单心动周期冠脉CTA的个体化三期扫描造影剂注射方案研究
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摘要
目的探讨个体化三期注射造影的方案在单心动周期成像的冠状动脉CT血管造影(CCTA)中的作用。方法前瞻性收集2018年3～8月首都医科大学附属北京友谊医院收治的106例行CCTA扫描的患者,将患者按照随机数字表法分为两组:A组(n=54)患者采用个体化三期造影剂注射方案,患者总碘量根据患者体重进行计算为体重(kg)×0. 21 g I/kg+2. 1 g I; B组(n=52)患者采用固定剂量的碘造影剂的造影剂注射方案,患者总碘量固定为17. 5 g I。对重建图像的冠脉血管和心脏解剖结构分别进行客观和主观评价。结果 A组患者的平均碘量为16. 48±2. 43 g I低于B组患者的平均碘量17. 5±0. 00gI(P <0. 05)。对于右心室的显影,A组中52例(96. 3%)的造影剂强化程度> 140HU,均达到对右心解剖结构的诊断需要; B组中3例(5. 8%)强化程度> 140 HU,右心解剖结构达到诊断要求的占28. 8%。对于冠脉血管的CT值,A组明显低于B组,两组在主观评价结果方面差异无统计学意义(P> 0. 05)。A组患者高体重(≥75 kg)和中低体重(<75 kg)之间各个解剖结构的造影剂强化差异无统计学意义(P> 0. 05),B组患者差异具有统计学意义(P <0. 05)。结论在单心动周期的冠脉CTA中个体化三期造影剂注射方案较传统固定剂量双期注射方案对冠脉血管的强化更为稳定,能够更好地显示右心系统的解剖结构,同时造影剂整体用量更低。
Objective To explore the effect of individualized split-bolus of contrast medium( CM) injection protocol in one-beat coronary CT angiography( CCTA) examination. Methods A total of 106 patients referred to undergo CCTA examination in this hospital during March to August in 2018 were prospectively enrolled and they were randomly divided into two groups. Patients in group A( n = 54) received an individualized split-bolus of CM injection protocol. The iodine dosage was calculated according to the weight of patients,that is the weight of patients( kg) × 0. 21 g I/kg + 2. 1 g I. Patients in group B( n = 52) received injection with fixed CM dosage( 17. 5 g I). Objective and subjective evaluation of coronary artery and cardiac anatomical structure in reconstructed images was performed. Results The average CM dosage in group A is lower than that of group B( 16. 48 ± 2. 43 g I vs. 17. 5 ± 0. 00 g I,P < 0. 05). In group A,52 cases( 96. 3%) achieved a satisfactory enhancement in right ventricle( CT value was greater than 140 HU) and the visualization of right ventricle fulfilled the diagnostic requirement. In group B,3( 5. 8%) patients achieved 140 HU enhancement and 15 cases( 28. 8%) fulfill the diagnostic requirement. As to the enhancement of coronary arteries,CT value in group A was significantly lower than that of group B( P < 0. 05). There was no significant difference in subjective scoring between these two groups( P > 0. 05). In group A,there was no significant difference in enhancement of main cardiac anatomical structure between patients with high body weight( ≥75 kg) and low body weight( < 75 kg)( P > 0. 05). In group B,the difference between high and low body weight patients was significant( P < 0. 05). Conclusion In one-beat CCTA,comparing with the traditional injection protocol with fixed CM dosage,individualized spit-bolus CM injection protocol can achieve a more efficient use of contrast agency,more stable coronary artery enhancement and better visualization of right ventricles.
