Zapala Matthew A, Zurakowski David, Lee Edward Y
1 Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
2 Department of Radiology and Biomedical Imaging, University of California, San Francisco, Benioff Children's Hospital, 1975 Fourth St, San Francisco, CA 94158.
AJR Am J Roentgenol. 2017 Mar;208(3):632-636. doi: 10.2214/AJR.16.16768. Epub 2017 Jan 11.
The purpose of this study was to assess the difference between mechanical versus hand administration of IV contrast agents on the diagnostic quality of pediatric pulmonary CT angiography (CTA).
A retrospective review of the medical records was performed to detect pediatric patients (≤ 18 years) with pulmonary CTA performed between September 2012 and March 2015. Patients were placed into two cohorts on the basis of the method of contrast administration (mechanical vs hand). Additional information obtained included IV size or gauge, IV site, amount and type of contrast agent administered, and rate of administration (mL/s). The quality of the CT images was independently evaluated by two pediatric radiologists using a qualitative 4-point visual assessment scale and quantitatively with attenuation (HU). An ANOVA controlling for age compared the contrast enhancement in the central pulmonary arteries between the cohorts.
One hundred forty-eight consecutive pediatric patients (71 boys and 77 girls; mean age, 11.1 years; age range, 8 days-17.9 years) were identified between September 2012 and March 2015. Mechanical administration of contrast material was performed in 117 patients (79.1%; mean age [± SD], 13.7 ± 3.7 years), and hand administration of contrast material was performed in 31 patients (20.9%; mean age, 1.6 ± 1.8 years). After adjusting for age, the degree of enhancement within the pulmonary arteries was not statistically different between the two IV contrast administration methods at the main pulmonary artery (mechanical vs hand administration: mean attenuation, 310 ± 128 vs 338 ± 142 HU, respectively, p = 0.505), right pulmonary artery (305 ± 124 vs 329 ± 146 HU, p = 0.556), and left pulmonary artery (303 ± 125 vs 340 ± 151 HU, p = 0.349).
It is possible to perform diagnostic-quality pulmonary CTA for the assessment of the central pulmonary arteries with hand administration of IV contrast material in pediatric patients with small-gauge IV catheters.
本研究旨在评估静脉注射造影剂时，机械注射与手动注射对小儿肺CT血管造影（CTA）诊断质量的差异。
对2012年9月至2015年3月期间接受肺CTA检查的小儿患者（≤18岁）的病历进行回顾性研究。根据造影剂注射方法（机械注射与手动注射）将患者分为两组。获取的其他信息包括静脉大小或规格、静脉穿刺部位、注射的造影剂数量和类型以及注射速率（mL/s）。由两名儿科放射科医生使用定性的4分视觉评估量表并通过衰减值（HU）对CT图像质量进行独立评估。采用控制年龄的方差分析比较两组患者中央肺动脉的造影剂增强情况。
2012年9月至2015年3月期间共纳入148例连续的小儿患者（71例男孩和77例女孩；平均年龄11.1岁；年龄范围8天至17.9岁）。117例患者（79.1%；平均年龄[±标准差]，13.7±3.7岁）采用机械注射造影剂，31例患者（20.9%；平均年龄1.6±1.8岁）采用手动注射造影剂。校正年龄后，两种静脉注射造影剂方法在主肺动脉（机械注射与手动注射：平均衰减值分别为310±128 HU和338±142 HU，p = 0.505）、右肺动脉（305±124 HU和329±146 HU，p = 0.556）和左肺动脉（303±125 HU和340±151 HU，p = 0.349）的增强程度在统计学上无差异。
对于使用小规格静脉留置针的小儿患者，手动注射静脉造影剂也能够进行诊断质量的肺CTA检查以评估中央肺动脉。
