“双低”注射方案在64排螺旋CT冠状动脉成像中应用的可行性研究

Feasibility Study on Application of Using Low-dose and Low-rate Injection Project in 64-multi Spiral Computed Tomography Coronary Angiography

目的:探讨在64排螺旋CT冠状动脉成像中使用低剂量对比剂及低速率注射方案的可行性。方法:经伦理委员会批准选取2016年9月-2017年1月笔者所在医院收治的疑似冠心病患者60例,按检查顺序分为试验组A组和对照组B组,每组30例,A组采用50 ml对比剂碘美普尔400联合生理盐水50 ml以3.5 ml/s的速度注射,B组采用90~100 ml碘佛醇320联合生理盐水50 ml以4.5 ml/s的速度注射,两组均在64排螺旋CT行冠状动脉成像扫描,运用冠状动脉专用分析软件及VR、MIP等后处理技术对原始数据进行处理,由两名医师对影像结果进行分析评价,比较两种对比剂的理化性质、各血管CT值、主观图像质量评分。结果:碘美普尔相对分子量、渗透压及黏滞度均低于碘佛醇,含碘量高于碘佛醇,其理化性质优于碘佛醇;两组患者相关各血管CT值比较差异均无统计学意义(P>0.05);两组患者主观图像质量合格率比较差异无统计学意义(P>0.05)。结论:使用低剂量对比剂及低速率的注射方案在64排螺旋CT冠脉成像中具有可行性,在保证诊断图像质量的同时还能实现"双低",减轻对比剂副作用对患者的损伤,有较好的临床应用价值。

Objective：To explore the feasibility of using low-dose contrast and low-rate injection protocol in 64-multi spiral computed tomography（64-MDCT）coronary angiography.Method：With the approval of the ethics committee,60 patients with suspected coronary heart disease who were admitted to the author＇s hospital from September 2016 to January 2017 were selected and divided into experimental group A and control group B according to the examination order,30 cases in each group.In group A,50 ml the contrast agent Iomeprol 400 combined with normal saline 50 ml was injected at a rate of 3.5 ml/s.In group B,90-100 ml Ioversol 320 and normal saline 50 ml were injected at a rate of 4.5 ml/s.Both groups performed coronary imaging scans on 64-MDCT.The coronary analysis system software and the reconstruction technique methods such as VR,MIP were used processing for the original data of coronary and its main branches.The images evaluated by two physicians.The physical and chemical properties of the two contrast agents, CT values of each blood vessel, and subjective image quality scores were compared.Result：The relative molecular weight,osmotic pressure and viscosity of Iomeprol were lower than those of Ioversol,and the Iodine content of Iomeprol was higher than that of Ioversol.The physicochemical properties of Iomeprol were superior to those of Ioversol.There was no significant difference in CT values of the blood vessels between the two groups（P〉0.05）.There was no significant difference in the subjective image quality qualification rate between the two groups（P〉0.05）.Conclusion：The use of low-dose contrast agent and low-rate injection protocol is feasible in 64-MDCT coronary angiography,not only ensure the image quality but also lower the contrast dose and the injection rate,lessen the harm from the side effect of the contrast material to the patients,which has good value in the application of the clinic.