低剂量对比剂联合生理盐水在64层螺旋CT头颈血管成像中的应用

The application of the reduced dosage of the contrast medium with saline flush in cerebral and carotid angiography with 64-slice spiral CT

目的初步探讨低剂量对比剂联合生理盐水在64层螺旋 CT 头颈血管成像中的应用。方法 40例患者行头颈 CT 血管成像(CTA),采用随机数字表法根据对比剂使用剂量将患者分成2组,低剂量组(A组):50 ml 对比剂+20 ml 生理盐水;对照组(B组):70 ml 对比剂。采用双盲法,由2名有经验的放射科医师分别独立进行评价分析。结果 (1)2名医师在颈动脉、颅底动脉环显示、静脉伪影以及 CT 值测量上的 Kappa 值分别为0.895、0.814、0.702、0.836。(2)在颈动脉的显示上,2组评分结果 A 医师分别为1.3、1.2分,B 医师分别为1.4、1.2分,2名医师 A、B 组之间的差异均无统计学意义(U 值分别为173、128,p 值均>0.05);在颅底动脉环的显示上,2组的评分结果 A 医师分别为1.4、1.2分,B 医师分别为1.2、1.2分,2名医师 A、B 组之间的差异均无统计学意义(U 值分别为160、106,P 值均>0.05);在注射侧锁骨下静脉、头臂静脉、腔静脉的伪影上,2组的评分结果 A 医师分别为1.3、2.1分,B 医师分别为1.2、1.9分,2名医师 A、B 组之间的差异均有统计学意义(U 值分别为75、82,P<0.05)。(3)2组各血管 CT 值的测量结果,A 医师分别为329.1、322.9、241.4、194.6 HU 和353.3、342.7、245.8、204.5 HU,B 医师分别为337.3、329.5、239.2、192.8 HU 和345.6、341.2、247.1、210.5 HU;2名医师2组之间差异均无统计学意义(t 值分别为0.298、0.233,P>0.05)。结论 64层螺旋 CT 进行头颈血管 CTA 检查时,应用低剂量对比剂联合生理盐水可获得良好的 CTA图像,能为临床医师提供可靠的诊疗依据。

Objective To ustilize the reduced contrast dose with saline flush in cerebral and carotid angiography with 64-slice spiral CT. Methods According to the contrast dose, 40 patients undergoing cerebral and carotid CTA examination were randomly divided into 2 groups, one group was treated with 50 ml contrast agent and 20 ml saline flush, the other group was administrated with 70 ml contrast agent. With double blindness method, the data were respectively evaluated and analyzed by two radiologists independently. Results For the two radiologists, on the manifestation of carotid and cerebral arteries, the venous artefact and the CT value measurement aspects, the Kappa value was respectively 0. 895,0. 814, 0. 702,0. 836. By rank sum test,on the manifestation of carotid arteries aspect,the grading score of the two groups of radiologist A was respectively 1.3, 1.2 ; and that of radiologist B was respectively 1.4, 1.2 ; the differences between the two groups of the two radiologists have no statistical significance（ U = 173 ,P 〉0. 05 ; U = 128,P 〉0. 05）. And on the manifestation of cerebral arteries aspect,the grading score of the two groups of radiologist A was respectively 1.4, 1.2;and that of radiologist B was respectively 1.2, 1.2;the differences between two groups of the two radiologists both have no statistical significance （U = 160, P 〉0. 05;U= 106,P 〉0.05）. And on the artefacts produced by the high contrast densities in the right subclavian vein, brachiocephalic vein and vena cava,the grading score of the two groups of radiologist A was respectively 1.3, 2. 1 ; and that of radiologist B was respectively 1.2, 1.9 ; the differences between the two groups of the two radiologists both have statistical significance （U = 75 ,P 〈0. 05;U = 82,P 〈0.05 ）. The CT value of the arteries of the two groups from radiologist A was respectively 329. 1,322. 9,241.4,194. 6, 353. 3,342. 7,245.8,204.5 HU;and the difference between the twogroups has no statistical significance （ t = 0. 298, P 〉 0. 05 ）. The CT value of the arteries of the two groups from radiologist B was respectively 337. 3,329. 5,239. 2,192. 8,345.6,341.2,247. 1,210. 5 HU;and the difference between the two groups hasno statistical significance （t = 0. 233,P 〉 0. 05 ）. Conclusion On the CTA exams with 64-slice spiral CT, good CTA image quality can be acquired with reduced contrast close and saline flush,thereby we can afford reliable diagnostic information for the clinicians.