低注射速率、低剂量对比剂3D-DSA脑血管造影

目的探讨低注射速率、低剂量对比剂3D-DSA脑血管造影的的可行性。方法连续收集疑似动脉瘤患者51例行3D-DSA脑血管造影,选择DynaCT 5sDSA成像,均采用非离子型对比剂碘普罗胺注射液(370mgI/100ml),导管尖端均位于平枢椎水平,按对比剂注射速率随机分为A组(1.5ml/s,n=18)、B组(2.0ml/s,n=18)、C组(3.0ml/s,n=15)。计算C臂锥形束CT轴位图像颈内动脉岩段(C2段)和眼段(C6段)、大脑中动脉水平段(M1段)、大脑前动脉水平段(A1段)的噪声、SNR及CNR,由2名医师对连续减影图像、VR及MIP重组图像的图像质量进行评分后行统计学分析。结果 B、C组与A组噪声的差异均无统计学意义(P均0.05)。A组与B组比较,M1、A1段的SNR、CNR差异均有统计学意义(P均0.05),C2、C6段SNR、CNR差异均无统计学意义(P均0.05);A组与C组比较,C2、C6、M1及A1段的SNR、CNR差异均有统计学意义(P均0.05)。3组间大脑中动脉、大脑前动脉连续减影图像及VR、MIP图像的图像质量主观评分差异均无统计学意义(P均0.05),均可充分显示颅内动脉瘤情况。结论 3D-DSA脑血管造影中实施个性化低注射速率、低剂量对比剂注射方案可行,能够降低患者碘摄入量及血管破裂出血风险。

Application of low injection rate and low contrast agent dose inthree-dimensional rotational digital subtraction angiography of cerebral vessels

Objective To explore the feasibility of low injection rate and low contrast agent dose in three-dimensional rotational digital subtraction angiography (3D-DSA) of cerebral vessels. Methods Totally 51 patients with suspected aneurysm who needed undergo 3D-DSA cerebral angiography were continuously collected. DynaCT 5 s DSA imaging mode and non-ionic iodinated contrast agent (Iopromide 370 mgI/100 ml) was used in all the patients. The catheter tip was keeped within internal carotid artery at epistropheus level. And the patients were divided into three groups randomly according to injection rate, i.e. group A (1.5 ml/s, n=18), group B (2.0 ml/s, n=18), group C (3.0 ml/s, n=15). The noise, SNR and CNR of the petrous segment and the ophtalmic segment of the internal carotid artery (C2 segment and C6 segment), the M1 segment of the middle cerebral artery and the A1 segment of the anterior cerebral artery (M1 segment and A1 segment) were calculated in the axial image of C-arm cone-beam CT. The continuous subtraction images and reconstructed images (VR, MIP) were evaluated by two physicians respectively, and then the results were compared statistically. Results No significant differences were found about noise between group A and group B, group A and group C, respectively (both P>0.05). Significant differences were found about SNR and CNR of M1 segment and A1 segment between group A and group B (all P<0.05), but for C2 segment and C6 segment, it was not significant (all P>0.05). Significant differences were found about SNR and CNR of C2 segment, C6 segment, M1 segment and A1 segment between group A and group C (all P<0.05). No significant differences were found about the scores evaluated by two physicians subjectively of the continuous reduction images of the anterior cerebral artery and the middle cerebral artery, VR images and MIP images among three groups (all P>0.05). All intracranial aneurysms can be showed clearly. Conclusion 3D-DSA cerebral angiography with a personalized injection protocol of low injection rate and low contrast agent dose is feasible. And the application of this protocol can reduce the dose of iodine and the risk of cerebral hemorrhage.