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European Radiology

11-03-2024 | CT Angiography | Cardiac

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

Authors: Yao Pan, Yaqi Gao, Zhaoqian Wang, Yana Dou, Xixia Sun, Zhiqiang Yang, Shuang Pan, Chongfu Jia

Published in: European Radiology

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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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Metadata
Title
Effects of low-tube voltage coronary CT angiography on plaque and pericoronary fat assessment: intraindividual comparison
Authors
Yao Pan
Yaqi Gao
Zhaoqian Wang
Yana Dou
Xixia Sun
Zhiqiang Yang
Shuang Pan
Chongfu Jia
Publication date
11-03-2024
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-024-10648-0