Kim Cherry, Lee Choong Wook, Hong Gil-Sun, Kim Gihong, Lee Ki Yeol, Kim Sung-Soo
Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan-si, Gyeonggi Department of Healthcare Management, Cheongju University, Cheongju, South Korea.
Medicine (Baltimore). 2017 Dec;96(49):e9099. doi: 10.1097/MD.0000000000009099.
The purpose of our study was to compare pulmonary artery (PA) enhancement according to venous routes of contrast media (CM) administration in patients who underwent CT pulmonary angiography (CTPA) in the emergency department (ED).This retrospective study reviewed the CTPAs of 24 patients who administered CM via leg veins (group A) and 72 patients via arm veins (group B) with age and gender matching at a ratio of 1:3. Clinical data, aorta attenuation (Aoatten), and PA attenuation (PAatten) were compared between group A and B. Each group was subcategorized into diagnostic and nondiagnostic CTPA subgroups, with a threshold of 250 HU at the PA. Then, clinical data, rates of pulmonary embolism (PE), and right ventricle (RV) strain were compared. In group A, the relationship between the narrowest suprahepatic IVC area (IVCarea) and the attenuation ratio of the RV to the intrahepatic IVC (RV/IVCatten) was evaluated.Aoatten (236.6 HU vs 293.1 HU, P < .001) and PAatten (266.7 HU vs 321.4 HU, P = .026) were significantly lower in group A than in group B. The proportion of nondiagnostic CTPA was significantly higher in group A than in group B (58.3% vs 19.4%, P = .001). In the subgroup analysis in of group A, patients with a nondiagnostic CTPA were significantly younger (55.3 years vs 68.6 years, P = .026) and showed a significantly lower incidence rate of PE (14% vs 70%, P = .01) than patients with a diagnostic CTPA. However, the radiological diagnostic rate of RV strain was comparable between patients with nondiagnostic and diagnostic CTPA. In group A, IVCarea and RV/IVCatten were positively correlated, with a correlation coefficient of 0.430 (P < .036).In conclusion, administration of CM through the leg veins increases the nondiagnostic CTPA rate, reducing the detection rate of PE. When CM is injected via the leg veins, the degree of PA enhancement is related with to the diameter of the suprahepatic IVC; therefore, adjustment of respiratory maneuvers may be needed to promote IVC flow into the right cardiac chamber, and to improve PA enhancement.
我们研究的目的是比较在急诊科接受CT肺动脉造影（CTPA）的患者中，根据静脉注射造影剂（CM）的途径不同，肺动脉（PA）的强化情况。这项回顾性研究纳入了24例经腿部静脉注射CM的患者（A组）和72例经手臂静脉注射CM的患者（B组），两组年龄和性别匹配，比例为1:3。比较了A组和B组的临床资料、主动脉衰减值（Aoatten）和PA衰减值（PAatten）。每组又分为诊断性CTPA亚组和非诊断性CTPA亚组，以PA处250HU为阈值。然后，比较了临床资料、肺栓塞（PE）发生率和右心室（RV）应变情况。在A组中，评估了肝上段下腔静脉最窄处面积（IVCarea）与RV和肝内下腔静脉衰减比值（RV/IVCatten）之间的关系。A组的Aoatten（236.6HU对293.1HU，P<0.001）和PAatten（266.7HU对321.4HU，P=0.026）显著低于B组。A组非诊断性CTPA的比例显著高于B组（58.3%对19.4%，P=0.001）。在A组的亚组分析中，非诊断性CTPA患者比诊断性CTPA患者显著年轻（55.3岁对68.6岁，P=0.026），且PE发生率显著更低（14%对70%，P=0.01）。然而，非诊断性CTPA患者和诊断性CTPA患者的RV应变的放射学诊断率相当。在A组中，IVCarea与RV/IVCatten呈正相关，相关系数为0.430（P<0.036）。总之，经腿部静脉注射CM会增加非诊断性CTPA率，降低PE的检出率。当经腿部静脉注射CM时，PA强化程度与肝上段下腔静脉直径有关；因此，可能需要调整呼吸动作以促进下腔静脉血流进入右心腔，并改善PA强化。
