Stückle C A, Kickuth R, Kirchner E M, Liermann D, Kirchner J
Klinik für Diagnostische Radiologie und Nuklearmedizin, Marienhospital Herne, Universitätsklinik.
Radiologe. 2002 Jun;42(6):480-4. doi: 10.1007/s00117-001-0712-z.
Recently bolus tracking systems were developed to improve the timing of intravenous contrast media application in helical computed tomography. We investigated the benefit of this new method as a parameter of the cardiac function.
Retrospective analysis of 64 patients which incidentally underwent bolus triggered contrast enhanced helical CT and invasive investigation of the heart within one week. All examinations were performed on the CT scanner Somatom Plus 4 Volume Zoom (Siemens Corp., Forchheim, Germany) using the C.A.R.E. Bolus software. This performs repetitive low-dose test scans (e.g. for the abdomen: 140 kV, 20 mA, Tl 0.5 s) and measures the Hounsfield attenuation (increase over the baseline) in a preselected region of interest. The displayed increase of vascular density over the time after peripheral contrast media injection (75 ml lopromid (300 mg/ml), 2 ml/s) was categorised to three types: (a) rapid increase, (b) deceleration before a 100 HE threshold was reached and (c) one or more peaks. The findings of the invasive investigation of the heart were correlated to the findings of the bolus-tracking measurements.
The examinations were categorized as follows: 19 type A, 34 type B, 11 type C. We found a high significant correlation between the type of the Hounsfield attenuation and systolic pressure in the left ventricle. There was no correlation between the type of the Hounsfield attenuation and the diastolic pressure in the left ventricle, the pressures related to the right ventricle or the ejection fraction. The bolus-tacking system showed a sensitivity of 53, a specificity of 82, an accuracy of 70%, a positive predictive value of 70% and a negative predictive value of 70% in detection of left heart failure.
The bolus tracking system C.A.R.E.-bolus often shows atypical Hounsfield attenuation in cases of cardiac failure but is not suitable as a screening method of the cardiopulmonary function.
最近开发了团注追踪系统，以改善螺旋计算机断层扫描中静脉注射造影剂的时机。我们研究了这种新方法作为心功能参数的益处。
回顾性分析64例患者，这些患者在一周内偶然接受了团注触发的对比增强螺旋CT检查及心脏侵入性检查。所有检查均在Somatom Plus 4 Volume Zoom CT扫描仪（西门子公司，德国福希海姆）上使用C.A.R.E. Bolus软件进行。该软件进行重复的低剂量测试扫描（例如对于腹部：140 kV，20 mA，层厚0.5 s），并在预先选定的感兴趣区域测量亨氏衰减（相对于基线的增加）。外周注射造影剂（75 ml碘普罗胺（300 mg/ml），2 ml/s）后，随时间显示的血管密度增加分为三种类型：（a）快速增加，（b）在达到100 HU阈值之前减速，（c）一个或多个峰值。心脏侵入性检查的结果与团注追踪测量的结果相关。
检查结果分类如下：19例为A类，34例为B类，11例为C类。我们发现亨氏衰减类型与左心室收缩压之间存在高度显著相关性。亨氏衰减类型与左心室舒张压、右心室相关压力或射血分数之间无相关性。在检测左心衰竭方面，团注追踪系统的敏感性为53，特异性为82，准确性为70%，阳性预测值为70%，阴性预测值为70%。
团注追踪系统C.A.R.E.-bolus在心力衰竭病例中常显示非典型的亨氏衰减，但不适合作为心肺功能的筛查方法。
