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制定死后 CT 血管造影中使用水溶性造影剂和聚乙二醇的标准化方案。

Development of a protocol for standardized use of a water-soluble contrast agent with polyethylene glycol in post-mortem CT angiography.

机构信息

Institut Für Rechtsmedizin, Ludwig-Maximillians-Universität München, Nussbaumstr. 26, D - 80336, Munich, Deutschland.

Centre Universitaire Romand de Médecine Légale, Centre Hospitalier Universitaire Vaudois, Chemin de La Vulliette 4, CH - 1000, Lausanne 25, Schweiz.

出版信息

Int J Legal Med. 2024 Jul;138(4):1437-1446. doi: 10.1007/s00414-024-03218-y. Epub 2024 Apr 3.

Abstract

Computed tomography angiography (PMCTA) is increasingly used in postmortem cases. Standardized validated protocols permit to compare different PMCTA images and make it more easily to defend a case in court. In addition to the well-known technique by Grabherr et al. (2011) which is using paraffin oil as a carrier substance, water-soluble polyethylene glycol 200 (PEG200) can be used in combination with the contrast agent Accupaque® 300. As to date, there exists no standardized protocol for the use of this contrast agent mixture, the aim of this study was to develop a protocol using it. Between 2012 and 2022, 23 PMCTA with PEG200 and Accupaque®300 were performed at the University Centre of Legal Medicine Lausanne (Switzerland) and the Institute of Forensic Medicine Munich (Germany). The images obtained were evaluated regarding the opacification of the vessels and possible artefacts. The best image quality was obtained with a mixing ratio of 1:15 (Accupaque®300:PEG200) and a perfusion volume of 1000 ml in the arterial, 1400 ml in the venous and 350 ml in the dynamic phase. The infusion rates described by Grabherr et al. were confirmed for the three phases. Overall, the opacification of the vessels was diagnostically sufficient. In 13 cases no opacification of the right coronary artery was observed due to a stratification artefact. By using the PMCTA protocol with PEG200 as a carrier, a good overall image quality can be achieved. This protocol offers the possibility to standardize PMCTA with PEG200.

摘要

计算机断层血管造影术(PMCTA)在尸检中越来越多地被使用。标准化的验证协议允许比较不同的 PMCTA 图像,使在法庭上更易于辩护。除了 Grabherr 等人(2011 年)使用石蜡油作为载体物质的众所周知的技术外,水溶性聚乙二醇 200(PEG200)也可以与造影剂 Accupaque®300 结合使用。迄今为止,还没有使用这种造影剂混合物的标准化方案,本研究的目的是开发一种使用该造影剂混合物的方案。2012 年至 2022 年,在瑞士洛桑大学法医学中心(瑞士)和慕尼黑法医研究所(德国)进行了 23 例 PMCTA 检查,使用 PEG200 和 Accupaque®300。评估了获得的图像中血管的显影和可能的伪影。使用 1:15(Accupaque®300:PEG200)的混合比和动脉灌注量 1000ml、静脉灌注量 1400ml 和动态期 350ml 获得最佳的图像质量。三个阶段的灌注率与 Grabherr 等人描述的相符。总体而言,血管显影具有诊断意义。在 13 例中,由于分层伪影,观察到右冠状动脉未显影。通过使用 PEG200 作为载体的 PMCTA 方案,可以获得良好的整体图像质量。该方案提供了标准化 PMCTA 与 PEG200 的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ef1e/11164774/342cda7e152f/414_2024_3218_Fig1_HTML.jpg

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