目的 探讨双低技术联合个体化注射方案对成人腹部增强CT的图像质量影响及安全性。方法 回顾性分析2019-06至2022-06在无锡市第二人民医院放射科行腹部增强CT检查的231例患者的临床及影像资料,按使用不同碘对比剂分为两组,选取采用等渗对比剂(碘克沙醇270 mgI/ml)的123例为等渗组,采用次高渗对比剂(碘佛醇320 mgI/ml)108例为次高渗组。比较两组临床资料,对图像质量进行主、客观评价,并对CT辐射剂量、CT检查前后肝、肾功能指标进行对比分析。结果 等渗组动脉期腹主动脉及门静脉期门静脉的CT值高于次高渗组,差异有统计学意义(P<0.05);等渗组肝脏动静脉期噪声低于次高渗组,差异有统计学意义(P<0.05);两组患者的性别、年龄、身高、体重、辐射剂量差异无统计学意义(P>0.05);两组患者肝脏平扫、动静脉期CT值及强化绝对值、动脉期腹主动脉及门静脉期门静脉噪声、竖脊肌动静脉期CT值、噪声差异均无统计学意义(P>0.05),两组患者腹主动脉、门静脉及门静脉期肝实质信噪比、对比噪声比、肝功能(谷丙转氨酶、谷草转氨酶)、肾功能(尿素氮、血肌酐)差异无统计学意义(P>0.05),两位医师对图像质量主观评估结果一致性极高。结论 双低技术联合个体化注射方案的等渗注射进行腹部增强CT可获得更高的动静脉强化程度,图像噪声较低,适宜进行CT后血管重建。
Abstract
Objective To discuss the effect of double low technology combined with individualized injection on image quality of abdominal enhanced CT in adults and its safety. Methods The clinical and imaging data of 231 patients who underwent abdominal enhanced CT in the Department of Radiology, Wuxi No.2 people's Hospital from June 2019 to June 2022 were retrospectively analyzed. They were divided into two groups according to the use of different iodine contrast agents. 123 patients were treated with isotonic contrast medium (iodoxalol 270mgI/ml) as isotonic group, while 108 patients with subhyperosmotic contrast medium (320 mgI/ml) as subhyperosmotic group. The clinical data of the two groups were compared, the image quality was evaluated subjectively and objectively, and the radiation dose of CT and the indexes of liver and kidney function before and after CT were compared and analyzed. Results The CT values of abdominal aorta and portal vein in the isotonic group were significantly higher than those in the subhypertonic group (P<0.05). The hepatic arteriovenous noise in the isotonic group was significantly lower than that in the subhypertonic group (P<0.05). There was no significant difference in sex, age, height, weight or radiation dose between the two groups (P>0.05). There was no significant difference in liver plain scan, arteriovenous phase CT value and absolute enhancement value, arterial phase abdominal aorta and portal vein phase portal vein noise, vertical spinal muscle arteriovenous phase CT value or noise between the two groups (P>0.05). There was no significant difference in signal-to-noise ratio, contrast-to-noise ratio, liver function (glutamic pyruvic transaminase, glutamic oxaloacetic transaminase), or renal function (urea nitrogen, serum creatinine) between the two groups (P>0.05). The subjective evaluation results of image quality were highly consistent between the doctors. Conclusions The iso-osmotic injection of double-low technique combined with individualized injection for abdominal enhanced CT can obtain higher degree of arteriovenous enhancement and lower image noise, so it is suitable for vascular reconstruction after CT.
关键词
对比剂 /
增强CT /
图像质量 /
辐射剂量 /
安全性
Key words
contrast agent /
enhanced CT /
image quality /
radiation dosage /
security
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参考文献
[1] 李 雪,郑淑梅,屈梅香. 影像科碘对比剂输注安全专家共识[J]. 介入放射学杂志,2018,27(8):707-712.
[2] Chartrand L C, White C S, Bhalla S, et al. Comparison of the effect of low- and iso-osmolar contrast agents on heart rate during chest CT angiography: results of a prospective randomized multicenter study[J]. Radiology,2011,258(3):930-937.
[3] 张 晶,邓毅凡,纪 军,等. 口服水化下不同渗透压对比剂冠脉暴露后肾功能影响的研究[J]. 中国老年保健医学,2022,20(4):76-78.
[4] Kim M, Hwang J Y, Choo K S, et al. Comparison of image quality of abdominopelvic CT in paediatric patients: low osmolar contrast media versus less iodine-containing iso-osmolar contrast media at different peak kilovoltages[J]. Clin Radiol,2019,74(11):896-899.
[5] 王 玮,徐康洁,张保翠,等. 100kVp条件下碘克沙醇(270mgI/ml)应用于肾动脉CTA检查中的研究[J]. 临床放射学杂志,2017,36(10):1518-1522.
[6] 黄晶晶. 绝对时相收缩期采集心律不齐患者冠状动脉CT血管造影的可行性[J]. 影像研究与医学应用,2022,6(15):56-58.
[7] 沈孟秋,刘 靖,李 辉,等. 碘对比剂每秒注入量对64排螺旋CT冠脉成像质量的影响[J]. 武警医学,2021,32(7):603-606.
[8] 孟东花,高志鹏,马菊香,等. 低管电压低碘含量对比剂上腹部增强CT检查[J]. 中国医学影像技术,2014,30(7):1100-1104.
[9] 程 香,何 玲,陈 欣. 双低扫描技术在儿童腹部增强CT中的应用研究[J]. 临床放射学杂志,2020,39(5):988-993.
[10] Paparo F, Garello I, Bacigalupo L, et al. CT of the abdomen: degree and quality of enhancement obtained with two concentrations of the same iodinated contrast medium with fixed iodine delivery rate and total iodine load[J]. Eur J Radiol,2014,83(11):1995-2000.
[11] Wang Y C, Tang A, Chang D, et al. Long-term adverse effects of low-osmolar compared with iso-osmolar contrast media after coronary angiography[J]. Am J Cardiol,2016,118(7):985-990.
[12] Yang C C, Mok G S, Law W Y, et al. Potential dose reduction of optimal ECG-controlled tube current modulation for 256-slice CT coronary angiography[J]. Acad Radiol,2011,18(6):731-737.
[13] Mcdonald J S, Mcdonald R J, Williamson E E, et al. Is intravenous administration of iodixanol associated with increased risk of acute kidney injury, dialysis, or mortality? A propensity score-adjusted study[J]. Radiology,2017,285(2):414-424.
[14] 陈 钊,王荣福. CT在新型冠状病毒肺炎诊断与鉴别诊断中的应用价值[J]. CT理论与应用研究,2020,29(3):273-279.
[15] 李 剑,郑敏文,石明国,等. 低kV和CARE Dose 4D技术对降低双源CT主动脉成像辐射剂量的价值[J]. 临床放射学杂志,2011,30(10):1528-1531.
[16] 刘海洋,任英红,王 博,等. 等渗对比剂碘克沙醇在腹部增强CT中图像质量及安全性评价[J]. 影像研究与医学应用,2022,6(11):71-73.
[17] 王彦颖. CT增强扫描中不同浓度碘对比剂所致不良反应观察及护理[J]. 实用临床医药杂志,2016,20(20):136-138.