Ultrasound-guided carotid angioplasty and stenting in a patient with iodinated contrast allergy:A case report

BACKGROUND Ischemic stroke is an entity with high incidence,morbidity,and mortality rates.Carotid artery stenosis is an important and independent risk factor for ischemic stroke.The three current approaches for treating carotid artery stenosis are drug treatment,carotid endarterectomy(CEA),carotid angioplasty and stenting(CAS).The approach is chosen based on the degree of stenosis.CEA or CAS could have been chosen for the current patient,who had severe carotid stenosis and an iodinated contrast allergy.After thoroughly communicating with the patient,the patient chose CAS for treatment.Therefore,we performed ultrasound-guided CAS to avoid the use of iodinated contrast.CASE SUMMARY The main symptoms of the patient were numbness and weakness of the left limb.Computed tomography angiography of the head and neck at another hospital indicated multiple sites of stenosis in the arteries of the head and neck.The patient requested CAS for treatment but was allergic to iodinated contrast media.Thus,routine digital subtraction angiography(DSA)with iodinated contrast could not be used for the procedure.The diagnosis of this patient was as follows:(1)Right parietal lobe cerebral infarction;(2)multiple sites of stenosis in the arteries of the head and neck(severe stenosis of the right internal carotid artery,severe stenosis of the right subclavian artery);(3)right subclavian steal syndrome;and(4)hypertension(stage 3,high risk).The interventions included routine treatment for cerebral infarction,oral administration of clopidogrel(75 mg qd)and aspirin(100 mg qd),ultrasound-guided CAS,and postoperative follow-up.Postoperative color Doppler ultrasound and cerebrovascular magnetic resonance angiography of the carotid artery showed good vascular recovery,and the postoperative follow-up indicated a good prognosis.CONCLUSION This case study suggests that ultrasound-guided endovascular treatment is a potential option for patients with contraindications to the iodinated contrast agents used in DSA-guided surgery,although excellent surgical operating skills are needed.

Shellfish allergy and relation to iodinated contrast media: United Kingdom survey

AIM: To assess current practice of United Kingdom cardiologists with respect to patients with reported shellfish/iodine allergy, and in particular the use of iodinated contrast for elective coronary angiography.Moreover we have reviewed the current evidence-base and guidelines available in this area.METHODS: A questionnaire survey was send to 500senior United Kingdom cardiologists(almost 50% cardiologists registered with British Cardiovascular Society)using email and first 100 responses used to analyze practise. We involved cardiologists performing coronary angiograms routinely both at secondary and tertiary centres. Three specific questions relating to allergy were asked:(1) History of shellfish/iodine allergy in pre-angiography assessment;(2) Treatments offeredfor shellfish/iodine allergy individuals; and(3) Any specific treatment protocol for shellfish/iodine allergy cases. We aimed to establish routine practice in United Kingdom for patients undergoing elective coronary angiography. We also performed comprehensive PubMed search for the available evidence of relationship between shellfish/iodine allergy and contrast media.RESULTS: A total of 100 responses were received, representing 20% of all United Kingdom cardiologists. Ninety-three replies were received from consultant cardiologists, 4 from non-consultant grades and 3 from cardiology specialist nurses. Amongst the respondents, 66% routinely asked about a previous history of shellfish/iodine allergy. Fifty-six percent would pre-treat these patients with steroids and anti-histamines. The other 44% do nothing, or do nonspecific testing based on their personal experience as following:(1) Skin test with 1 mL of subcutaneous contrast before intravenous contrast;(2) Test dose 2 mL contrast before coronary injection;(3) Close observation for shellfish allergy patients; and(4) Minimal evidence that the steroid and anti-histamine regime is effective but it makes us feel better.CONCLUSION: There is no evidence that allergy to shellfish alters the risk of reaction to intravenous contrast more than any other allergy and asking about such allergies in pre-angiogram assessment will not provide any additional information except propagating the myth.

