64排VCT直接法锁骨下静脉和上腔静脉联合成像效果及其影响因素

Effect of combined imaging by 64 slice VCT direct method of subclavian vein and superior vena cava and its influencial factors

目的探讨64排CT(volume CT,VCT)直接法锁骨下静脉和上腔静脉联合成像效果及其影响因素,寻求较为理想的CT直接法造影方案。方法选择锁骨下静脉和上腔静脉疾病患者34例,采用不同对比剂浓度、不同注射速率进行CT直接法锁骨下静脉和上腔静脉联合造影检查,并对图像进行对比分析,21例与X线锁骨下静脉和上腔静脉数字减影血管造影(DSA)进行分节段静脉显示能力对比分析。结果血流相关性伪影为影响CT锁骨下静脉和上腔静脉造影图像质量的主要因素,注射速率1.5mL/s和2.5 mL/s组的图像评级差异有统计学意义(χ2=5.241,P=0.021),对比剂稀释浓度为25%与15%的图像评判差异无统计学意义(χ2=3.526,P=0.073)。CT直接法锁骨下静脉和上腔静脉联合造影检查与DSA造影在右锁骨下静脉、右头臂静脉、左锁骨下静脉、左头臂静脉、上腔静脉显示能力相同(χ2=2.078,P=0.139),CT显示双侧锁骨下静脉的能力优于DSA造影(χ2=8.251,P=0.004)。结论CT显示双侧锁骨下静脉的能力优于DSA造影;采用延迟22 s经双侧肘正中静脉直接法以2.5 mL/s注射速率,52 mgI/mL浓度可获得非常满意的诊断图像。

Objective To explore the effect and influencial factors of direct method subclavian vein and superior vena cava combined imaging by 64 slice volume CT （VCT） , and to seek the ideal scheme of direct method combined CT imaging. Methods Thirty-four patients with the subclavian vein and superior vena cava diseases were performed with direct method combined CT imaging by different contrast agent concentration and different injection rate, then the ima- ges were compared and analysed, at last, 21of 34 patients were compared segmentally with the subclavian vein and superior vena cava digital subtraction angiography （DSA）. Results Blood flow associated artifacts was the main influeneial factors of CT angiography image quality of subclavian vein and superior vena cava, the injection rate of 1.5 mL/s and 2.5 mL/s group image rating were significant different （X2 = 5. 241, P = 0. 021 ）, contrast agent dilution con- centration of 25% and 15% image evaluation were not different （X2 =3. 526, P =0. 073）. CT direct method of subclavian vein and superior vena cava combined with angiography and DSAangiography in fight subclavian vein, fight brachiocephalic vein, left subclavian vein, left bra- chioeephalic vein, superior vena cava showed the same ability （X2 =2. 078, P =0. 139）. The images of CT in bilateral subclavian vein were better than that of DSA angiography （X2 = 8.251, P = 0. 004 ）. Conclusion The images of CT in bilateral subclavian veins are better than that of DSA ; The images of direct method combined CT imaging with 22 s delay, 2.5 mL/ s injection rate and 52 mg/mL concentration are very satisfactory.