Objective To explore the effect of individualized split-bolus of contrast medium( CM) injection protocol in one-beat coronary CT angiography( CCTA) examination. Methods A total of 106 patients referred to undergo CCTA examination in this hospital during March to August in 2018 were prospectively enrolled and they were randomly divided into two groups. Patients in group A( n = 54) received an individualized split-bolus of CM injection protocol. The iodine dosage was calculated according to the weight of patients,that is the weight of patients( kg) × 0. 21 g I/kg + 2. 1 g I. Patients in group B( n = 52) received injection with fixed CM dosage( 17. 5 g I). Objective and subjective evaluation of coronary artery and cardiac anatomical structure in reconstructed images was performed. Results The average CM dosage in group A is lower than that of group B( 16. 48 ± 2. 43 g I vs. 17. 5 ± 0. 00 g I,P < 0. 05). In group A,52 cases( 96. 3%) achieved a satisfactory enhancement in right ventricle( CT value was greater than 140 HU) and the visualization of right ventricle fulfilled the diagnostic requirement. In group B,3( 5. 8%) patients achieved 140 HU enhancement and 15 cases( 28. 8%) fulfill the diagnostic requirement. As to the enhancement of coronary arteries,CT value in group A was significantly lower than that of group B( P < 0. 05). There was no significant difference in subjective scoring between these two groups( P > 0. 05). In group A,there was no significant difference in enhancement of main cardiac anatomical structure between patients with high body weight( ≥75 kg) and low body weight( < 75 kg)( P > 0. 05). In group B,the difference between high and low body weight patients was significant( P < 0. 05). Conclusion In one-beat CCTA,comparing with the traditional injection protocol with fixed CM dosage,individualized spit-bolus CM injection protocol can achieve a more efficient use of contrast agency,more stable coronary artery enhancement and better visualization of right ventricles.
引文
[1]Moss AJ,Newby DE.CT coronary angiographic evaluation of suspected anginal chest pain[J].Heart,2016,102(4):263-268.
[2]Ellis C,Gamble G,Edwards C,et al.The value of CT cardiac angiography and CT calcium score testing in a modern cardiology service in New Zealand:a report of a single centre eight-year experience from 5,237 outpatient procedures[J].N Z Med J,2016,129(1446):22-32.
[3]Andreini D,Pontone G,Mushtaq S,et al.Atrial Fibrillation:Diagnostic Accuracy of Coronary CT Angiography Performed with a WholeHeart 230-μm Spatial Resolution CT Scanner[J].Radiology,2017,284(3):676-684.
[4]Liu Z,Sun Y,Zhang Z,et al.Feasibility of Free-breathing CCTA using 256-MDCT[J].Medicine(Baltimore),2016,95(27):e4096.
[5]Bae KT.Intravenous contrast medium administration and scan timing at CT:considerations and approaches[J].Radiology,2010,256(1):32-61.
[6]Behrendt FF,Bruners P,Keil S,et al.Effect of different saline chaser volumes and flow rates on intravascular contrast enhancement in CT using a circulation phantom[J].Eur J Radiol,2010,73(3):688-693.
[7]Schindera ST,Nelson RC,Howle L,et al.Effect of varying injection rates of a saline chaser on aortic enhancement in CT angiography:phantom study[J].Eur Radiol,2008,18(8):1683-1689.
[8]鲁锦国,吕滨,邱金海,等.64层螺旋CT冠状动脉血管成像不同对比剂注射方案应用的研究[J].中华放射学杂志,2008,42(6):586-591.
[9]Cochet H,Denis A,Komatsu Y,et al.Automated Quantification of Right Ventricular Fat at Contrast-enhanced Cardiac Multidetector CTin Arrhythmogenic Right Ventricular Cardiomyopathy[J].Radiology,2015,275(3):683-691.
[10]Takx RA,Moscariello A,Schoepf UJ,et al.Quantification of left and right ventricular function and myocardial mass:comparison of low-radiation dose 2nd generation dual-source CT and cardiac MRI[J].Eur J Radiol,2012,81(4):e598-604.
[11]Aghayev A,Murphy DJ,Keraliya AR,et al.Recent developments in the use of computed tomography scanners in coronary artery imaging[J].Expert Rev Med Devices,2016,13(6):545-553.
[12]Oda S,Utsunomiya D,Yuki H,et al.Low contrast and radiation dose coronary CT angiography using a 320-row system and a refined contrast injection and timing method[J].J Cardiovasc Comput Tomogr,2015,9(1):19-27.
[13]Kok M,Kietselaer BL,Mihl C,et al.Contrast Enhancement of the Right Ventricle during Coronary CT Angiography-Is It Necessary[J]?PLo S One,2015,10(6):e0128625.
[14]Lee AM,Beaudoin J,Engel LC,et al.Assessment of image quality and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography(c CTA)with arrhythmia rejection algorithm in systole versus diastole:a retrospective cohort study[J].Int J Cardiovasc Imaging,2013,29(6):1361-1370.
[15]Leipsic J,Labounty TM,Hague CJ,et al.Effect of a novel vendorspecific motion-correction algorithm on image quality and diagnostic accuracy in persons undergoing coronary CT angiography without ratecontrol medications[J].J Cardiovasc Comput Tomogr,2012,6(3):164-171.
