多层螺旋CT肺动脉成像中对比剂剂量使用固定值的可行性研究

目的 探讨肺动脉CT成像中对比剂用量使用固定值的可行性.方法 肺动脉成像患者分为两组,试验组(A组):对比剂用量使用固定值(370 mgI/ml,35 ml);对照组(B组):对比剂用量按照0.7 ml/kg体重(370 mgI/ml)计算.分别测量A组与B组的肺动脉主干、上腔静脉及左心房的平均CT值,分析两组数据差异有无统计学意义.结果 A、B两组肺动脉主干、左心房平均CT值差异无统计学意义,上腔静脉CT平均值有显著性差异,B组大于A组.结论 肺动脉CT成像中对比剂用量使用固定值是可行的.     

MSCT肺动脉成像高浓度低剂量对比剂应用的可行性研究

目的:探讨多层螺旋CT肺动脉成像中使用高浓度、低剂量对比剂的可行性.方法:40例被检查者分为两组,A组为采用300mgI/ml对比剂,剂量为100ml、生理盐水30ml;B组为采用400mgI/ml对比剂,剂量为60ml、生理盐水30ml.注射流速均为4ml/s,行胸部肺动脉同层动态扫描,计算肺动脉主干峰值时间(time to peak)、强化峰值(peak contrast enhaneement)以及强化CT值大于200HU起始时间(Tb200和持续时间(T200).结果:肺动脉主干到达峰值的时间,B组明显早于A组、强化峰值,B组明显高于A组,且均有显著性差异;T200及Tb200,两组间也存在显著性差异.结论:在多层螺旋CT肺动脉成像检查中,使用高浓度、低剂量对比剂可以满足临床需要.     

多层螺旋CT低剂量高浓度对比剂腹部血管成像应用研究

目的:探讨多层螺旋CT应用低剂量、高浓度对比剂腹部血管成像的可行性.方法:40例腹部CT血管成像(CTA)分为2组,A组:采用300 mg I/ml对比剂剂量为100 ml、生理盐水30 ml;B组:采用400 mg I/ml对比剂剂量为60 ml、生理盐水30 ml.注射流率均为4 ml/s.根据原始图像和最大强度投影(MIP)像,评价两组病例腹主动脉及其分支、肾动脉及其分支的显示程度;并测量动脉内对比剂的浓度.结果:两组病例均清晰显示腹主动脉、腹腔干、肝总动脉、脾动脉、肠系膜上动脉、肾动脉及其分支;两组动脉内的对比剂浓度虽然均维持在较高的水平,但B组明显高于A组,差异有显著性意义.肾动脉及其分支显示程度评分,B组明显优于A组,两组间存在显著性差异.结论:多层螺旋CT腹部血管成像使用低剂量、高浓度对比剂可以满足临床需要.     

非离子型对比剂在特殊消化道疾病诊断中的应用

目的探讨非离子型对比剂在特殊类消化道疾病诊断中的应用价值。方法将38例临床怀疑或需要检查的特殊类消化道疾病患者随机分为A、B两组,其中A组患者应用碘海醇300mgI/ml,B组患者应用碘海醇350mgI/ml,总量各用100~200ml行造影检查及治疗,并分析影像学资料。结果:非离子型对比剂(碘海醇)应用于38例特殊类消化道疾病患者检查成功率100%,未发生副反应及并发症,A组与B组患者比较,影像清晰度、病变差异无统计学意义,诊疗有效。结论:非离子型对比剂碘海醇300mgI/ml,总量100~200ml适用于特殊类消化道疾病患者检查,影像显示满意。     

