Department of Diagnostic Radiology, Lasarettet Trelleborg, University of Lund, 231 85 Trelleborg, Sweden.
Eur Radiol. 2010 Jun;20(6):1321-30. doi: 10.1007/s00330-009-1691-0. Epub 2009 Dec 24.
To analyse 80-kVp 16-MDCT in patients with clinically suspected pulmonary embolism (PE) and diminished renal function after a reduction in dose of contrast medium (CM) from 200 to 150 mg I/kg.
Fifty patients with suspected PE and glomerular filtration rate (GFR) less than 50 mL/min underwent 80-kVp 16-MDCT with 150 mg I/kg. Mean density/image noise (1 standard deviation) was measured in a region of interest in the left pulmonary artery (LPA) and a lower lobe segmental artery (LLSA), and the contrast-to-noise ratio (CNR) was calculated. The values of LPA and LLSA were averaged.
Median values/2.5-97.5 percentiles were: age 84/67-96 years, weight 65/43-84 kg, GFR 36/21-45 mL/min, CM dose 9.6/6.4-12 g of iodine, PA density 353/164-495 HU and CNR 11/4.4-20. PE incidence was 16%, and 8% and 12% of the examinations were regarded suboptimal by observer 1 and 2, respectively. Density/CNR values were within ranges reported for common 120-kVp MDCT protocols. None of 32 patients with plasma-creatinine follow-up within 1 week experienced a rise of more than 44.2 mumol/L and none of 50 patients had oliguria/anuria or dialysis. None of 40 patients with a negative CT/no anticoagulation had thromboembolism during follow-up.
80-kVp MDCT combined with individualised ultralow CM doses may provide satisfactory diagnostic quality, which should be to the benefit of patients at risk of contrast medium-induced nephropathy.
分析在对比剂（CM）剂量从 200mg I/kg 降至 150mg I/kg 后，用于疑似患有临床肺栓塞（PE）和肾功能降低的患者的 80kVp16-MDCT。
50 名疑似患有 PE 且肾小球滤过率（GFR）低于 50ml/min 的患者接受了 150mg I/kg 16-MDCT 检查。在左肺动脉（LPA）和下叶段动脉（LLSA）的感兴趣区域测量平均密度/图像噪声（1 个标准差），并计算对比噪声比（CNR）。平均 LPA 和 LLSA 的值。
中位数/2.5-97.5 百分位数为：年龄 84/67-96 岁，体重 65/43-84kg，GFR 36/21-45ml/min，CM 剂量 9.6/6.4-12g 碘，PA 密度 353/164-495HU 和 CNR 11/4.4-20。PE 发生率为 16%，观察者 1 和 2 分别认为 8%和 12%的检查结果不理想。密度/CNR 值在常用的 120kVp MDCT 方案报告的范围内。在 1 周内进行血浆肌酐随访的 32 名患者中，无 1 名患者的肌酐升高超过 44.2umol/L，50 名患者中无 1 名出现少尿/无尿或透析。在随访期间，40 名接受 CT 阴性/未抗凝治疗且无血栓栓塞的患者中无 1 例发生血栓栓塞。
80kVp MDCT 联合个体化超低 CM 剂量可能提供令人满意的诊断质量，这可能对有发生对比剂肾病风险的患者有益。
