Platt J F, Glazer G M
Department of Radiology, University of Michigan Medical Center, Ann Arbor 48109-0030.
AJR Am J Roentgenol. 1988 Aug;151(2):275-7. doi: 10.2214/ajr.151.2.275.
Despite a decade of experience, there is still no consensus as to the optimal IV contrast regimen for use in combined abdominal and pelvic CT scanning. In order to determine which regimen is most effective, 90 patients undergoing CT were prospectively randomized into one of three groups, depending on the method by which IV contrast material was administered: (1) a single bolus (150 ml or 175 ml, depending on the patient's weight) started when scans were made at the level of the dome of the diaphragm; (2) a split bolus delivered by means of a power injector, with the first bolus (100 or 125 ml) given when scans were made at the level of the dome of the diaphragm and the second bolus (50 ml) given when scans were made at the level of the iliac crest; (3) an initial hand-delivered bolus (100 or 125 ml) given when scans were made at the level of diaphragm, followed by rapid IV drip infusion of 50 ml throughout the remainder of the study. Quantitative comparison of pre- and postcontrast scans was performed at two levels: at the mid-liver to assess hepatic enhancement and 1 cm above the sacrosciatic notch to assess pelvic vascular enhancement. The single bolus provided better mean liver enhancement (46 H) than did either the split-bolus (36 H) or the bolus-drip (32 H) method (p less than .05). The last two methods achieved a sufficient aortocaval difference (greater than 10 H) to allow for evaluation of the liver in the nonequilibrium phase of contrast enhancement in which lesion detection is thought to be optimal. Mean enhancement of pelvic vessels was significantly better with the split bolus (arterial enhancement of 56 H, venous enhancement of 47 H) than with the single bolus (34 H, 31 H) or bolus-drip infusion (38 H, 35 H) (p less than .05). We conclude that the split-bolus method is optimal for routine combined abdominal and pelvic CT scanning. The bolus-drip method is the least effective method for administering the contrast material.
尽管已有十年的经验，但对于腹部和盆腔联合CT扫描中最佳的静脉造影剂方案仍未达成共识。为了确定哪种方案最有效，90例接受CT检查的患者根据静脉造影剂的给药方法被前瞻性地随机分为三组：(1) 单次团注（150 ml或175 ml，取决于患者体重），在扫描膈顶水平时开始；(2) 通过动力注射器进行的分次团注，第一次团注（100或125 ml）在扫描膈顶水平时给予，第二次团注（50 ml）在扫描髂嵴水平时给予；(3) 在扫描膈顶水平时给予初始手动团注（100或125 ml），随后在研究的剩余时间内快速静脉滴注50 ml。在两个层面进行造影前和造影后扫描的定量比较：在肝脏中部评估肝脏强化，在坐骨神经切迹上方1 cm评估盆腔血管强化。单次团注提供的平均肝脏强化（46 H）优于分次团注（36 H）或团注-滴注法（32 H）（p<0.05）。后两种方法实现了足够的主动脉腔静脉差值（大于10 H），以允许在造影剂增强的非平衡期评估肝脏，在该时期病变检测被认为是最佳的。分次团注时盆腔血管的平均强化（动脉强化56 H，静脉强化47 H）明显优于单次团注（34 H，31 H）或团注-滴注法（38 H，35 H）（p<0.05）。我们得出结论，分次团注法是腹部和盆腔联合CT常规扫描的最佳方法。团注-滴注法是给药造影剂最无效的方法。
