颈内动脉血流导向装置置入后不同稀释浓度等渗对比剂对高分辨C型臂CT图像影响的实验研究  

Experimental study on the effect of different dilution concentrations of isotonic contrast agents on high-resolution C-arm CT images after implantation of internal carotid artery blood flow diversion device

作　　者：李腾飞[1] 余笋 马骥[1] 时程程 冉云彩[2] 桑海强[3] 程敬亮[2] 韩新巍[1] Li Tengfei;Yu Sun;Ma Ji;Shi Chengcheng;Ran Yuncai;Sang Haiqiang;Cheng Jingliang;Han Xinwei(Department of Radiology and Interventional Medicine,the First Affiliated Hospital of Zhengzhou University,Institute of Interventional Therapy,Zhengzhou University,Zhengzhou 450052,China;Department of Magnetic Resonance Imaging,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Cardiovascular Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射介入科,郑州大学介入治疗研究所,郑州450052 [2]郑州大学第一附属医院磁共振科,郑州450052 [3]郑州大学第一附属医院心内科,郑州450052

出　　处：《中华神经外科杂志》2023年第8期834-839,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81801806);河南省医学科技攻关计划省部共建青年项目(KYDZ2020120441);河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2022029)。

摘　　要：目的探讨在巴马小型猪颈内动脉置入Tubridge血流导向装置(FD)后,给予不同稀释浓度的等渗对比剂对高分辨C型臂CT扫描图像质量的影响。方法纳入9头3~4个月龄健康实验猪,分别在左侧颈总动脉内置入FD。对FD置入区域行高分辨C型臂CT扫描的同时,每头实验猪依次经动脉注射以生理盐水稀释为10%、12%、14%,16%及18%浓度的等渗对比剂(碘克沙醇320),每次总量为44ml。由1名神经影像科医生和1名神经介人医生分别对后处理图像的质量(支架、血管壁和血管的显影情况)进行评价并给予评分(1~3分,评分越低图像质量越好)。以血管内超声(IVUS)为标准,评估给予不同稀释浓度的对比剂获得的重建图像显示FD贴壁的准确性。观察手术相关并发症的发生情况。结果9头实验猪均成功置人FD。2名医生对后处理图像质量的评估结果具有较好的一致性(Kappa值为0.76,P<0.05)。给予稀释10%、12%、14%,16%及18%等渗对比剂进行高分辨C型臂CT扫描后图像质量评分分别为(2.33±0.50)分、(2.06±0.39)分、(1.72±0.57)分、(1.11±0.32)分、(1.83±0.50)分(P<0.01);分别有4、6、8、9及7头实验猪能清晰显示FD的贴壁情况,IVUS证实9头实验猪的9枚FD均完全贴壁。术中3头实验猪给予对比剂时出现血管中度痉挛,给予肝素后好转。术后均未观察到穿刺点出血、血管夹层、血栓脱落等并发症。结论TubridgeFD置人后,给予16%稀释浓度的等渗对比剂进行高分辨C型臂CT扫描图像质量最优,均能清晰显示FD的贴壁情况。Objective To investigate the effect of isotonic contrast agents with different dilution concentrations on the image quality of high resolution C-arm CT after intracranial Tubridge flow-diverter(FD)implantation in the carotid artery of Bama mini-piglets(experimental pigs).Methods Nine healthy experimental pigs(3-4 months old)were enrolled and FD was implanted into the left carotid artery of each pig.During high-resolution C-arm CT scanning of the FD implantation area,isotonic contrast agents(iodixanol 320)with dilutions of 10%,12%,14%,16%,and 18%were sequentially injected into the arteries of each experimental pig at a rate of 2 ml/s for a total duration of 22 s and with a total volume of 44 ml.One radiological and one neuro-interventional physician evaluated the quality of the post-processing images(including the visualization of stent,vessel wall and blood vessels)and determined a qualitative score ranging from 1 to 3 points(with lower scores indicating better image quality).Intravascular ultrasound(IVUS)was used to validate the accuracy of FD wall apposition assessment using high-resolution C-arm CT reconstruction images obtained with different contrast agent dilution concentrations.The occurrence of surgery-related complications was observed.Results Nine experimental pigs were successfully implanted with FD,with a technical success rate of 100%.After high-resolution C-arm CT scans with contrast agents of dilutions of 10%,12%,14%,16%,and 18%,two physicians showed good consistency in the evaluation of the quality of the post-processing images(Kappa value:0.76,P<0.05).The image quality scores were 2.33±0.50,2.06±0.39,1.72±0.57,1.11±0.32 and 1.83±0.50 points respectively(P<0.01).Among them,4,6,8,9,and 7 experimental pigs showed clear display of the apposition of FD to the vessel wall,which was completely consistent with the IVUS evaluation.During the operation,moderate vascular spasm occurred in 3 experimental pigs after contrast agent administration,which improved after heparin administration.No complication

关 键 词：体层摄影术 X线计算机 颈内动脉 高分辨率 对比剂 血流导向装置 贴壁 巴马小型猪 

分 类 号：R816.2[医药卫生—放射医学]