ペースメーカ植込み患者における被ばく低減を考慮した冠動脈ＭＤＣＴの撮影法

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  • A New Acquisition Method with Pacemaker Resetting of Coronary Multidetector-row Computed Tomography for Reduction of Radiation Dose in Patients with Pacemaker
  • ペースメーカ ウエコミ カンジャ ニ オケル ヒバクテイゲン オ コウリョ シタ カンドウミャク MDCT ノ サツエイホウ

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We proposed a new acquisition method of coronary MDCT achieved by pacing rate resetting and/or propranolol or verapamil injection in patients with a pacemaker. Coronary MDCT was undertaken in 57 patients with a pacemaker (DDD: 51, VVI: 6) and in 2975 patients with sinus rhythm as control using Aquilion 64 (Toshiba). Pacing rate was reset to 60 beats per minute (bpm) in DDD, and spontaneous beats were suppressed by propranolol injection. Pacing rate was reset to 70 bpm in atrial fibrillation with VVI, and spontaneous beats were suppressed by verapamil injection. Coronary MDCT was undertaken using as high a beam pitch (BP) as possible. When spontaneous beats were not suppressed, we selected the optimal gantry speed and BP to get the highest temporal resolution. Image quality makes no significant difference between pacemaker and sinus rhythm. When spontaneous beats were completely suppressed (all pacing), mean radiation dose and acquisition time, respectively, decreased by 33.0% and 35.2% in DDD compared with the method recommended by Heart Navi (by Toshiba), and they decreased by 38.1% and 25.9%, respectively, in VVI compared with the method recommended by Heart Navi. We could not estimate coronary stenosis in the proximal right coronary artery by lead artifacts in 30% of DDD pacemakers. In conclusion, the new method is useful for not only reducing radiation dose and acquisition time, but also for maintaining image quality in patients with a pacemaker.

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