Remy-Jardin Martine, Bahepar Julbert, Lafitte Jean-Jacques, Dequiedt Philippe, Ertzbischoff Olivier, Bruzzi John, Delannoy-Deken Valérie, Duhamel Alain, Remy Jacques
Departmentsof Radiology, Calmette Hospital, University Center of Lille, France.
Radiology. 2006 Mar;238(3):1022-35. doi: 10.1148/radiol.2382042100.
To prospectively evaluate gadolinium dose safety and effectiveness for 16-detector pulmonary computed tomographic (CT) angiography.
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.
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.
Gadolinium chelates may be used as an alternative CT contrast agent in patients who cannot receive iodine.
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。
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。
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。
钆螯合物可作为不能接受碘造影剂患者的替代CT造影剂。
