低浓度对比剂心脏CT扫描方案在儿童中的应用

Application of low concentration contrast media for enhanced CT scan in children with congenital heart disease

目的探讨使用低浓度对比剂270 mg I/m L碘克沙醇在儿童先天性心脏病增强电子计算机断层扫描(Computed tomography,CT)检查中应用的可行性。方法分析首都医科大学附属北京儿童医院自2014年11月至2015年6月拟诊为先天性心脏病的60例患儿,采用数字表法随机分为两组:A组为实验组,B组为对照组,各30例患者,均采用相同参数标准的前瞻性心电门控扫描方案,A组使用270 mg I/m L碘克沙醇,B组使用320 mg I/m L碘克沙醇。两组均使用Discovery CT750 HD(GE Healthcare)进行心脏增强CT扫描,对比剂流率及用量均采用相同标准的个体化给药标准。扫描数据均经30%自适应统计迭代重建(adaptive statistical iterative reconstruction,ASIR),对比两组病例的影像主客观质量评价、造影剂使用量、诊断符合率。结果两组图像均满足诊断要求,诊断符合率差异无统计学意义(P>0.05)。两组图像客观噪声、信噪比差异无统计学意义(P>0.05)。对照组心室强化度、对比噪声比优于实验组。两组图像质量主观评分差异无统计学意义(P>0.05)。结论低浓度对比剂进行心脏增强CT扫描获得的影像能够满足儿童先天性心脏病诊断需求,可降低对比剂肾病的风险。

Objective To explore the feasibility of low concentration contrast media 270 mg I/m L iodixanol for enhanced computed tomography（ CT） examination of congenital heart disease in children. Methods Sixty patients with congenital heart disease were randomly divided into two groups with 30 cases in each. Groups A and B were scanned with prospective ECG gated scanning scheme. In Group A 270 mg I / m L iodixanol and in group B 320 mg I / m L iodixanol was used. All the cases were scanned on a CT750 HD Discovery（ Healthcare GE） with the same parameters of injection of the contrast media. The scanning data were reconstructed by the 30% ASIR,and the two groups of cases were compared with subjective and objective quality evaluation,the dosage of contrast media,and the diagnostic accordance rate. Results All images in two groups met the diagnostic requirements; diagnostic coincidence rate showed no significant difference. Ventricular enhanced degree and contrast to noise ratio of group B were better than those of group A. Comparison of the objective noise and signal to noise ratio and subjective image quality score of the two groups have no significant difference. Conclusion The image of enhanced CT scan with low concentration contrast media can meet the diagnostic requirements for children with congenital heart disease,and can reduce the risk of contrast induced nephropathy.