Wüst W, Zunker C, May M, Anders K, Ropers D, Achenbach S, Uder M, Kuettner A
Radiologisches Institut, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Rofo. 2009 Apr;181(4):324-31. doi: 10.1055/s-2008-1027857. Epub 2009 Mar 16.
Due to the technical advance of multislice cardiac CT and the recently introduced dual source CT, the acquisition times for cardiac CT exams are < 10 sec. At the same time the assessment of left ventricular function is possible. However, in many patients a complete right ventricular outwash is noted, leading to insufficient septal delineation. Studies were able to demonstrate that contrast media (CM) mixed in the saline chaser bolus is sufficient for significantly better visualization of septal structures. The aim of this study was to investigate whether this dual flow concept works as well for 64-slice and dual source CT angiography using only 20 % CM in the saline chaser bolus.
97 patients were included in this prospective study. 47 patients underwent 64-slice CT coronary angiography. 80 cc were administered at 5 cc/sec as the main bolus followed by a 50 cc saline chaser bolus containing 20 % contrast media. The other 50 patients were examined using dual source CT. They received a CM protocol adapted for the scan time with the identical saline/CM chaser bolus. The datasets were quantitatively examined in defined ROIs along the septum and in the right ventricle with respect to the density. The septal delineation was qualitatively analyzed and both groups were compared. In a final step the density was measured in the proximal and distal RCA as well as in the LAD and also compared.
Using the protocol adapted for the scan time, significantly less CM was used. No significant difference was able to be found regarding the septal delineation or coronary enhancement.
The study shows that the dual flow concept allows for robust septal delineation regardless of the CM injection protocol used as long as a 20 % saline chaser bolus is used. A CM protocol adapted for the scan time also leads to significant CM reduction at equal image quality.
由于多层心脏CT技术的进步以及最近推出的双源CT,心脏CT检查的采集时间小于10秒。同时,对左心室功能的评估成为可能。然而,在许多患者中,右心室流出道显示完整,导致室间隔勾画不足。研究表明,在盐水追注团注中混合造影剂(CM)足以显著更好地显示室间隔结构。本研究的目的是调查这种双流概念对于仅在盐水追注团注中使用20%CM的64层CT血管造影和双源CT血管造影是否同样有效。
97例患者纳入本前瞻性研究。47例患者接受64层CT冠状动脉造影。以5cc/秒的速度注入80cc作为主团注,随后注入50cc含20%造影剂的盐水追注团注。另外50例患者使用双源CT进行检查。他们接受了根据扫描时间调整的CM方案,使用相同的盐水/CM追注团注。在沿室间隔和右心室的定义感兴趣区域(ROI)中对数据集进行密度定量检查。对室间隔勾画进行定性分析,并比较两组。最后一步,测量右冠状动脉近端和远端以及左前降支的密度并进行比较。
使用根据扫描时间调整的方案,使用的CM显著减少。在室间隔勾画或冠状动脉强化方面未发现显著差异。
该研究表明,只要使用20%的盐水追注团注,双流概念无论使用何种CM注射方案都能实现可靠的室间隔勾画。根据扫描时间调整的CM方案在图像质量相同的情况下也能显著减少CM用量。