低对比剂注射方案在320排CT冠状动脉成像中的研究
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摘要
目的:探讨320排CT冠状动脉成像使用39 mL低对比剂注射的可行性。方法:连续收集行320排CT冠状动脉成像检查的患者100例(男性52例,女48例),将患者随机分为低对比剂组、对照组,每组50例。低对比剂组采用三时相共39 mL对比剂的注射方案,对照组采用两时相共50 mL对比剂的注射方案。测量并比较主要血管CT值及信噪比、对比噪声比,由两位诊断经验丰富的医生对冠状动脉进行评价和分析。结果:两组患者性别比、年龄、体重、BMI、曝光时平均心率、主动脉根部噪声、SNR、上腔静脉、CNRRCA1和CNRLM比较,差异均无统计学意义(P> 0.05);两组患者主动脉根部、右心房、右心室、RCA1、LM、心室壁CT值比较,差异有统计学意义(P <0.05)。1217个冠状动脉节段中,94.91%(1155/1217)的节段能够满足诊断的图像质量要求。低对比剂组、对照组图像质量可诊断率分别为95.4%(555/582)、94.5%(600/635),差异无统计学意义(P> 0.05)。结论:320排CT冠状动脉血管成像在采用三时相注射方案时,使用小剂量的39 mL对比剂成像检查具有可行性,能以较低的对比剂量获得诊断所需图像质量。
Objective: To investigate the feasibility of 39 mL low contrast agent injection adopted for 320-row CT coronary artery imaging. Methods: Sampling among 100 patients(52 males and 48 females) with 320-slice CT coronary angiography for consistent data collection. The patients were randomly divided into low contrast group and control group with 50 patients respectively. The low-contrast agent group adopts three-phase injection protocol with 39 m L contrast agent in total, while the control group receives 50 m L contrast agent injection protocol for two phases. Measure and compare CT values of main blood vessels, signal-to-noise ratios and contrast-to-noise ratios. Then the coronary arteries are evaluated and analyzed by two experienced doctors. Results:There is no statistical difference reflected from gender ratio, age, weight, BMI, average heart rate during exposure,aortic root noise, SNR, superior vena cava, CNRRCA1, and CNRLM between the two groups(P > 0.05). Meanwhile,the comparison of CT values of arterial root, right atrium, right ventricle, RCA1, LM, and ventricular wall of the two groups reveals a statistical difference(P < 0.05). Among 1217 coronary segments, 94.91%(1155/1217)segments meet the diagnostic image quality requirement. The image quality acceptability rates of the low contrast group and the control group were 95.4%(555/582) and 94.5%(600/635) respectively, which reflects few statistical difference(P > 0.05). Conclusion: It's feasible to use a small-dose(39 m L) contrast agent injection in320-slice CT coronary angiography with three-phase injection protocol, which is able to form qualified diagnosis images with less contrast agent injection.
Objective: To investigate the feasibility of 39 mL low contrast agent injection adopted for 320-row CT coronary artery imaging. Methods: Sampling among 100 patients(52 males and 48 females) with 320-slice CT coronary angiography for consistent data collection. The patients were randomly divided into low contrast group and control group with 50 patients respectively. The low-contrast agent group adopts three-phase injection protocol with 39 m L contrast agent in total, while the control group receives 50 m L contrast agent injection protocol for two phases. Measure and compare CT values of main blood vessels, signal-to-noise ratios and contrast-to-noise ratios. Then the coronary arteries are evaluated and analyzed by two experienced doctors. Results:There is no statistical difference reflected from gender ratio, age, weight, BMI, average heart rate during exposure,aortic root noise, SNR, superior vena cava, CNRRCA1, and CNRLM between the two groups(P > 0.05). Meanwhile,the comparison of CT values of arterial root, right atrium, right ventricle, RCA1, LM, and ventricular wall of the two groups reveals a statistical difference(P < 0.05). Among 1217 coronary segments, 94.91%(1155/1217)segments meet the diagnostic image quality requirement. The image quality acceptability rates of the low contrast group and the control group were 95.4%(555/582) and 94.5%(600/635) respectively, which reflects few statistical difference(P > 0.05). Conclusion: It's feasible to use a small-dose(39 m L) contrast agent injection in320-slice CT coronary angiography with three-phase injection protocol, which is able to form qualified diagnosis images with less contrast agent injection.
引文
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[15]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.Lu JG, Lu B, Qiu JH, et al. Application of different contrast agent injection protocols in64-slice spiral CT coronary angiography[J]. Chinese Journal of Radiology, 2008, 42(6):586-591.(in Chinese).
[16] Hein PA, May J, Rogalla P, et al. Feasibility of contrast material volume reduction in coronary artery imaging using 320-slice volume CT[J]. European Radiology, 2010, 20(6):1337-1343.
[17]杨文才,骆春柳,冼朝晖,等. 320排冠脉CT成像中根据体重调整的对比剂最低用量的可行性研究[J].影像诊断与介入放射学, 2014,(1):16-21.Yang WC, Luo CL, Xian ZH, et al. Feasibility study of the lowest dosage of contrast agent adjusted by weight in 320-row coronary CT imaging[J]. Imaging Diagnosis and Interventional Radiology, 2014,(1):16-21.(in Chinese).
[18] Zhu X, Zhu Y, Xu H, et al. The influence of body mass index and gender on coronary arterial attenuation with fixed iodine load per body weight at dual-source CT coronary angiography[J].Acta Radiologica, 2012, 53(6):637-640.
