左右肘静脉注射对比剂对不同部位CT血管成像效果影响的研究进展

Advances of the study on the impact of intravenous injection of contrast agentinto left and right elbow on CT angiography at different sites

多层螺旋CT血管成像(MSCTA)作为一项简便、快捷、无创的检查技术已广泛应用于冠状动脉、肺动脉、头颈动脉、主动脉等的成像,并已逐渐取代数字减影血管造影(DSA)成为诊断血管性疾病首选的影像学检查方法。但在临床工作中,如何获得一幅高质量的MSCTA图像对可靠、准确地诊断血管性疾病具有十分重要的意义。而对如何提高MSCTA的图像质量既往的研究主要围绕如何减少对比剂用量、改变扫描方向和快速注射对比剂等方案,近年研究发现,由于左头臂静脉和右头臂静脉在解剖学上存在差异,右头臂静脉较短且几乎呈垂直状下降汇入上腔静脉,左头臂静脉则较长,起自左锁骨胸骨端的后方,跨过左胸廓内动脉、左锁骨下动脉和左颈总动脉、左膈神经、左迷走神经、气管和头臂干前方再汇入上腔静脉,主动脉弓位于其下方,经左肘静脉注入对比剂易受上述这些毗邻结构的影响,因此,相较经左肘静脉注射对比剂,经右肘静脉注射对比剂能更有效提高靶血管内对比剂浓度,其冠状动脉、肺动脉、头颈动脉、主动脉等MSCTA的成像效果要优于经左肘静脉注射对比剂,本文对这一研究进展进行简单综述。

As a simple,fast and non-invasive examination technique,multi-slice spiral CT angiography(MSCTA)has been widely used for the imaging of coronary arteries,pulmonary arteries,head and neck arteries,aorta,etc.,and has gradually replaced digital subtraction angiography(DSA)to be the preferred imaging examination method for the diagnosis of vascular diseases.In clinical practice,how to obtain a high-quality MSCTA image is of great importance for reliable and accurate diagnosis of vascular diseases.However,previous studies mainly focused on the reduction of the amount of contrast,change of the scanning direction and quick injection of contrast agent to improve the quality of MSCTA image.Recent studies have found that due to the anatomical differences between the left brachiocephalic vein and the right brachiocephalic vein,the right brachiocephalic vein is shorter and descends almost vertically into the superior vena cava,while the left brachiocephalic vein is longer,starting from the posterior location of the sternal end of the left clavicle and crossing the left internal thoracic artery,left subclavian artery and left common carotid artery,left phrenic nerve,left vagus nerve,trachea and anterior brachiocephalic trunk and then converging into the superior vena cava,with the aortic arch located below it.Accordingly,contrast agent injection via the left elbow vein is susceptible to the influence of these adjacent structures.Therefore,compared with contrast agent injection via the left elbow vein,contrast agent injection via the right elbow vein can more effectively increase the contrast concentration in the target vessel,and the imaging effect of MSCTA of coronary artery,pulmonary artery,head and neck artery,and aorta is better than that of contrast agent injection via the left elbow vein.This paper intends to briefly review this study advances.