Effects of iodinated contrast on various magnetic resonance imaging sequences and field strength: Implications for characterization of hemorrhagic transformation in acute stroke therapy

AIM: To characterize the effects of iodinated contrast material(ICM) on magnetic resonance imaging(MRI) comparing different sequences and magnetic fields, with emphasis to similarities/differences with well-known signal characteristics of hemorrhage in the brain. METHODS: Aliquots of iopamidol and iodixanol mixed with normal saline were scanned at 1.5T and 3T. Signal intensity(SI) was measured using similar spin-echo(SE)-T1, SE-T2, gradient-echo(GRE) and fluid-attenuationinversion-recovery(FLAIR) sequences at both magnets. Contrast to noise ratio(CNR)(SI contrast-SI saline/SD noise) for each aliquot were calculated and Kruskall-wallis test and graphic analysis was used to compare different pulse sequences and ICMs. RESULTS: Both ICM showed increased SI on SE-T1 and decreased SI on SE-T2, GRE and FLAIR at both 1.5T and 3T, as the concentration was increased. By CNR measurements, SE-T2 had the greatest conspicuity at 3T with undiluted iopamidol(92.6 ± 0.3, P < 0.00) followed by iodixanol(77.5 ± 0.9, P < 0.00) as compared with other sequences(CNR range: 15-40). While SE-T2 had greatest conspicuity at 1.5T with iopamidol(49.3 ± 1, P < 0.01), SE-T1 showed similar or slightly better conspicuity(20.8 ± 4) than SE-T2 with iodixanol(23 ± 1.7). In all cases, hypo-intensity on GRE was less conspicuous than on SE-T2.CONCLUSION: Iodixanol and iopamidol shorten T1 and T2 relaxation times at both 1.5T and 3T. Hypo-intensity due to shortened T2 relaxation time is significantly more conspicuous than signal changes on T1-WI, FLAIR or GRE. Variations in signal conspicuity according to pulse sequence and to type of ICM are exaggerated at 3T. We postulate T2 hypointensity with less GRE conspicuity differentiates ICM from hemorrhage; given the wellknown GRE hypointensity of hemorrhage. Described signal changes may be relevant in the setting of recent intra-arterial or intravenous ICM administration in translational research and/or human stroke therapy.

Predictive Study of Velocimetry in the Coronary Artery after Iodinated Contrast Agent Injection

This study aims to determine the retention time of iodinated contrast agents (ICA) in the coronary artery. The mechanical aspect of ICA displacement was studied in order to better understand the effect of these products on the inner wall of the artery of patients with coronary artery stenosis, undergoing repeated imaging examinations with iodinated contrast agents. ICA flow, ICA and blood flow in the artery were modelled. The fluid was regarded to be viscous, incompressible and Newtonian. Blood flow was presumed to be unidirectional, laminar and unstationary. Iodine flow velocity and retention time were calculated using the Runge-Kutta 4th order method programmed in C++ and MatLab R2013a language. The results showed that for coronary artery CT-scans, ICA retention time is 1 minute 40 seconds and for coronary arteriography it is between 2.41 and 3.61 seconds. The values calculated were compared to theoretical values and to clinical observations. The results enabled us to validate our model.

Molecular interactions between anticancer drugs and iodinated contrast media: An in vitro spectroscopic study