[16]Sun G,Hou YB,Zhang B,et al.Application of low tube voltage coronary CT angiography with low-dose iodine contrast agent in patients with a BMI of 26-30 kg/m2[J].Clin Radiol,2014,70(2):138-145.
[17]Kondo M,Nagao M,Yonezawa M,et al.Improvement of automated right ventricular segmentation using dual-bolus contrast media injection with 256-slice coronary CT angiography[J].Acad Radiol,2014,21(5):648-653.
[2]Ellis C,Gamble G,Edwards C,et al.The value of CT cardiac angiography and CT calcium score testing in a modern cardiology service in New Zealand:a report of a single centre eight-year experience from 5,237 outpatient procedures[J].N Z Med J,2016,129(1446):22-32.
[3]Andreini D,Pontone G,Mushtaq S,et al.Atrial Fibrillation:Diagnostic Accuracy of Coronary CT Angiography Performed with a WholeHeart 230-μm Spatial Resolution CT Scanner[J].Radiology,2017,284(3):676-684.
[4]Liu Z,Sun Y,Zhang Z,et al.Feasibility of Free-breathing CCTA using 256-MDCT[J].Medicine(Baltimore),2016,95(27):e4096.
[5]Bae KT.Intravenous contrast medium administration and scan timing at CT:considerations and approaches[J].Radiology,2010,256(1):32-61.
[6]Behrendt FF,Bruners P,Keil S,et al.Effect of different saline chaser volumes and flow rates on intravascular contrast enhancement in CT using a circulation phantom[J].Eur J Radiol,2010,73(3):688-693.
[7]Schindera ST,Nelson RC,Howle L,et al.Effect of varying injection rates of a saline chaser on aortic enhancement in CT angiography:phantom study[J].Eur Radiol,2008,18(8):1683-1689.
[8]鲁锦国,吕滨,邱金海,等.64层螺旋CT冠状动脉血管成像不同对比剂注射方案应用的研究[J].中华放射学杂志,2008,42(6):586-591.
[9]Cochet H,Denis A,Komatsu Y,et al.Automated Quantification of Right Ventricular Fat at Contrast-enhanced Cardiac Multidetector CTin Arrhythmogenic Right Ventricular Cardiomyopathy[J].Radiology,2015,275(3):683-691.
[10]Takx RA,Moscariello A,Schoepf UJ,et al.Quantification of left and right ventricular function and myocardial mass:comparison of low-radiation dose 2nd generation dual-source CT and cardiac MRI[J].Eur J Radiol,2012,81(4):e598-604.
[11]Aghayev A,Murphy DJ,Keraliya AR,et al.Recent developments in the use of computed tomography scanners in coronary artery imaging[J].Expert Rev Med Devices,2016,13(6):545-553.
[12]Oda S,Utsunomiya D,Yuki H,et al.Low contrast and radiation dose coronary CT angiography using a 320-row system and a refined contrast injection and timing method[J].J Cardiovasc Comput Tomogr,2015,9(1):19-27.
[13]Kok M,Kietselaer BL,Mihl C,et al.Contrast Enhancement of the Right Ventricle during Coronary CT Angiography-Is It Necessary[J]?PLo S One,2015,10(6):e0128625.
[14]Lee AM,Beaudoin J,Engel LC,et al.Assessment of image quality and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography(c CTA)with arrhythmia rejection algorithm in systole versus diastole:a retrospective cohort study[J].Int J Cardiovasc Imaging,2013,29(6):1361-1370.
[15]Leipsic J,Labounty TM,Hague CJ,et al.Effect of a novel vendorspecific motion-correction algorithm on image quality and diagnostic accuracy in persons undergoing coronary CT angiography without ratecontrol medications[J].J Cardiovasc Comput Tomogr,2012,6(3):164-171.
[16]Sun G,Hou YB,Zhang B,et al.Application of low tube voltage coronary CT angiography with low-dose iodine contrast agent in patients with a BMI of 26-30 kg/m2[J].Clin Radiol,2014,70(2):138-145.
[17]Kondo M,Nagao M,Yonezawa M,et al.Improvement of automated right ventricular segmentation using dual-bolus contrast media injection with 256-slice coronary CT angiography[J].Acad Radiol,2014,21(5):648-653.