Yoshiura Takayuki, Masuda Takanori, Matsumoto Yoriaki, Sato Tomoyasu, Yamashita Yukari, Kobayashi Yukie, Ishibashi Tooru, Oku Takayuki, Imada Naoyuki, Funama Yoshinori
Department of Medical Technology, Tsuchiya General Hospital.
Department of Medical Physics, Faculty of Life Sciences, Kumamoto University.
Nihon Hoshasen Gijutsu Gakkai Zasshi. 2019;75(8):765-770. doi: 10.6009/jjrt.2019_JSRT_75.8.765.
A three-dimensional (3D) image from computed tomography (CT) angiography is a useful method for evaluation of complex anatomy such as congenital heart disease. However, 3D imaging requires high contrast enhancement for distinguishing between blood vessels and soft tissue. To improve the contrast enhancement, many are increasing the injection rate. However, one method is the use of fenestrated catheters, it allows use of a smaller gauge catheter for high-flow protocols. The purpose of this study was to compare the pressure of injection rate and CT number of a 24-gauge fenestrated catheter with an 22-gauge non-fenestrated catheter for i.v. contrast infusion during CT.
Between December 2014 and March 2015, 50 newborn patients were randomly divided into two protocols; 22-gauge conventional non-fenestrated catheter (24 newborn; age range 0.25-8 months, body weight 3.6±1.2 kg) and 24-gauge new fenestrated catheter (22 newborn; age range 0.25-12 months, body weight 3.3±0.9 kg). Helical scan of the heart was performed using a 64-detector CT (LightSpeed VCT, GE Healthcare) (tube voltage 80 kV; detector configuration 64×0.625 mm, rotation time 0.4 s/rot, helical pitch 1.375, preset noise index for automatic tube current modulation 40 at 0.625 mm slice thickness).
We compared the maximum pressure of injection rate, CT number of aortic enhancement, and CT number of pulmonary artery enhancement between both protocols. The median injection rate, CT number of aortic enhancement, and CT number of pulmonary artery enhancement were 0.9 (0.5-3.4) ml/s, 455.5 (398-659) HU, and 500.0 (437-701) HU in 22-gauge conventional non-fenestrated catheter and 0.9 (0.5-2.0) ml/s, 436.5 (406-632) HU, and 479.5 (445-695) HU in the 24-gauge fenestrated catheter, respectively. There are no significantly different between a 24-gauge fenestrated catheter and 22-gauge non-fenestrated catheters at injection rate and CT number. Maximum pressure of injection rate was lower with 24-gauge non-fenestrated catheters (0.33 kg/cm) than 22-gauge non-fenestrated catheters (0.55 kg/cm) (p<0.01Conclusion: A 24-gauge fenestrated catheter performs similarly to an 22-gauge non-fenestrated catheter with respect to i.v. contrast infusion and aortic enhancement levels and can be placed in most subjects whose veins are deemed insufficient for an 22-gauge catheter.
计算机断层扫描（CT）血管造影的三维（3D）图像是评估先天性心脏病等复杂解剖结构的有用方法。然而，3D成像需要高对比度增强来区分血管和软组织。为了改善对比度增强，许多人正在提高注射速率。然而，一种方法是使用开窗导管，它允许在高流量方案中使用较小规格的导管。本研究的目的是比较24号开窗导管和22号非开窗导管在CT静脉造影期间的注射速率压力和CT值。
2014年12月至2015年3月期间，50例新生儿患者被随机分为两个方案组；22号传统非开窗导管组（24例新生儿；年龄范围0.25 - 8个月，体重3.6±1.2 kg）和24号新型开窗导管组（22例新生儿；年龄范围0.25 - 12个月，体重3.3±0.9 kg）。使用64层CT（LightSpeed VCT，GE医疗）进行心脏螺旋扫描（管电压80 kV；探测器配置64×0.625 mm，旋转时间0.4 s/rot，螺旋螺距1.375，在0.625 mm层厚时自动管电流调制的预设噪声指数40）。
我们比较了两个方案组之间的最大注射速率压力、主动脉增强的CT值和肺动脉增强的CT值。22号传统非开窗导管组的中位注射速率、主动脉增强的CT值和肺动脉增强的CT值分别为0.9（0.5 - 3.4）ml/s、455.5（398 - 659）HU和500.0（437 - 701）HU，24号开窗导管组分别为0.9（0.5 - 2.0）ml/s、436.5（406 - 632）HU和479.5（445 - 695）HU。24号开窗导管和22号非开窗导管在注射速率和CT值方面无显著差异。24号非开窗导管的最大注射速率压力（0.33 kg/cm）低于22号非开窗导管（0.55 kg/cm）（p<0.01）结论：在静脉造影剂注入和主动脉增强水平方面，24号开窗导管的表现与22号非开窗导管相似，并且可以放置在大多数认为静脉不足以容纳22号导管的受试者中。