Purpose: The purpose of this study is to assess molecular interactions between several anticancer drugs and an iodinated contrast medium by Fourier transform infrared spectroscopy (FT-IR) and ultraviolet-visible spectroscopy (UV-Vis). Materials and Methods: Iopamidol (IPM) was used as an iodinated contrast medium, and mitomycin C (MTI), epirubicin hydrochloride (EPI), cisplatin (CDDP), 5-fluorouracil (5FU), irinotecan hydrochloride (CPT11), gemcitabine hydrochloride (dFdC), carboplatin (CBDCA), oxaliplatin (1OHP), paclitaxel hydrochloride (TAX) and docetaxel trihydrate (TXT) were used as anticancer drugs. For FT-IR, the purified IPM was mixed stoichiometrically with each anticancer drug as well as with a combination of MTI and EPI. After measuring each separated sample and the mixtures, the spectra of the mixtures were compared with the spectra of the sum of pure samples or the combination. For UV-Vis, IPM and anticancer drugs were dissolved in pure water;subsequently for the titration experiments, the mixtures were prepared by varying the molar ratio. IR absorption corresponds to stretching vibrations between atoms having covalent bonding, whereas UV-Vis spectra depend on molecular dynamics and shapes. Both UV-Vis and IR spectra change when there are molecular interactions such as aromatic ring stacking and hydrogen bonding. Result: IPM exhibited molecular interactions with MTI, EPI, CDDP, dFdC, CBDCA, 1OHP, TAX and TXT, as well as with the combination of MTI and EPI on FT-IR. However, molecular interactions were not observed on UV-Vis. Conclusion: Several anticancer drugs have molecular interactions with IPM, which could be clinically utilized for superselective intraarterial infusion chemotherapy.

Thyroid Dysfunction in Children Exposed to Iodinated Contrast Media:A Meta-Analysis and Systematic Review

Iodinated contrast media(ICM)has the potential to cause thyroid dysfunction in some patients.However,it is unclear whether this relationship exists in children.We conducted a systematic review and meta-analysis aim to obtain a general overview of the relationship between ICM exposure and the risk of thyroid dysfunction in children.Methods:Computer search of Web of Science,EMbase,PubMed,Cochrane Library,collection of relevant literature on ICM and thyroid dysfunction in children,the search period was from the establishment of the database to July 2021.Meta-analysis was performed using Stata 14.0 software.Results:A total of 8 literatures with 3497 children.The incidence of hypothyroidism in children with ICM exposure was 0.05(95%CI:0.05,0.12),P<0.0001.Subgroup analysis showed that the incidence of hypothyroidism in ICM exposed children in the European region was 0.21(95%CI:0.13,0.30),P<0.0001,a statistically significant difference.Conclusion:The current evidence shows that children exposed to ICM are at risk for hypothyroidism,with a higher risk in neonates,especially children with congenital heart disease.

Application of Low Tube Voltage, Low-concentration Contrast Agent Using a 320-row CT in Coronary CT Angiography: Evaluation of Image Quality, Radiation Dose and Iodine Intake

The effect of low voltage and low concentration contrast agent on image quality of coronary CT angiography,radiation dose and iodine intake was evaluated.A total of 121 patients with body mass index(BMI)<26 kg/m2 and heart rate(HR)<70 beats/min were randomly divided into four groups:group A(n=31,80 kVp,270 mgl/mL);group B(n=33,100 kVp,270 mgl/mL);group C(h=30,100 kVp,320 mgl/mL);group D(w=27,100 kVp,400 mgl/mL).The automatic current modulation system and the iterative algorithm for reconstruction were adopted in each group.The CT values and SD values of the aortic root(AR),subcutaneous fat,left coronary artery opening(LCA),and right coronary artery opening(RCA)were measured in all groups,the signalto-noise ratio(SNR)and contrast noise ratio(CNR)were calculated,and effective radiation dose and iodine intake were recorded.The subjective assessment for image quality was performed by two physicians using a 4-point scale.The results were compared using the one-way ANOVA and rank sum tests.The image quality of the four groups met the clinical diagnostic requirements.The CT values of AR in groups A,B,C,and D were 537.6±71.4,447.2±81.9,445.2±64.9 and 518.5±94.9 Hu,respectively,with no significant difference between group A and group D,or between group B and group C,while CT values in groups B and C were significantly lower than those in groups A and D(P<0.05).In groups A,B,C,and D,the LCA SNR values were 22.7±9.1,23.3±9.1,23.3±7.7 and 26.6±8.9,and the RCA CNR values were 26.9±9.&28.5±11.4,27.7土&8 and 32」±10.6,respectively.The AR visual scores in groups A,B,C and D were 3.8±0.2,3.9±0.3,3.9±0.3 and 4.0±0.3,respectively.There were no significant differences in SNR,CNR and visual score among the four groups(P>0.05).The radiation doses in groups A,B,C and D were 2.6±1.4,3.6±1.&4.9±3.5 and 4.9±2.8 mSv,respectively.The radiation dose in group A was significantly less than that in the rest three groups(P<0.05).The iodine intakes in groups A,B,C and D were 14.9±1.5,15.0±1.5,17.7±2.0 and 18.1±2.5 g,respectively.There was no significant difference in the intake of iodine between groups C and D,or between groups A and B,while iodine intake in groups A and B were significantly reduced as compared with that in groups C and D(P<0.05).It was concluded that for patients with low BMI and controlled HR,compared to 100 kVp tube voltage combined with multiple concentration contrast agents,80 kVp combined with 270 mgl/mL contrast agent is enough to ensure the quality of the images,and can reduce the radiation dose significantly,while reducing the amount of iodine intake notably,thus reducing the incidence of adverse reaction.

