一例体外膜肺氧合成功抢救碘帕醇对比剂致过敏性休克的护理体会

体外膜肺氧合（Extra corporeal membrane oxygenation,ECMO）又称体外生命支持系统,是指将患者的静脉血引流至体外,经人工肺（氧合器）氧合后再输回患者动脉或静脉的中短期心肺辅助治疗,使心肺得到充分休息,为心肺功能的恢复赢得时间[1]。而非离子型造影剂因其渗透压低,没有阳离子的生物学作用,不良反应少,具有良好的血管内皮和神经系统的耐受性,已广泛用于影像检查及介入治疗。     

Feasibility of coronary artery calcium scoring on virtual unenhanced images derived from single-source fast kVp-switching dual-energy coronary CT angiography

BackgroundDual-energy CT technology enables acquisition of virtual unenhanced (VUE) images from contrast-enhanced scans.ObjectiveTo assess the feasibility of coronary artery calcium (CAC) scoring on VUE images derived from fast kVp-switching dual-energy coronary CT angiography.MethodsTwenty-seven patients underwent true noncontrast CAC-scoring CT followed by routine single-energy (120-kVp) and fast kVp-switching dual-energy coronary CT angiography, in a random acquisition order on the same day. We calculated the CAC scores on true noncontrast and VUE images. The image noises and the signal-to-noise and contrast-to-noise ratios of the aorta and coronary arteries were measured on both the single-energy coronary CT angiography images and dual-energy coronary CT angiography images (70 keV virtual monochromatic spectral images). The Pearson correlation coefficient test and paired t test were used for statistical analysis.ResultsExcellent correlation was observed between the CAC scores on the true noncontrast and those on the VUE images (r = 0.88; P < .001). Compared with single-energy coronary CT angiography, dual-energy coronary CT angiography showed significantly reduced image noise and increased signal-to-noise and contrast-to-noise ratios in all regions (all P < .001). The effective dose of dual-energy coronary CT angiography (4.3 ± 0.3 mSv) was significantly lower than that of true noncontrast CAC-scoring CT plus single-energy coronary CT angiography (5.4 ± 0.7 mSv; P < .0001).ConclusionsExcellent correlation was observed between the CAC scores on the VUE images and true noncontrast images. Thus, fast kVp-switching dual-energy coronary CT angiography could allow prediction of the true CAC scores, potentially reducing the total radiation exposure and image acquisition time by obviating the need for true noncontrast CAC-scoring CT.     

Subharmonic,Non-linear Fundamental and Ultraharmonic Imaging of Microbubble Contrast at High Frequencies

There is increasing use of ultrasound contrast agent in high-frequency ultrasound imaging. However, conventional contrast detection methods perform poorly at high frequencies. We performed systematic in vitro comparisons of subharmonic, non-linear fundamental and ultraharmonic imaging for different depths and ultrasound contrast agent concentrations (Vevo 2100 system with MS250 probe and MicroMarker ultrasound contrast agent, VisualSonics, Toronto, ON, Canada). We investigated 4-, 6- and 10-cycle bursts at three power levels with the following pulse sequences: B-mode, amplitude modulation, pulse inversion and combined pulse inversion/amplitude modulation. The contrast-to-tissue (CTR) and contrast-to-artifact (CAR) ratios were calculated. At a depth of 8 mm, subharmonic pulse-inversion imaging performed the best (CTR = 26 dB, CAR = 18 dB) and at 16 mm, non-linear amplitude modulation imaging was the best contrast imaging method (CTR = 10 dB). Ultraharmonic imaging did not result in acceptable CTRs and CARs. The best candidates from the in vitro study were tested in vivo in chicken embryo and mouse models, and the results were in a good agreement with the in vitro findings.     

超声造影规范化护理专家共识

为了实现超声对比剂（也称超声造影剂）高效、合理、安全、规范化输注，国内相关医护专家总结了国内外文献证据及临床经验，按照循证医学原则充分讨论后，制订了该共识，旨在为我国超声对比剂安全输注的规范化和标准化提供参考意见。共识介绍了超声对比剂的应用现状和安全性、相关法规与流程，造影前、中、后的规范化护理，并提出16条推荐意见。提出目前国内批准上市使用的超声对比剂安全性高，建议医护人员根据最新说明书或专家共识进行配药和给药，并从造影室管理、风险预案、人员资质等方面予以规范。     

64层螺旋CT使用低剂量对比剂在CTA中对脑动脉瘤的诊断价值

目的 研究64层螺旋CT使用低剂量对比剂联合生理盐水在CTA中对脑动脉瘤的应用价值.方法 对临床疑有脑动脉瘤51例患者分为三组:甲组90ml对比剂不用生理盐水冲洗；乙组、丙组分别使用70ml、50ml对比剂之后用相同流速生理盐水40ml冲洗.对比剂流速为5.0ml/s.当颈内静脉显影的一刹那开始扫描.利用工作站软件进行图像处理,评估三组血管图像质量及动脉瘤显示情况.结果 三组病例动脉瘤的灵敏度、特异性在统计学上没有明显差异,甲组动静脉均显示很好,CT值较高.丙组动脉显示良好,静脉少,污染轻,血管CT值略低.乙组居于二者之间.结论 使用低剂量对比剂50ml+40ml生理盐水以5.0ml/s流率注射,不仅可以得到理想的图像,还是一种安全、快速、经济的检查方法.     

Contrast-induced encephalopathy presenting as acute subarachnoid hemorrhage

Contrast media induced encephalopathy is a rare complication of contrast administration characterized by non-specific neurological signs and symptoms that may present both clinically and radiolographically as subarachnoid hemorrhage. While there are few reported presentations in the neurology literature after inpatient contrast administration, similar emergency department presentations have not been documented. We describe a patient who presented with encephalopathy and expressive aphasia after outpatient evaluation of an intrathecal analgesia pump who had radiographic imaging consistent with acute subarachnoid hemorrhage. The hyperdensities seen on computed tomography scanning were subsequently identified as residual gadolinium contrast media resulting in allergic encephalopathy in this patient.     

超声造影在乳腺良恶性肿瘤鉴别诊断中的价值

目的：探讨超声造影对乳腺良恶性肿瘤的鉴别诊断价值。方法：对55例乳腺肿瘤的患者行二维及彩色多普勒超声检查后,用声诺维SonoVue造影剂进行超声造影检查,记录并分析造影灌注过程。结果：恶性组不均匀增强占86.4%（19/22）,良性组不均匀性增强占15.2%（5/33）,恶性组高增强占68.2%（15/22）,良性组高增强占9.1%（3/33）,恶性组以快进慢退为主（16/22）,良性组以慢进快退为主（16/30）,恶性组不均匀增强明显大于良性组,恶性组高增强明显大于良性组,两者之间的差异有显著性意义（P〈0.05）。结论：超声造影对乳腺肿瘤的诊断提供了更多的信息,提高了诊断的准确率,对于良恶性的鉴别有重要价值。