Novel contrast-injection protocol for coronary computed tomographic angiography: contrast-injection protocol customized according to the patient's time-attenuation response
Novel contrast-injection protocol for coronary computed tomographic angiography: contrast-injection protocol customized according to the patient's time-attenuation response
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DOI：
10.1007/s00380-013-0338-x
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发表时间：
2014-03-01
影响因子：
1.5
通讯作者：
Yamashita, Yasuyuki
中科院分区：
文献类型：
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作者：
Kidoh, Masafumi;Nakaura, Takeshi;Yamashita, Yasuyuki
我们开发了一种新的个性化定制的对比剂注射协议的基础上，在测试团的时间衰减响应的冠状动脉计算机断层扫描（CT）血管造影术，并研究其临床适用性。我们使用64排CT扫描仪扫描了60名疑似冠心病患者，他们被随机分配到两种方案中的一种。在方案1（P1）中，我们根据对9 s内输送的小剂量测试团注（0.3 ml/kg体重）的时间衰减响应，估计了产生400 HU峰值主动脉衰减的造影剂剂量。然后我们在9秒内给予定制的造影剂剂量。在方案2（P2）中，根据患者体重调整剂量;该组接受0.7 ml/kg体重，注射持续时间为9 s。我们比较了两种方案的造影剂剂量、峰值衰减、升主动脉衰减值的变化以及冠状动脉充分衰减（250-350 HU）的成功率。P1的造影剂剂量明显小于P2（36.9 +/- 9.2 vs 43.1 +/- 7.0 ml，P < 0.01）。P1组的主动脉峰值衰减显著低于P2组（384.1 +/- 25.0 vs 413.5 +/- 45.7，P < 0.01）。衰减值的平均变异（标准差）在P1中小于P2（25.0 vs 45.7，P < 0.01）。P1组冠状动脉充分衰减的成功率明显高于P2组（85.0vs65.8%，P < 0.01）。P1有助于降低造影剂剂量，减少峰值主动脉衰减的个体差异，并且比P2更频繁地实现最佳冠状动脉CT衰减（250-350 HU）。
We developed a new individually customized contrast-injection protocol for coronary computed tomography (CT) angiography based on the time-attenuation response in a test bolus, and investigated its clinical applicability. We scanned 60 patients with suspected coronary diseases using a 64-detector CT scanner, who were randomly assigned to one of two protocols. In protocol 1 (P1), we estimated the contrast dose to yield a peak aortic attenuation of 400 HU based on the time-attenuation response to a small test-bolus injection (0.3 ml/kg body weight) delivered over 9 s. Then we administered a customized contrast dose over 9 s. In protocol 2 (P2), the dose was tailored to the patient's body weight; this group received 0.7 ml/kg body weight with an injection duration of 9 s. We compared the two protocols for dose of contrast medium, peak attenuation, variations in attenuation values of the ascending aorta, and the success rate of adequate attenuation (250-350 HU) of the coronary arteries. The contrast dose was significantly smaller in P1 than in P2 (36.9 +/- 9.2 vs 43.1 +/- 7.0 ml, P < 0.01). Peak aortic attenuation was significantly less under P1 than under P2 (384.1 +/- 25.0 vs 413.5 +/- 45.7, P < 0.01). The mean variation (standard deviation) of the attenuation values was smaller in P1 than in P2 (25.0 vs 45.7, P < 0.01). The success rate of adequate attenuation of the coronary arteries was significantly higher with P1 than with P2 (85.0 vs 65.8 %, P < 0.01). P1 facilitated a reduction in the contrast dose, reduced the individual variations in peak aortic attenuation, and achieved optimal coronary CT attenuation (250-350 HU) more frequently than P2.