Protective Effect of Oral Steroid Premedication: Adverse Reactions to Nonionic Iodine Contrast Media for Computed Tomography

This study aimed to investigate the protective effect of oral steroid premedication in terms of adverse reactions to non-ionic contrast media. We investigated the incidence of adverse reactions among patients who underwent contrast-enhanced computed tomography. Patients in the premedication group took 30 mg of prednisolone orally the night before and on the morning of the scheduled computed tomography. Sixty-five patients received the same contrast media. Among them, 56 took prednisolone orally prior to the procedure (premedication without change of contrast media group) and nine without premedication (no premedication and no change of contrast media group). In total, 379 patients received different contrast media. Among them, 340 took prednisolone orally (premedication with change of contrast media group), while 39 did not take the premedication (no premedication with change of contrast media group). The adverse reaction rates in the premedication with change of contrast media and no premedication with change of contrast media groups were 1.8% (6/340 cases) and 2.6% (1/39 cases) (P = 0.54), respectively. The incidence of adverse reaction after the administration of non-ionic iodinated contrast media did not differ significantly based on whether an oral steroid was administered prior to compute tomography. Our evaluation is limited due to the small sample size of the contrast media-changed group. However, even if premedication with steroids is effective, it may only result in an adverse reaction reduction rate of ≤3%.

低浓度碘对比剂在肥胖患者冠状动脉计算机断层扫描血管造影检查中的应用

目的探究低浓度碘对比剂在肥胖患者低管电压冠状动脉检查中的应用。方法2020年8月至2021年5月前瞻性入选玉林市第一人民医院80例疑似冠状动脉粥样硬化性心脏病(冠心病)行冠状动脉计算机断层扫描血管造影(coronary computed tomography angiography,CCTA)检查的肥胖患者。按随机数字表法分组,每组40例。高浓度组采用优维显浓度为370 mgI/mL,低浓度组采用优维显浓度为300 mgI/mL,均进行低管电压CCTA检查。比较两组患者图像的质量、辐射剂量、碘摄入量及注入率、注射对比剂外渗率、不适感及检查前后肾功能指标、对比剂肾病发生情况,并以数字减影血管造影(digital subtraction angiography,DSA)为“金标准”评价低浓度碘对比剂对中度及以上动脉血管狭窄的鉴别诊断价值。结果低浓度组患者的图像质量分值与高浓度组比较,差异无统计学意义[(4.29±0.37)分vs.(4.32±0.36)分,P>0.05],且2名医师对图像质量评估的一致性较高(P<0.05)。两组患者冠状动脉各节段计算机断层扫描(computed tomography,CT)值、对比噪声比(contrast-to-noise ratio,CNR)、信噪比(signal-to-noise ratio,SNR)及图像优良指数(figure of merit,FOM)比较,差异均无统计学意义(P>0.05)。两组患者容积CT剂量指数(volumetric CT dose index,CTDIvol)、有效剂量(effective dose,ED)及造影剂量比较,差异无统计学意义(P>0.05);低浓度组患者总碘用量及碘注入率均少于高浓度组,差异有统计学意义(P<0.05)。相较于治疗前,两组患者治疗后肾功能指标均有所上调,且低浓度组较高浓度组低,差异有统计学意义(P<0.05)。低浓度组患者注射对比剂热感、疼痛感及对比剂肾病发生率均低于高浓度组,差异有统计学意义(P<0.05)。以DSA检查为“金标准”,Kappa检验结果显示,低浓度碘对比剂与DSA诊断动脉血管狭窄程度的一致性较高(P<0.05),且低浓度对比剂对中度及以上动脉血管狭窄的诊断准确率为95.06%。结论低浓度对比剂应用在肥胖患者低管电压条件下行CCTA检查,在保证图像质量及诊断动脉血管狭窄准确率前提下,可明显减少碘摄入量,降低不良反应发生率,值得临床推广与应用。

