高浓度对比剂联合“三低”方案行颈动脉CTA可行性分析

Feasibility analysis of high concentration contrast agent combined with"three low"scheme for carotid artery CTA

目的分析采用高浓度对比剂联合低管电压、低剂量、低流速注射方案行颈动脉CTA的可行性。方法于2020年10月~2021年10月收集120例于我院预行颈动脉CTA的患者,随机分为A_(1)、A_(2)、B_(1)、B_(2)4组,每组30例。对比剂注射及扫描方案如下:A_(1)组,碘帕醇(370mg I/mL),注射剂量65mL,注射流速5.0mL/s,扫描管电压120kV;A_(2)组,碘帕醇(370mg I/mL),注射剂量65mL,注射流速5.0mL/s,扫描管电压100kV;B_(1)组,碘美普尔(400mg I/mL),注射剂量45mL,注射流速4.0mL/s,扫描管电压100kV;B_(2)组,碘美普尔(400mg I/mL),注射剂量45mL,注射流速4.0mL/s,扫描管电压80kV。对图像质量进行主观评分,并测量客观评价指标:颈动脉强化血管CT值、信噪比(SNR)和对比度噪声比(CNR),以及辐射剂量指标:容积CT剂量指数(CTDIvol)、辐射剂量长度乘积(DLP)和有效辐射剂量(ED),比较4组患者间所有指标的差异。结果4组患者的图像质量主观评分差异无统计学意义(P>0.05);客观评价差异均有统计学意义(A_(1)、B_(1)、B_(2)>A_(2),P<0.001);辐射剂量差异有统计学意义(B_(2)<B_(1)<A_(2)<A_(1),P<0.001);对比剂外渗差异有统计学意义(P<0.05)。结论高浓度对比剂联合“三低”方案行颈动脉CTA能在保证图像质量的同时降低有效辐射剂量以及对比剂外渗的风险。

Objective To analyze the feasibility of carotid artery CTA with high concentration contrast agent combined with low tube voltage,low dose and low flow rate injection.Methods 120 patients who underwent carotid artery CTA in our hospital from October 2020 to October 2021 were prospectively collected and randomly divided into four groups:A_(1),A_(2),B_(1)and B_(2),each group has 30 patients.The scanning scheme was as follows:A_(1)group,iodipanol(370mg I/mL)65mL,flow rate 5.0 mL/s,tube voltage 120kV;Group A_(2),iopanol(370mg I/mL)65mL,flow rate 5.0mL/s,tube voltage 100kV;Group B_(1),iomeprol(400mg I/mL)45mL,flow rate 4mL/s,tube voltage 100kV;Group B_(2),imemeprol(400mg I/mL)45mL,flow rate 4mL/s,tube voltage 80kV.Subjective scores were performed for the image quality of patients in the four groups,and objective evaluation indexes were measured:CT value of carotid artery enhancement vessels,SNR and CNR,as well as radiation dose indexes:CTDIvol,DLP and ED.Differences of all indexes among the four groups were compared.Results There was no significant difference in subjective scores of image quality among the four groups(P>0.05).Objective evaluation of image quality showed statistically significant difference(A_(1)、B_(1)、B_(2)>A_(2),P<0.001).The difference of radiation dose was statistically significant(B_(2)<B_(1)<A_(2)<A_(1),P<0.001).There was statistical significance in extravasation of contrast agent(P<0.05).Conclusion The combination of high concentration of contrast agent and"three low"regimen for carotid CTA can guarantee image quality and reduce the effective radiation dose and the risk of contrast extravasation.