Mihl Casper, Maas Monique, Turek Jakub, Seehofnerova Anna, Leijenaar Ralph T H, Kok Madeleine, Lobbes Marc B I, Wildberger Joachim E, Das Marco
Maastricht University Medical Center, Maastricht University CARIM School for Cardiovascular Diseases, Maastricht, Netherlands.
Radiology, Maastricht University Medical Center, Maastricht, Netherlands.
Rofo. 2017 Apr;189(4):312-325. doi: 10.1055/s-0042-121609. Epub 2017 Mar 6.
Various different injection parameters influence enhancement of the coronary arteries. There is no consensus in the literature regarding the optimal contrast media (CM) injection protocol. The aim of this study is to provide an update on the effect of different CM injection parameters on the coronary attenuation in coronary computed tomographic angiography (CCTA). Studies published between January 2001 and May 2014 identified by Pubmed, Embase and MEDLINE were evaluated. Using predefined inclusion criteria and a data extraction form, the content of each eligible study was assessed. Initially, 2551 potential studies were identified. After applying our criteria, 36 studies were found to be eligible. Studies were systematically assessed for quality based on the validated Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-II checklist. Extracted data proved to be heterogeneous and often incomplete. The injection protocol and outcome of the included publications were very diverse and results are difficult to compare. Based on the extracted data, it remains unclear which of the injection parameters is the most important determinant for adequate attenuation. It is likely that one parameter which combines multiple parameters (e. g. IDR) will be the most suitable determinant of coronary attenuation in CCTA protocols. Research should be directed towards determining the influence of different injection parameters and defining individualized optimal IDRs tailored to patient-related factors (ideally in large randomized trials). · This systematic review provides insight into decisive factors on coronary attenuation.. · Different and contradicting outcomes are reported on coronary attenuation in CCTA.. · One parameter combining multiple parameters (IDR) is likely decisive in coronary attenuation.. · Research should aim at defining individualized optimal IDRs tailored to individual factors.. · Future directions should be tailored towards the influence of different injection parameters.. · Mihl C, Maas M, Turek J et al. Contrast Media Administration in Coronary Computed Tomography Angiography - A Systematic Review. Fortschr Röntgenstr 2017; 189: 312 - 325.
各种不同的注射参数会影响冠状动脉的强化效果。关于最佳对比剂（CM）注射方案，文献中尚无共识。本研究的目的是更新不同CM注射参数对冠状动脉计算机断层血管造影（CCTA）中冠状动脉衰减的影响。对通过Pubmed、Embase和MEDLINE检索到的2001年1月至2014年5月发表的研究进行评估。使用预先定义的纳入标准和数据提取表，对每项符合条件的研究内容进行评估。最初，识别出2551项潜在研究。应用我们的标准后，发现36项研究符合条件。根据经过验证的诊断准确性研究质量评估（QUADAS）-II清单对研究进行系统的质量评估。提取的数据被证明具有异质性且往往不完整。纳入出版物的注射方案和结果差异很大，结果难以比较。根据提取的数据，尚不清楚哪个注射参数是足够衰减的最重要决定因素。很可能一个综合多个参数的参数（如注射速率）将是CCTA方案中冠状动脉衰减最合适的决定因素。研究应致力于确定不同注射参数的影响，并根据患者相关因素定义个性化的最佳注射速率（理想情况下在大型随机试验中）。· 本系统评价深入了解了冠状动脉衰减的决定性因素。· 关于CCTA中冠状动脉衰减的报道结果不同且相互矛盾。· 一个综合多个参数的参数（注射速率）可能对冠状动脉衰减起决定性作用。· 研究应旨在根据个体因素定义个性化的最佳注射速率。· 未来的方向应针对不同注射参数的影响。· Mihl C, Maas M, Turek J等。冠状动脉计算机断层血管造影中的对比剂给药 - 一项系统评价。Fortschr Röntgenstr 2017; 189: 312 - 325。