碘对比剂全程化药学服务共识

目的探讨碘对比剂全程化药学服务模式,促进碘对比剂的临床合理使用。方法中国医药教育协会临床合理用药专业委员会和广东省药学会用药评价与临床科研专家委员会组织国内专家,成立《碘对比剂全程化药学服务共识》工作组,针对碘对比剂的发展历程、适应证、禁忌证、不良反应、药物相互作用、特殊人群用药、药学服务等进行文献检索、循证分析和研讨,梳理全程化药学服务的内容与流程,最终形成共识。结果制定的碘对比剂全程化药学服务共识包括检查前对患者、肾功能、合并用药和水化方案的评估,检查中有无发生对比剂外渗或发生(可疑)急性不良反应,检查后的观察时间点和随访等内容,以药学服务流程图展示各阶段的具体工作,并形成用药监护记录表用以记录工作情况。结论本共识构建了碘对比剂全程化药学服务体系,为临床医生、护理人员合理使用该类特殊药品提供了科学依据,也为药师进行相关药学服务提供了参考。

基于德尔菲-熵权法的碘对比剂外渗风险评估体系的构建

目的联合德尔菲法和熵权法构建碘对比剂静脉外渗风险评估体系,为碘对比剂使用风险筛查提供参考依据。方法以4R危机管理理论为指导,通过文献循证研究,结合临床数据回顾分析,形成碘对比剂外渗风险评估体系初稿,采用目的抽样的方法选取20名长期从事碘对比剂外渗研究的医学、护理专家,运用德尔菲(Delphi)法进行评估体系的修订,最后应用熵权法确定指标权重系数。结果碘对比外渗风险评估体系包括患者因素、注射因素、药物因素、疾病因素4个维度(一级指标),根据不同维度的特征确定了13个二级指标,对二级指标应用熵权法进行权重计算,确定了年龄、导管留置时间、导管留置部位、基础疾病和血管情况5个关键指标。结论基于德尔菲—熵权法构建的碘对比剂静脉外渗风险评估体系具有重要性、科学性和实用性,可为碘对比剂静脉外渗风险评估提供科学依据。

