Keberle Marc, Tschammler Alexander, Hahn Dietbert
Department of Radiology, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany.
Radiology. 2002 Jul;224(1):171-6. doi: 10.1148/radiol.2241010894.
To evaluate different contrast material volumes, flow rates, and start delays for contrast material enhancement of neck structures and squamous cell carcinoma to determine the most effective examination protocol.
Seventy patients with squamous cell carcinoma were prospectively randomized into four groups for examination with different protocols (125 mL of contrast material administered at a flow rate of 2.5 mL/sec, 100 mL at 2.0 mL/sec, 90 mL at 1.5 mL/sec, or 70 mL at 1.0 mL/sec). Dynamic series were performed on the tumors and relevant anatomic structures to obtain time-attenuation curves. The protocols were compared (analysis of variance and Tukey-Kramer tests) with regard to time and level of maximum tumor enhancement and carotid arterial enhancement of more than 150 HU. One selected protocol was tested in 30 additional routine examinations with start delays of 40 seconds (for laryngeal and/or hypopharyngeal tumors, 3-mm collimation) and 45 seconds (for oropharyngeal tumors, 5-mm collimation).
Except for the 70-mL bolus administered at 1.0 mL/sec, the other protocols performed similarly well, yielding comparable maximum tumor enhancement at 52 seconds and later. In spite of a smaller volume of 90 mL, due to the prolonged flow time at 1.5 mL/sec, carotid arterial enhancement of more than 150 HU was prolonged (when compared with that in 100- or 125-mL protocols). As a result of these circumstances, injection of 90 mL at 1.5 mL/sec was considered more effective, providing no significant differences in tumor (P =.39) or carotid arterial (P =.52) enhancement between routine examinations and dynamic series.
A single bolus of 90 mL administered at 1.5 mL/sec appears to be the most desirable protocol for contrast enhancement.
评估不同的对比剂用量、流速和开始延迟时间对颈部结构及鳞状细胞癌的对比增强效果，以确定最有效的检查方案。
70例鳞状细胞癌患者被前瞻性随机分为四组，采用不同方案进行检查（分别以2.5 mL/秒的流速注入125 mL对比剂、以2.0 mL/秒的流速注入100 mL、以1.5 mL/秒的流速注入90 mL或以1.0 mL/秒的流速注入70 mL）。对肿瘤及相关解剖结构进行动态扫描，以获得时间-密度曲线。比较各方案在肿瘤最大强化时间和强化程度以及颈动脉强化超过150 HU方面的差异（采用方差分析和Tukey-Kramer检验）。在另外30例常规检查中对一种选定方案进行测试，开始延迟时间分别为40秒（用于喉和/或下咽肿瘤，准直3 mm）和45秒（用于口咽肿瘤，准直5 mm）。
除了以1.0 mL/秒的流速注入70 mL团注外，其他方案的效果相似，在52秒及以后肿瘤最大强化程度相当。尽管90 mL的用量较小，但由于1.5 mL/秒的流速使流动时间延长，颈动脉强化超过150 HU的时间也延长（与100 mL或125 mL方案相比）。基于这些情况，认为以1.5 mL/秒的流速注入90 mL更有效，在常规检查和动态扫描之间，肿瘤（P = 0.39）或颈动脉（P = 0.52）强化方面无显著差异。
以1.5 mL/秒的流速注入90 mL的单次团注似乎是最理想的对比增强方案。
