64排螺旋CT冠状动脉成像中降低对比剂用量的初步研究

Initial Experience in Reducing the Amount of Contrast Media in Sixty-Four-Slice Spiral CT Coronary Angiography

目的:研究多排螺旋CT冠状动脉成像时降低对比剂剂量、注射速率及对比剂浓度的可行性。材料与方法:100例可疑或确诊冠心病而行CT冠状动脉造影的患者,随机分为五组,每组20例。对比剂剂量、注射速率、对比剂浓度分别设为A组70m L、5.0m L/s,以5ml/s速率追加30ml盐水,B组50m L、5.0m L/s,以5ml/s速率追加30ml盐水,C组50m L、3.5m L/s、以3.5ml/s速率追加30ml盐水。D组60m L、4m L/s、以4ml/s速率追加30ml盐水。E组50m L、4.5m L/s、以4.5ml/s速率追加30ml盐水。A、B组,扫描触发点设定于主动脉弓;C、D、E组,扫描触发点设定于降主动脉。应用美国心脏协会(AHA)冠状动脉改良分段法进行冠状动脉成像质量评价。测量各段冠状动脉管腔内CT值。分别比较各方法获得的冠状动脉成像质量与管腔内CT值。使用SPSS14.0行统计学分析,采用秩和检验Wilcoxon法,当P<0.05时,差异有统计学意义。结果:图像成像质量比较,A组与D组比较,P>0.05,两组间差异没有统计学意义。B、C、E各组间的成像质量比较,P>0.05,差异没有统计学意义。A、D与其余三组间差异有统计学意义,P<0.05。结论:注射速率4ml/s、总量60ml追加生理盐水30ml的对比剂注射方案,能够在减少对比剂用量的同时,保持与应用70ml对比剂相同的诊断效能。

Purpose： To evaluate how to decrease the Iodine intake of patients by using the least contrast quantity and iodine concentration in 64-detector computed tomography coronary imaging. Materials and Methods： 100 patients underwent CT coronary angiography using 64-detector CT who were known or suspected as CAD was randomly divided into five groups： A, B, C, D and E. Contrast quantity, velocity of injection and iodine concentration was respectively used as 70ml contrast （5.0mL/s） and 30ml saline（5.0ml/s） in group A; 5Oral contrast （5.0mL/s） and 30ml saline（5ml/s） in group B; 50ml contrast （3.5mL/s） and 3Oral saline（3.5ml/s） in group C; 60ml contrast （4. 0mL/s） and 30ml saline（4ml/s） in group D; 50ml contrast （4. 5mL/s） and 3Oral saline（4. 5ml/s） in group E. Image qualities of all coronary images according to the AHA classification were evaluated respectively. CT values of the cavity were measured respectively. Image qualities and CT values of every group were compared by using Wilcoxon rank sum test respectively. There was significant difference when P 〈 0.05. Results： There was no significant difference between the image quality of group A and D. There was no significant difference between the image quality of group B, C and E. There was no significant difference between the CT values of 50ml contrast groups. There was significant difference between the CT values of AD and BCE groups. Conclusion： Images with the same quality could be obtained by using lower contrast amount, velocity of injection and iodine concentration, such as 60ml contrast （4. 0mL/s） and 30ml saline（4ml/s）.