Revolution CT 70 kVp低管电压联合等渗碘对比剂在头颈心“一站式”CTA中的应用价值

目的探讨Revolution CT 70 kVp低管电压联合等渗碘对比剂(碘克沙醇320 mgI/mL)在头颈心“一站式”CT血管成像(Computed Tomography Angiography,CTA)中的应用价值。方法前瞻性收集我院2022年8月至2023年4月行头颈心“一站式”CTA的患者50例,并按随机数字表法分为A、B两组,各25例。A组管电压70 kVp,碘克沙醇320 mgI/mL;B组管电压100 kVp,碘美普尔400 mgI/mL,对比剂剂量均按0.7 mL/kg计算。比较两组患者图像质量的客观评价和主观评分指标、辐射剂量和摄碘量。结果A组冠状动脉主干及分支血管、头颈部动脉的平均CT值和SD值均高于B组,差异具有统计学意义(P<0.05);但A组图像的信噪比及对比噪声比与B组相比,差异无统计学意义(P>0.05)。A、B两组冠状动脉CTA和头颈部CTA的图像质量差异均无统计学意义(P>0.05);两名医师对冠状动脉和头颈部血管图像质量的主观评分一致性好(分别为0.839、0.719和0.762、0.749)。与B组相比,A组冠状动脉CTA的有效辐射剂量(Effective Dose,ED)降低约68.68%,头颈部CTA的ED降低约65.75%,患者摄碘量降低约21.23%(均P<0.001)。结论Revolution CT 70 kVp低管电压联合等渗碘对比剂在中老年患者头颈心“一站式”CTA中具有较好的应用价值,能显著降低辐射剂量和摄碘量。

对比剂个性化在肝脏增强CT扫描的初步研究

目的探讨对比剂个性化在肝脏增强CT应用的图像质量及可重复性。方法肝脏三期增强受检者以个性化方案扫描,评价图像质量及肝实质期强化效应可重复性。结果192例受检者实际单位体重碘剂量(374.8±52.1)mgl/Kg,实际注射碘流率(1138.0±130.9)mgl/s,有效碘总量(21320.0±3017.7)mgl,肝脏EU肝实质期为(53.2±7.0)Hu。主动脉强化、动脉期时机、肝实质期强化满足诊断分别约89.06%、94.3%、97.9%;医师间主动脉强化(χ^(2)=3.333)与扫描时机(χ^(2)=1.833)、肝实质期强化效应(χ^(2)=7.667)评价未见显著差异(均P≥0.05),医师评价高度一致(kappa值分别为0.861,0.803,0.914,均P=0.000),样本均数与50Hu比较未见统计差异(t=1.745,P=0.083),变异系数为13.13%,其中16例受检者两次扫描肝实质EU分别为(49.8±6.4)Hu、(50.3±6.7)Hu,差值均数(-0.5000±2.8432)Hu与0比较未见统计差异(t=-0.703,P=0.493)。结论对比剂个性化扫描的肝脏图像质量优良、可重复性较好,易于推广应用。

碘造影剂过敏样反应相关机制及防治措施的研究进展

碘造影剂是一种广泛应用于医学影像学的重要工具,然而,由于个体差异和特定情况,部分患者在接受碘造影剂后可能会出现过敏样反应。虽然这种反应较为罕见,但其可能带来的严重并发症需要引起医学界的高度重视。为了降低碘造影剂过敏样反应的发生率,医学界进行了广泛的研究和实践,探索了多种防治措施。本论文综述了碘造影剂过敏样反应的研究进展,包括过敏样反应的临床表现与分类、发生机制、危险因素、预防措施以及治疗策略,旨在为临床医生提供更为有效的指导,保障患者安全。

