University Hospital of Munich Großhadern, Department of Radiology, Munich, Germany.
Invest Radiol. 2011 Jul;46(7):457-64. doi: 10.1097/RLI.0b013e31821c7ff4.
To compare a contrast agent with high iodine concentration with an iso-osmolar contrast agent for coronary dual-source computed tomography angiography (DS-CTA), and to assess whether the contrast agent characteristics may affect the diagnostic quality of coronary DS-CTA.
Patients were randomized to receive either 80 mL of iodixa:nol-320 (Visipaque, GE Healthcare, Chalfont St. Giles, United Kingdom) or iomeprol-400 (Iomeron, Bracco Imaging SpA, Milan, Italy) at 5 mL/s. Mean, minimum, maximum heart rate, and its variation (max-min) were assessed during calcium scoring scan and coronary DS-CTA. Three off-site readers independently evaluated the image sets in terms of technical adequacy, reasons for inadequacy, vessel visualization, diagnostic confidence (based on a 5-point scale), and arterial contrast opacification in Hounsfield units (HUs).
Ninety-six patients were included in the final evaluation. No significant differences were observed for pre- and postdose heart rate values for iomeron-400 compared with iodixanol-320, and changes in heart rate variation were also not significantly different (-2.3 ± 11.7 vs. -2.5 ± 7.3 bpm, P > 0.1). Contrast measurements in all analyzed vessels were significantly higher for iomeprol-400 (mean, 391.5-441.4 HU) compared with iodixanol-320 (mean, 332.3-365.5 HU, all P ≤ 0.0038). There was no significant difference in qualitative visualization of coronary arteries (mean scores, 4.3-4.5 for iomeprol, 4.1-4.3 for iodixanol, P = 0.15-0.28), or in diagnostic confidence scores. HU were inversely correlated with the number of insufficiently opacified segments (all readers P ≤ 0.0006).
The high-iodine concentration contrast medium iomeprol-400 demonstrated significant benefit for coronary arterial enhancement compared with the iso-osmolar contrast medium iodixanol-320 when administered at identical flow rates and volumes for coronary DS-CTA. In addition, higher enhancement levels were found to be associated with lower numbers of inadequately visualized segments. Finally, observed mean heart rate changes after intravenous contrast injection were generally small during the examination and comparable for both agents.
比较高浓度碘对比剂与等渗对比剂在冠状动脉双源 CT 血管造影（DS-CTA）中的应用，评估对比剂特性是否会影响冠状动脉 DS-CTA 的诊断质量。
患者随机分为碘克沙醇 320 组（威视派克，通用电气医疗集团，英国钱利圣吉尔）和碘普罗胺 400 组（碘美普尔，博莱科影像公司，意大利米兰），注射速度均为 5ml/s。在进行钙评分扫描和冠状动脉 DS-CTA 时，评估平均、最小、最大心率及其变化（最大-最小）。三位离线阅片者根据技术充分性、不充分性原因、血管可视性、诊断信心（基于 5 分制）以及亨氏单位（HU）的动脉对比增强情况，对图像集进行独立评估。
96 例患者最终纳入评估。碘普罗胺 400 组的注射前后心率值与碘克沙醇 320 组相比无显著差异，心率变化也无显著差异（-2.3±11.7 比-2.5±7.3bpm，P＞0.1）。碘普罗胺 400 组（平均 391.5-441.4HU）所有分析血管的对比测量值均显著高于碘克沙醇 320 组（平均 332.3-365.5HU，均 P≤0.0038）。冠状动脉的定性可视化（碘普罗胺平均评分为 4.3-4.5，碘克沙醇平均评分为 4.1-4.3，P=0.15-0.28）或诊断信心评分无显著差异。HU 与未充分增强节段数量呈负相关（所有阅片者 P≤0.0006）。
与等渗碘克沙醇 320 相比，在相同流速和体积下用于冠状动脉 DS-CTA 时，高浓度碘对比剂碘普罗胺 400 对冠状动脉增强具有显著优势。此外，更高的增强水平与未充分可视化节段数量减少相关。最后，静脉注射对比剂后观察到的平均心率变化在检查过程中通常较小，两种药物之间无差异。
