基于钆的造影剂行肺循环多排螺旋CT血管造影：60例患者的前瞻性评估

Multi-detector row CT angiography of pulmonary circulation with gadolinium-based contrast agents: prospective evaluation in 60 patients.

作者信息

Remy-Jardin Martine, Bahepar Julbert, Lafitte Jean-Jacques, Dequiedt Philippe, Ertzbischoff Olivier, Bruzzi John, Delannoy-Deken Valérie, Duhamel Alain, Remy Jacques

机构信息

Departmentsof Radiology, Calmette Hospital, University Center of Lille, France.

出版信息

Radiology. 2006 Mar;238(3):1022-35. doi: 10.1148/radiol.2382042100.

DOI:10.1148/radiol.2382042100

PMID:16505397

Abstract

PURPOSE

To prospectively evaluate gadolinium dose safety and effectiveness for 16-detector pulmonary computed tomographic (CT) angiography.

MATERIALS AND METHODS

Ethics committee approval and informed consent were obtained. Sixty patients with contraindications to iodine underwent CT of the pulmonary circulation with 0.5 mmol/L gadolinium chelate given at either 0.3 (n = 29, group A) or 0.4 (n = 31, group B) mmol/kg; clinical and biologic tolerances were evaluated. Enhancement of central and segmental pulmonary arteries was measured (poor enhancement, <100 HU; good, 100-150 HU; excellent, >150 HU). Subsegmental artery enhancement was assessed as similar or inferior to that of segmental arteries. Confidence in analysis of the pulmonary arterial bed was graded according to arterial enhancement: Grades 1-3, diagnostic images; grade 4, nondiagnostic. The main effectiveness parameter for comparison between groups A and B was diagnostic value of CT angiograms. Nonparametric statistics were used to analyze results.

RESULTS

The mean (+/- standard deviation) contrast material volume was 50.09 mL +/- 8.45 (all patients: range, 30-64 mL; group A: 46.54 mL +/- 8.59; group B: 53.42 mL +/- 6.92). Diagnostic images were obtained in 55 (92%) patients, and confident analysis of pulmonary arteries to the subsegmental level was achieved in 26 (grade 1, 44%) and to the segmental level, in 21 (grade 2, 35%). Mean attenuation was higher in group B than in group A in central (180.61 HU +/- 53.85 vs 148.14 HU +/- 52.61; P = .04) and segmental (201.59 HU +/- 54.70 vs 164.73 HU +/- 59.26; P = .03) arteries. Number of diagnostic CT angiograms was higher (P = .02) in group B (n = 31 [100%]) than in group A (n = 24 [83%]). In both groups, mean enhancement of pulmonary arteries was significantly higher at 80 or 100 kV than at 120 kV. Renal function was impaired in two group A patients.

CONCLUSION

Gadolinium chelates may be used as an alternative CT contrast agent in patients who cannot receive iodine.

摘要

目的

前瞻性评估钆剂剂量在16排肺部计算机断层扫描（CT）血管造影中的安全性和有效性。

材料与方法

获得伦理委员会批准并取得知情同意。60例对碘造影剂有禁忌证的患者接受了肺循环CT检查，给予0.5 mmol/L钆螯合物，剂量分别为0.3 mmol/kg（n = 29，A组）或0.4 mmol/kg（n = 31，B组）；评估临床和生物学耐受性。测量中央和节段性肺动脉的强化程度（强化差，<100 HU；良好，100 - 150 HU；优秀，>150 HU）。亚段动脉强化程度评估为与节段动脉相似或低于节段动脉。根据动脉强化程度对肺动脉床分析的信心进行分级：1 - 3级为诊断性图像；4级为非诊断性。A组和B组之间比较的主要有效性参数是CT血管造影的诊断价值。采用非参数统计分析结果。

结果

平均（±标准差）对比剂用量为50.09 mL ± 8.45（所有患者：范围，30 - 64 mL；A组：46.54 mL ± 8.59；B组：53.42 mL ± 6.92）。55例（92%）患者获得诊断性图像，26例（1级，44%）患者对肺动脉亚段水平进行了可靠分析，21例（2级，35%）患者对节段水平进行了可靠分析。B组中央动脉（180.61 HU ± 53.85 vs 148.14 HU ± 52.61；P = .04）和节段动脉（201.59 HU ± 54.70 vs 164.73 HU ± 59.26；P = .03）的平均衰减高于A组。B组（n = 31 [100%]）诊断性CT血管造影的数量高于A组（n = 24 [83%]）（P = .02）。在两组中，80或100 kV时肺动脉的平均强化程度均显著高于120 kV时。A组有2例患者肾功能受损。