[2]闫亮亮,杨学华,张永高,等. 270碘对比剂结合低管电压及SAFIRE技术在冠状动脉血管成像中的应用[J].实用放射学杂志, 2014, 30(1):143-146, 175.Yan LL, Yang XH, Zhang YG, et al. Application of 270 iodine contrast media combined with low voltage and SAFIRE technique in coronary artery angiography[J]. Journal of Practical Radiology, 2014, 30(1):143-146, 175.(in Chinese).
[3]邓琦,罗泽斌,夏俊.低辐射、低对比剂CT血管成像技术的临床应用现状[J].实用放射学杂志,2014, 30(5):872-874, 982.Deng Q, Luo ZB, Xia J. Current status of clinical application of low-radiation, low-contrast CT angiography[J]. Journal of Practical Radiology, 2014, 30(5):872-874, 982.(in Chinese).
[4]孙凯,韩瑞娟,马利军,等.大螺距双源CT前瞻性心电门控扫描评价冠状动脉狭窄的临床研究[J].中华放射学杂志, 2012, 46(1):49-53.Sun K, Han RJ, Ma LJ, et al. Clinical study of prospective electrocardiographic gating scanning with large-pitch dual-source CT in the evaluation of coronary artery stenosis[J].Chinese Journal of Radiology, 2012, 46(1):49-53.(in Chinese).
[5]侯阳,于兵,郭启勇,等.迭代重建对前置门控冠状动脉CT图像质量及辐射剂量的影响[J].中华放射学杂志, 2013, 47(4):305-309.Hou Y, Yu B, Guo QY, et al. Influence of iterative reconstruction on image quality and radiation dose of pre-gated coronary artery CT[J]. Chinese Journal of Radiology, 2013, 47(4):305-309.(in Chinese).
[6] Supplements ER. Basics of cardiac MDCT:Techniques and contrast application[J]. European Radiology, 2005, 15(2):B2-B9.
[7]潘昌杰,王涛,钱农,等.等渗低浓度对比剂冠状动脉CT低剂量成像的初步研究[J].中华放射学杂志, 2014, 48(10):800-804.Pan CJ, Wang T, Qian N, et al. Preliminary study on low-dose imaging of coronary artery CT using isotonic low-concentration contrast media[J]. Chinese Journal of Radiology, 2014,48(10):800-804.(in Chinese).
[8]顾玲玲,刘士远,于红,等.先天性冠状动脉变异的256层螺旋CT诊断[J].实用放射学杂志, 2013,29(8):1234-1237.Gu LL, Liu SY, Yu H, et al. Diagnosis of congenital coronary artery variability with 256-slice spiral CT[J]. Journal of Practical Radiology, 2013, 29(8):1234-1237.(in Chinese).
[9] Mcdonald RJ, Mcdonald JS, Bida JP, et al. Intravenous contrast material-induced nephropathy:Causal or coincident phenomenon[J]. Radiology, 2013, 267(1):106-118.
[10] Mcdonald JS, Mcdonald RJ, Carter RE, et al. Risk of intravenous contrast material-mediated acute kidney injury:A propensity score-matched study stratified by baseline-estimated glomerular filtration rate[J]. Radiology, 2014, 271(1):65-67.
[11] Tomizawa N, Yamamoto K, Akahane M, et al. The feasibility of halfcycle reconstruction in high heart rates in coronary CT angiography using 320-row CT[J]. International Journal of Cardiovascular Imaging, 2013, 29(4):907-910.
[12] Tomizawa N, Komatsu S, Akahane M, et al. Influence of hemodynamic parameters on coronary artery attenuation with 320-detector coronary CT angiography[J]. European Journal of Radiology, 2012, 81(2):230-233.
[13] Kang EJ, Lee J, Lee KN, et al. An initial randomised study assessing free-breathing CCTA using 320-detector CT[J]. European Radiology, 2013, 23(5):1199-1209.
[14] Pflederer T, Jakstat J, Marwan M, et al. Radiation exposure and image quality in staged low-dose protocols for coronary dual-source CT angiography:A randomized comparison[J].European Radiology, 2010, 20(5):1197-1206.
[15]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.Lu JG, Lu B, Qiu JH, et al. Application of different contrast agent injection protocols in64-slice spiral CT coronary angiography[J]. Chinese Journal of Radiology, 2008, 42(6):586-591.(in Chinese).
[16] Hein PA, May J, Rogalla P, et al. Feasibility of contrast material volume reduction in coronary artery imaging using 320-slice volume CT[J]. European Radiology, 2010, 20(6):1337-1343.
[17]杨文才,骆春柳,冼朝晖,等. 320排冠脉CT成像中根据体重调整的对比剂最低用量的可行性研究[J].影像诊断与介入放射学, 2014,(1):16-21.Yang WC, Luo CL, Xian ZH, et al. Feasibility study of the lowest dosage of contrast agent adjusted by weight in 320-row coronary CT imaging[J]. Imaging Diagnosis and Interventional Radiology, 2014,(1):16-21.(in Chinese).
[18] Zhu X, Zhu Y, Xu H, et al. The influence of body mass index and gender on coronary arterial attenuation with fixed iodine load per body weight at dual-source CT coronary angiography[J].Acta Radiologica, 2012, 53(6):637-640.