心脑血管病患者CT增强检查中非离子型碘对比剂相关急性不良反应预测模型的构建

目的探究心脑血管病患者CT增强检查中非离子型碘对比剂相关急性不良反应(ICM-AARs)预测模型构建的价值。方法选取2023年1月~2023年5月期间于四川大学华西医院进行CT增强检查的心脑血管病患者2031例,统计ICM注射后1h内AARs的发生情况,从2031例患者中选取符合纳入标准的未发生AARs的患者174例,纳入未发生ICM-AARs组,发生AARs的患者58例纳入ICM-AARs组,收集并比较两组患者临床资料,采用Logistic回归分析明确导致心脑血管病患者CT增强检查中发生AARs的危险因素。应用独立危险因素构建列线图预测模型,并采用受试者工作特征曲线(ROC)、Bootstrap法验及Calibration曲线对模型进行评价。结果2031例心脑血管病患者进行CT增强检查中发生ICM-AARs 58例,ICM-AARs发生率为2.86%;ICM-AARs组有过敏史、检查前未水化、未外预热、注射速率≥3.5mL/s、静脉注射及使用碘普罗胺的人数占比均高于未发生ICM-AARs组(P<0.05);Logistic回归分析结果显示,有过敏史、检查前未水化、未外预热、注射速率≥3.5mL/s、静脉注射及使用碘普罗胺是影响CT增强检查发生ICM-AARs的独立危险因素(P<0.05);ROC曲线显示,预测模型曲线下面积(AUC)为0.765(95%CI:0.706~818),灵敏度89.66%、特异度81.03%、约登指数0.706;Bootstrap法验证结果显示,C-index值为0.779(95%CI:0.713~0.861);Calibration曲线结果显示,Hosmer-Lemeshowχ^(2)=0.708,P=0.295。结论有过敏史、检查前未水化、未外预热、注射速率≥3.5mL/s、静脉注射及碘普罗胺均为心脑血管病患者CT增强检查中发生ICMAARs的独立危险因素,上述因素构建的列线图预测模型对ICM-AARs具有较高的预测效能。

冠心病合并甲亢患者使用碘克沙醇1例并文献分析

为了探讨冠心病合并甲状腺功能亢进(甲亢)患者选用何种碘对比剂,本研究依据1例冠心病合并甲亢患者病情特点,临床药师检索及查阅文献,阐述碘对比剂对冠心病合并甲亢风险人群甲状腺功能影响及防治措施。冠心病合并甲亢患者行经皮冠状动脉介入术时优先选择第3代等渗非离子型对比剂如碘克沙醇,在碘对比剂前立即给予预防性治疗(甲巯咪唑片30 mg,po,qd,持续14 d)。临床中应关注碘对比剂对甲状腺功能影响,使用前需筛查高风险人群,并综合评估患者甲状腺疾病、心血管合并症、年龄等因素后,个体化给予药物预防。

基于体表面积的碘对比剂个性化方案在冠状动脉CT血管造影增强效能中的应用

目的:探讨体表面积(BSA)的碘对比剂个性化方案在受检者自由呼吸状态下冠状动脉CT血管造影(CTA)效能增强的可行性。方法:将临床疑似冠状动脉疾病的30例患者纳入研究,按BSA分为两组:BSA≤1.6 m^(2)的患者为小BSA组,BSA>1.6 m^(2)的患者为大BSA组。然后基于BSA计算碘对比剂的用量[造影剂用量(mL)=(BSA×10/碘浓度)],造影剂注射时间为10 s。利用Revolution CT在患者自由呼吸状态下对冠状动脉进行造影成像。由具备5年以上胸部影像诊断经验的医师对数据进行主观和客观图像质量评分,采用5分法对A组和B组图像进行主观评分;同时测量两组患者降主动脉、升主动脉、左冠状动脉主干、左前降支、左回旋支、右冠状动脉主干6支血管的CT值及信噪比(SNR)值。结果:两组图像的主观评分数值均能达到3分以上,可满足诊断要求,且两位医师主观评分的一致性(ICC)较好(分别为0.81、0.71)。客观评分结果显示两组图像冠状动脉的显影效果较好,且冠状动脉CT值和SNR值差异无统计学意义(P>0.05)。结论:基于BSA的碘对比剂个性化方案具有临床可行性,冠状动脉血管的强化程度合适且均一,可满足临床诊断要求。

