JACC Cardiovasc Imaging. 2009 Dec;2(12):1404-11. doi: 10.1016/j.jcmg.2009.08.010.
This study sought to evaluate the feasibility of using ultra-low-dose intra-arterial contrast injection for iliofemoral computed tomographic (CT) angiography to follow diagnostic cardiac catheterization.
Cardiovascular interventions such as percutaneous aortic valve replacement require transfemoral delivery of large-bore intra-arterial catheters; therefore, pre-procedural assessment of aortoiliofemoral anatomy is important. CT angiography is ideal for this purpose but requires a large volume of intravenous contrast.
Consecutive patients requiring evaluation of aortoiliofemoral anatomy underwent conventional anteroposterior projection iliac angiography during cardiac catheterization. A pigtail catheter was left in situ in the infrarenal abdominal aorta, and patients were transferred to the CT suite. Subsequently, 10 to 15 ml of contrast diluted with normal saline was injected intra-arterially via the pigtail catheter while a spiral CT of the abdomen and pelvis was acquired. Conventional angiographic and CT images were analyzed independently to assess suitability for large-bore (7-mm-diameter)intra-arterial catheter access.
Excellent CT image quality was achieved in 34 of 37 patients (92%). The mean contrast dose for CT was 12 +/- 2 ml. In 9 patients (24%), CT changed the assessment of femoral access feasibility. Furthermore, in another 7 patients (19%), unfavorable anatomy as shown by CT directed the avoidance of a particular side. Overall, CT findings altered the interventional approach in 16 patients (43%). There was no significant deterioration detected in renal function after coronary and CT angiography (estimated glomerular filtration rate 54.8 +/- 3.8 ml/min before 53.3 +/- 3.9 ml/min after, p = 0.55).
High-quality aortoiliofemoral CT angiography can be obtained with a technical success rate of >90% using 10 to 15 ml of contrast injected via a catheter in the abdominal aorta, and offers an alternative to conventional X-ray or CT angiography with high-volume intravenous contrast injection.
本研究旨在评估超小剂量经动脉内对比注射用于髂股计算机断层（CT）血管造影术以随访诊断性心导管检查的可行性。
心血管介入治疗，如经皮主动脉瓣置换术，需要经股动脉输送大口径动脉内导管；因此，术前评估主动脉-股动脉解剖结构非常重要。CT 血管造影术是理想的选择，但需要大剂量的静脉对比剂。
连续接受主动脉-股动脉解剖评估的患者在心脏导管检查期间进行常规前后位投影髂动脉造影术。在肾下腹部主动脉内留置猪尾导管，然后将患者转至 CT 室。随后，通过猪尾导管经动脉内注射 10 至 15 毫升对比剂，同时进行腹部和骨盆螺旋 CT 扫描。分别分析常规血管造影和 CT 图像，以评估是否适合大口径（7 毫米直径）动脉内导管进入。
37 例患者中有 34 例（92%）获得了出色的 CT 图像质量。CT 的平均对比剂量为 12±2 毫升。在 9 例患者（24%）中，CT 改变了对股动脉入路可行性的评估。此外，在另外 7 例患者（19%）中，CT 显示的不利解剖结构指导避免了特定一侧。总的来说，CT 结果改变了 16 例患者（43%）的介入方法。冠状动脉和 CT 血管造影后肾功能无明显恶化（肾小球滤过率估计值为 54.8±3.8ml/min，之前为 53.3±3.9ml/min，p=0.55）。
使用腹部主动脉内导管注射 10 至 15 毫升对比剂可获得技术成功率>90%的高质量主动脉-股动脉 CT 血管造影，为传统 X 射线或高容量静脉对比剂注射 CT 血管造影提供了替代方案。
