang Pan & Chongfu Jia

  2. Siemens Healthineers Ltd, No. 7, Wangjing Zhonghuan South Road, Beijing, 100102, China

    Yana Dou

Authors
  1. Yao Pan
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  2. Yaqi Gao
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  3. Zhaoqian Wang
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  4. Yana Dou
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  5. Xixia Sun
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  6. Zhiqiang Yang
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  7. Shuang Pan
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  8. Chongfu Jia
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Corresponding author

Correspondence to Chongfu Jia.

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Guarantor

The scientific guarantor of this publication is Zhaoqian Wang.

Conflict of interest

Y.D. is an employee of Siemens Healthineers Ltd. The remaining authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

The approval from the Ethics Committee of the First Affiliated Hospital of Dalian Medical University was obtained.

Study subjects or cohorts overlap

None

Methodology

• prospective

• case-control study

• performed at one institution

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Zhaoqian Wang is a contributing author.

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Pan, Y., Gao, Y., Wang, Z. et al. Effects of low-tube voltage coronary CT angiography on plaque and pericoronary fat assessment: intraindividual comparison. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10648-0

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  • DOI: https://doi.org/10.1007/s00330-024-10648-0

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