个体化对比剂双低注射方案单心动周期冠状动脉CT成像可行性  

Feasibility study of contrast injection scheme based on body mass and iodine flow rate in coronary computed tomography angiography with wide detector CT

作　　者：刘军波[1] 张计旺[1] 张晓浩[1] 周伟[1] 袁滨 范丽娟[1] Liu Junbo;Zhang Jiwang;Zhang Xiaohao;Zhou Wei;Yuan Bin;Fan Lijuan(TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院放射科,天津300457

出　　处：《中华医学杂志》2020年第43期3448-3452,共5页National Medical Journal of China

摘　　要：目的探讨100 kV下基于体重和碘流率的个体化对比剂注射方案单心动周期冠状动脉CT成像的可行性。方法前瞻性纳入2018年5至7月因临床疑似冠状动脉病变于泰达国际心血管病医院行冠状动脉CT造影(CCTA)检查者270例,随机数字法分为3组,每组各90例:A组对比剂总量0.5 ml/kg,B组对比剂总量0.6 ml/kg,A组和B组采用对比剂注射流速=(体重×25)/对比剂浓度;C组(常规方案组)对比剂总量0.8 ml/kg,对比剂流速5 ml/s。3组对比剂均使用碘海醇(含碘浓度350 mgI/ml)。比较3组图像主动脉根部CT值、前降支中段和右冠状动脉中段管腔CT值、主动脉根部信噪比(SNR)、对比噪声比(CNR)、标准差(SD)值、冠状动脉主观评分以及有效辐射剂量(ED)差异。结果A、B和C组3组图像质量客观指标(主动脉根部CT值、前降支中段和右冠状动脉中段CT值、主动脉根部SNR、CNR、SD值)和主观评分差异均无统计学意义(均P>0.05);3组对比剂流速差异有统计学意义[(4.5±0.5)ml/s比(4.5±0.5)ml/s比5 ml/s,P=0.015],其中A组和B组之间差异无统计学意义(P>0.05),但低于C组(P=0.015);3组对比剂总量差异有统计学意义[(32±3)ml/kg比(38±4)ml/kg比(53±7)ml/kg,P<0.001],A组<B组<C组;3组辐射剂量差异无统计学意义[(1.5±0.5)mSv比(1.5±0.6)mSv比(1.3±0.6)mSv,P=0.613)]。结论基于对比剂总量为0.5 ml/kg、对比剂流速为[(体重×25)/350]ml/s的个体化注射方案单心动周期CCTA成像在保证图像质量的同时,最大程度降低了对比剂总量,并实现了个体化碘流率。Objective To investigate the feasibility of coronary computed tomography angiography(CCTA)with the individualized contrast medium injection scheme based on body mass and iodine flow rate by using wide detector CT at 100 kV.Methods From May 2018 to July 2018,270 patients with clinically suspected coronary artery disease underwent CCTA in TEDA International Cardiovascular Hospital.They were randomly divided into three groups,90 cases in each group:group A was 0.5 ml/kg,group B was 0.6 ml/kg,the flow rate of contrast medium injection in group A and group B was(body mass×25 mg)/the concentration of contrast medium,group C was 0.8 ml/kg and the flow rate of contrast medium was 5 ml/s.Iohexol(iodine concentration 350 mgI/ml)was used in all three groups.The CT values of the aorta root in the three groups,the CT value of the middle segment of LAD and RCA,SNR、CNR、SD of the aortic root,subjective score of coronary artery and effective dose(ED)were compared.Results There was no significant difference in CT value of aortic root,CT value of middle LAD and RCA,SNR、CNR、SD of the aortic root,subjective score of coronary artery among group A,group B and group C(all P>0.05).The flow rates of the three groups of contrast agents were statistically different(4.5±0.5 vs 4.5±0.5 vs 5,P=0.015),and there was no statistical difference between group A and group B(P>0.05)but lower than group C(P=0.015);the amount of contrast agent in the three groups was statistically different(32±3 vs 38±4 vs 53±7,P<0.001),group A<B Group<C group;there was no significant difference in ED between the three groups(1.5±0.5 vs 1.5±0.6 vs 1.3±0.6,P=0.613).Conclusions CCTA imaging with a wide body detector based on a 0.5 ml/kg contrast agent dosage and a flow rate of((body mass×25)/350)ml/s individualized injection scheme can ensure the image quality while reducing the total amount of contrast agent and realizing individualized iodine flow rate.

关 键 词：体层摄影术 X线计算机 冠状动脉成像 辐射剂量 对比剂 流速 

分 类 号：R816.2[医药卫生—放射医学]