非离子型碘对比剂的临床合理应用及管理对策

目的分析不同浓度、注射速率的非离子型碘对比剂成像效果及不良反应,为临床CT检查中正确选择用药、扫描方案及不良反应处理提供依据。方法随机选择12500例使用非离子型碘对比剂患者,根据常用的三种对比剂使用模式,将患者分为A(2780例)、B(6230例)、C(3490例)组。A组采用碘帕醇370 mg/L,速率5 mL/s;B组采用碘海醇300 mg/L,速率3 mL/s;C组采用碘克沙醇270 mg/L,速率2.5 mL/s。比较三组的影像图像质量、对比剂渗漏及不良反应发生情况。结果三组患者的图像质量不合格153例,占比1.22%(153/12500);图像质量合格12347例,占比98.78%(12347/12500)。三组患者的图像质量合格率比较,差异无统计学意义(P>0.05)。三组患者对比剂渗漏25例,发生率为0.20%(25/12500);A组对比剂渗漏17例,发生率为0.61%(17/2780);B组对比剂渗漏7例,发生率为0.11%(7/6230);C组对比剂渗漏1例,发生率为0.03%(1/3490);三组患者的对比剂渗漏发生率比较,差异具有统计学意义(P<0.005)。三组患者共发生不良反应97例,占比0.78%(97/12500),其中轻度反应84例,占比0.67%(84/12500);中度反应13例,占比0.10%(13/12500);无重度不良反应。三组患者的不良反应总发生率比较,差异具有统计学意义(P<0.005);B组的不良反应总发生率低于A组,差异具有统计学意义(P<0.05)。结论预防和处理非离子型碘对比剂的应用风险是目前CT扫描中一个十分重要的问题;从非离子型碘对比剂不良反应风险预防、对比剂渗漏风险预防与护理等方面加以分析,可在确保获得最佳图像效果的同时保证患者安全。

含碘对比剂静脉外渗护理管理实践指南的循证实践研究

目的基于《含碘对比剂静脉外渗护理管理实践指南》实施临床循证实践,确保指南科学有效应用于临床,降低碘对比剂外渗率。方法成立循证实践团队,对指南推荐意见进行临床适用性评价后构建审查指标,分析指南临床实施的障碍因素,制定并实施循证实践方案。比较循证实践前后碘对比剂外渗发生率、护士对审查条目的执行率及碘对比剂外渗护理管理相关知识。结果循证实践后碘对比剂外渗发生率为0.16%,显著低于循证实践前的0.51%(P<0.05);循证实践后护士对审查条目的执行率及相关知识评分显著高于实践前(均P<0.05)。结论将基于指南的碘对比剂外渗预防及管理综合策略运用于临床实践,可提高护士对碘对比剂外渗相关知识的认知水平及执行依从性,降低碘对比剂静脉外渗发生率。

双低剂量肺动脉血管造影(CTPA)成像技术在诊断肺动脉栓塞的可行性研究

目的探讨64排螺旋CT在低碘对比剂剂量和低辐射剂量下施行肺动脉血管造影(CTPA)成像技术在诊断肺动脉栓塞的可行性。方法选取本院2021-2023年度疑似患有肺动脉栓塞的受检者60例。所有受检者均接受CTPA检查,将受检者分为常规剂量组管电压120KV,碘对比剂剂量30~40ml(30例)和低剂量组管电压100KV,碘对比剂剂量15mL(30例)均使用非离子型水溶性碘对比剂碘美普尔(400gl/100mL)。两组受检者均憋气扫描完成,比较两组受检者的CT值、背景噪声、信噪比(signal to noise ratio,SNR)、容积CT剂量指数(computed tomography dose index,CTDIvoI)、剂量长度乘积(dose length product,DLP)。结果低剂量组与常规剂量组的CT值、背景噪声、SNR、DLP、CTDIvoI相比有差异有统计学意义(P<0.01)。低剂量组与常规剂量组的图像质量相比没有统计学意义(P>0.05)。低剂量组与常规剂量组相比,其动脉栓塞检出率没有统计学意义(P>0.05)。结论在肺动脉血管造影(CTPA)成像上选用双低剂量,能够减少受检者发生碘对比剂肾病(contrast induced nephronpathy,CIN)并降低所承受到的辐射剂量,且双低剂量CTPA成像对肺动脉栓塞检查可行性高值得临床应用及推广。