冠状动脉CT血管造影中个体化体重适配对比剂注射的评估。
Evaluation of individually body weight adapted contrast media injection in coronary CT-angiography.
作者信息
Mihl Casper, Kok Madeleine, Altintas Sibel, Kietselaer Bas L J H, Turek Jakub, Wildberger Joachim E, Das Marco
机构信息
Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Radiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.
出版信息
Eur J Radiol. 2016 Apr;85(4):830-6. doi: 10.1016/j.ejrad.2015.12.031. Epub 2016 Jan 7.
OBJECTIVES
Contrast media (CM) injection protocols should be customized to the individual patient. Aim of this study was to determine if software tailored CM injections result in diagnostic enhancement of the coronary arteries in computed tomography angiography (CTA) and if attenuation values were comparable between different weight categories.
MATERIALS AND METHODS
265 consecutive patients referred for routine coronary CTA were scanned on a 2nd generation dual-source CT. Group 1 (n=141) received an individual CM bolus based on weight categories (39-59 kg; 60-74 kg; 75-94 kg; 95-109 kg) and scan duration ('high-pitch: 1s; "dual-step prospective triggering": 7s), as determined by contrast injection software (Certegra™ P3T, Bayer, Berlin, Germany). Group 2 (n=124) received a standard fixed CM bolus; Iopromide 300 mgI/ml; volume: 75 ml; flow rate: 7.2 ml/s. Contrast enhancement was measured in all proximal and distal coronary segments. Subjective and objective image quality was evaluated. Statistical analysis was performed using SPSS (IBM, version 20.0).
RESULTS
For group 1, mean attenuation values of all segments were diagnostic (>325 HU) without statistical significant differences between different weight categories (p>0.17), proximal vs. distal: 449 ± 65-373 ± 58 HU (39-59 kg); 443 ± 69-367 ± 81 HU (60-74 kg); 427 ± 59-370 ± 61 HU (75-94 kg); 427 ± 73-347 ± 61 HU (95-109 kg). Mean CM volumes were: 55 ± 6 ml (39-59 kg); 61 ± 7 ml (60-74 kg); 71 ± 8 ml (75-94 kg); 84 ± 9 ml (95-109 kg). For group 2, mean attenuation values were not all diagnostic with differences between weight categories (p<0.01), proximal vs. distal: 611 ± 142-408 ± 69 HU (39-59 kg); 562 ± 135-389 ± 98 HU (60-74 kg); 481 ± 83-329 ± 81 HU (75-94 kg); 420 ± 73-305 ± 35 HU (95-109 kg). Comparable image noise and image quality were found between groups (p ≥ 0.330).
CONCLUSIONS
Individually tailored CM injection protocols yield diagnostic attenuation and a more homogeneous enhancement pattern between different weight groups. CM volumes could be reduced for the majority of patients utilizing individualized CM bolus application.
目的
造影剂（CM）注射方案应根据个体患者进行定制。本研究的目的是确定软件定制的CM注射是否能在计算机断层扫描血管造影（CTA）中增强冠状动脉的诊断效果，以及不同体重类别之间的衰减值是否具有可比性。
材料与方法
对265例连续接受常规冠状动脉CTA检查的患者进行第二代双源CT扫描。第1组（n = 141）根据体重类别（39 - 59 kg；60 - 74 kg；75 - 94 kg；95 - 109 kg）和扫描时长（“高螺距：1秒；“双步前瞻性触发”：7秒）接受个体化CM团注，由造影剂注射软件（Certegra™ P3T，拜耳，德国柏林）确定。第2组（n = 124）接受标准固定CM团注；碘普罗胺300 mgI/ml；体积：75 ml；流速：7.2 ml/s。测量所有冠状动脉近端和远端节段的造影剂增强情况。评估主观和客观图像质量。使用SPSS（IBM，版本20.0）进行统计分析。
结果
对于第1组，所有节段的平均衰减值均具有诊断意义（>325 HU），不同体重类别之间无统计学显著差异（p>0.17），近端与远端：449±65 - 373±58 HU（39 - 59 kg）；443±69 - 367±81 HU（60 - 74 kg）；427±59 - 370±61 HU（7� - 94 kg）；427±73 - 347±61 HU（95 - 109 kg）。平均CM体积分别为：55±6 ml（39 - 59 kg）；61±7 ml（60 - 74 kg）；71±8 ml（75 - 94 kg）；84±9 ml（95 - 109 kg）。对于第2组，平均衰减值并非都具有诊断意义，体重类别之间存在差异（p<0.01），近端与远端：611±142 - 408±69 HU（39 - 59 kg）；562±135 - 389±98 HU（60 - 74 kg）；481±83 - 329±81 HU（75 - 94 kg）；420±73 - 305±35 HU（95 - 109 kg）。两组之间的图像噪声和图像质量相当（p≥0.330）。
结论
个体化定制的CM注射方案可产生具有诊断意义的衰减，并在不同体重组之间产生更均匀的增强模式。对于大多数使用个体化CM团注的患者，CM体积可以减少。
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