Jens Sjoerd, Schreuder Sanne M, De Boo Diederik W, van Dijk Lukas C, van Overhagen Hans, Bipat Shandra, Koelemay Mark J W, Reekers Jim A
Department of Radiology, Academic Medical Center, Room G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
HagaZiekenhuis, Leyweg 275, 2545 CH, Den Haag, Netherlands.
Eur Radiol. 2016 Aug;26(8):2446-54. doi: 10.1007/s00330-015-4109-1. Epub 2015 Dec 2.
To determine the influence of lowering iodinated contrast concentration on confidence of interventional radiologists in diagnosing and treating lesions during endovascular interventions in patients with symptomatic peripheral arterial disease (PAD).
A randomized controlled non-inferiority trial was performed in 60 patients. Intervention was performed with contrast concentrations (in mg of iodine per mL, mgI/mL) of 300 (standard), 240, or 140 mgI/mL. Primary outcome was confidence (score 0-100 %) of radiologists in diagnosing and treating arterial lesions. Secondary outcomes were procedural iodine load and image quality (i.e. non-diagnostic, limited, diagnostic, exemplary).
Median confidence scores in diagnosing lesions were 100 % (range 81-100 %) for the 300 group (n = 21), 100 % (range 82-100 %) for the 240 group (n = 19), and 100 % (range 91-100 %) for the 140 group (n = 20) (both p = 1.00 compared to the 300 group). Median scores for treating lesions in the 240 and 140 groups, 100 % (range 79-100 %, p = 0.40), and 100 % (range 63-100 %, p = 0.25), respectively, were not lower compared to the 300 group (median 100 %, range 78-100 %). Procedural iodine load was lower in the 240 (24.3 ± 7.6 g, p = 0.022) and 140 groups (17.8 ± 5.6 g, p < 0.001) compared to the 300 group (29.7 ± 6.3 g). Image quality was diagnostic for all groups.
Using iodine contrast of 140 mgI/mL for diagnosis and interventions in PAD patients significantly reduces administered iodine load without compromising image quality. Future use of lower iodine dose is recommended.
• Lower iodinated contrast concentration during endovascular intervention does not decrease radiologist's confidence. • Image quality of standardized angiographies remains diagnostic using 140 mgI/mL iodinated contrast concentration. • Iodine load during intervention can be decreased by >40 % when using 140 mgI/mL. • Implementing the use of a lower iodinated contrast concentration will reduce the costs of the procedure.
确定降低碘化造影剂浓度对有症状外周动脉疾病（PAD）患者进行血管内介入治疗时介入放射科医生诊断和治疗病变信心的影响。
对60例患者进行了一项随机对照非劣效性试验。采用300（标准）、240或140mgI/mL的造影剂浓度（每毫升碘毫克数，mgI/mL）进行干预。主要结局是放射科医生诊断和治疗动脉病变的信心（0 - 100%评分）。次要结局是操作碘负荷和图像质量（即非诊断性、有限、诊断性、典范性）。
300mgI/mL组（n = 21）诊断病变的中位信心评分为100%（范围81 - 100%），240mgI/mL组（n = 19）为100%（范围82 - 100%），140mgI/mL组（n = 20）为100%（范围91 - 100%）（与300mgI/mL组相比，p均 = 1.00）。240mgI/mL组和140mgI/mL组治疗病变的中位评分分别为100%（范围79 - 100%，p = 0.40）和100%（范围63 - 100%，p = 0.25），与300mgI/mL组（中位100%，范围78 - 100%）相比并不更低。240mgI/mL组（24.3±7.6g，p = 0.022）和140mgI/mL组（17.8±5.6g，p < 0.001）的操作碘负荷低于300mgI/mL组（29.7±6.3g）。所有组的图像质量均为诊断性。
在PAD患者中使用140mgI/mL的碘造影剂进行诊断和干预可显著降低碘给药量，且不影响图像质量。建议未来使用更低碘剂量。
•血管内介入治疗期间降低碘化造影剂浓度不会降低放射科医生的信心。•使用140mgI/mL的碘化造影剂浓度时，标准化血管造影的图像质量仍为诊断性。•使用140mgI/mL时，干预期间的碘负荷可降低>40%。•采用更低的碘化造影剂浓度将降低手术成本。
