小剂量呋塞米分次团注对比剂法在多层螺旋CT尿路成像中的应用分析

Application of low dose of furosemide and fractionated injection in imaging technology of the MSCTU

目的探讨静脉注射小剂量呋塞米后分次团注对比剂在多层螺旋CT尿路成像(MSCTU)检查中的应用价值。方法收集该院2010年3月至2011年6月行CTU检查的患者60例(其中男34例,女26例,平均年龄52岁,年龄范围14～78岁),随机(数字表法)分为传统法CTU组(30例)及改良法CTU组(30例),检查设备采用GE公司产Lightspeed VCT(64排)。传统法CTU组共扫描4期,即平扫、增强动脉期及肾实质期、并于注射对比剂后30 min扫描排泄期,扫描条件为管电压120 kVp,管电流400 mA,球管转速0.4 s·r-1,扫描范围包括全尿路区;改良法CTU组先缓慢静脉注射(注射时间不短于1 min)呋塞米10 mg(或0.1 mg·kg-1体重),再行全尿路区平扫,于注射呋塞米后约2～3 min用高压注射器注射碘海醇(300 gI·L-1)65 ml,3.5 ml·s-1,延迟后5～10 min后再次注射对比剂35 ml,并于第二次对比剂注射后100～120 s启动增强扫描程序;即改良法CTU共扫描2期,平扫和实质、排泄组合期,扫描参数同传统法CTU。扫描结束后,原始数据行薄层(0.625 mm)重建,并传至GE AW4.4工作站,采用VR、MPR、MIP、CPR等方法行尿路成像后处理,并评价两种方法对尿路的显示效果和诊断效能。结果改良法CTU能清晰显示泌尿系统整体和局部细微结构、走形及与周围组织关系,因减少2期扫描,故能明显减少受检者所接受的辐射剂量。结论小剂量呋塞米分次团注对比剂法MSCTU检查,在泌尿系统显示更加完整的同时患者辐射剂量明显降低,改良法CTU明显优于传统法CTU,是泌尿系统病变可靠的新型影像学检查方法。

Objective To explore the diagnostic value of intravenous injection of furosemide and low dose bolus injection of contrast medium graded method in the application value of multi-slice CT urography.Methods Sixty patients with CTU examination from March 2010 to June 2011 were collected,including 34 males and 26 females,median age 55 years,age 14 to 78 years.The patients were randomly divided into 2 groups： traditional CTU group（30 people）,modified CTU group（30 people）.Checkout set was Light Speed VCT（64 rows） from GE.Traditional CTU group had 4 periods of scanning,which consisted of plain CT scanning,strengthened artery period,renal parenchyma period,and scanning discharge period 30 minutes after the inject on of contrast agents.Scanning conditions were Tube voltage 120kVp,Tube current 400mA,bulb tube speed 0.4 s·r-1.Scanning scope included all the urinary area.Modified CTU group had slow intravenous injection first（Injection time not less than 1 minute）,furosemide 10mg or 0.1 mg·kg-1,then all the urinary areas had plain CT scan.Injectning（300 mgI/ml）65ml,3.5 ml·s-1was injected by using high pressure injector in injecting furosemide after about 2 ～ 3 min,delay 5～10 min,then contrast agents 35ml.And after the second injection of contrast agents 100 ～ 120s we started enhancing scanning program;the modified CTU group had two periods,including plain CT scanning and the combination of renal parenchyma period and scanning discharge period.Sweep parameters were the same as those of traditional CTU group.After scanning,original data carried out thin layer reconstruction,uploaded to GE AW4.4 workstation.Post-processing was carried out for urinary imaging by using VR,MPR,MIP,CPR and other methods of renal artery imaging,urinary tract imaging.At the same time,The display effect and diagnostic performance of the two methods in urinary tract were evaluated.Results The modified method of CTU group could clearly displayed the whole urinary system and the local minute structure,the urinary system of shape and the relationship with adjacent tissue,because of the reduction of 2 periods of scanning.Then patients could significantly receivd the lower radiation dose.Conclusion Small doses of furosemide in a bolus injection of contrast agent MSCTU make the image more clearly more fully display the details,without missing small lesions.Patients also receive significantly lower doses of radiation.Improved CTU is significantly better than the tradition CTU.It is a new type of reliable imaging method for urinary system diseases.