能谱CT结合ASIR和低浓度对比剂腹部动脉成像质量及辐射剂量研究

目的与常规CT血管成像对比,评价能谱CT结合自适应迭代统计(ASIR)技术和低浓度对比剂在腹部动脉成像质量及辐射剂量。方法将61例行腹部CTA检查的患者随机分成A、B两组。A组:31例,进行能谱CTA扫描,螺距1.375,运用能谱(GSI)扫描,结合50%ASIR重建优化血管成像。B组:30例,进行常规CTA扫描(120k Vp),噪声指数12,螺距1.375。A组用270碘克沙醇对比剂(浓度270mgl/ml),B组用350碘普罗胺对比剂(浓度350mgl/ml),两组对比剂总量都为1ml/kg,注射速度为5ml/s。兴趣区分别放在腹腔干水平的腹主动脉和左侧深层椎旁肌。测量A、B两组腹主动脉CT值及图像噪声,计算出血管信噪比和对比噪声比。利用统计学比较这两组的辐射计量,对比剂计量和反映图像质量的信噪比和对比噪声比等。结果两组BMI值没有差异性(P0.05),A组DLP是(245.59±32.96)m Gy.cm,B组是(380.42±104.54)m Gy.cm,两组具有差异性(P0.05)。辐射计量和对比剂剂量在A组分别降低了35.4%和22.9%。A组图像的腹主动脉的信号强度显著高于B组(432.0±74.8)HU vs(340.7±65.3)HU,(P0.05)。A组图像腹主动脉的对比噪声比和信噪比也是显著高于B组(分别是40.63±2.75 vs.30.45±1.94和48.76±3.23 vs.38.75±2.52,P0.05)。结论与常规CTA模式相比,运用低浓度对比剂结合50%ASIR能谱模式的腹部CTA提供良好的血管成像同时显著的降低辐射计量和对比剂剂量。     

多层螺旋CT胰腺检查:不同注射条件下时间窗的选择

目的探讨多层螺旋CT胰腺三期增强扫描,不同注射条件下时间窗的选择。资料与方法40例无胰腺疾病患者,随机分为A、B两组各20例,A组注射条件为:对比剂总量为120ml,注射流率为5ml/s;B组注射条件为:对比剂总量为90ml,注射流率为3ml/s。行胰腺同层动态增强扫描,于不同时间点,分别测定胰腺、肝脏实质及胰周主动脉、门静脉的CT值,最后分别绘制时间密度曲线。结果两组胰周主动脉强化到达峰值的平均时间分别为(33.2±3.8)s(A组)及(40.1±3.8)s(B组),而20s(A组)及25s(B组)时胰周动脉CT值多可达200HU;胰腺实质强化到达峰值的平均时间分别为(42.7±3.3)s(A组)及(46.8±4.5)s(B组);胰周门静脉强化到达峰值的平均时间分别为(47.5±4.8)s(A组)及(53.3±4.8)s(B组);肝脏实质强化到达峰值的平均时间分别为(59.2±4.7)s(A组)及(64.2±4.5)s(B组)。结论在不同的注射条件下,多层螺旋CT胰腺检查三期增强扫描的时间窗的设定并不相同。笔者推荐,对比剂总量为120ml,注射流率为5ml/s时,动脉期延迟时间为20s,胰腺期延迟时间为45s,肝脏期延迟时间为65s;对比剂总量为90ml,注射流率为3ml/s时,动脉期延迟时间为25s,胰腺期延迟时间为50s,肝脏期延迟时间为65s。     

低触发阈值联合多期双流技术在大体重人群低对比剂用量头颈CTA中的应用

目的利用西门子Perspective 128层螺旋CT探讨触发阈值为30HU联合多期双流注射45ml对比剂对大体重人群(90.0±7.35)kg行头颈部联合CTA扫描的可行性。方法将60例符合条件的行头颈联合CTA扫描患者随机分成实验组(A组)和对照组(B组),每组30例。A组注射对比剂45ml及生理盐水55ml,并将触发阈值设为30HU,B组注射对比剂55ml及生理盐水45ml,并将触发阈值设为100HU,两组间其余扫描参数设置相同。比较两组间图像质量。结果 A组主动脉弓、双侧颈总动脉及颈内动脉、双侧大脑中动脉强化程度低于B组,差异具有统计学意义(P0.05);A组头颈部静脉显影情况主观评分好于B组,差异具有统计学意义(P0.05);两组间头颈部各段动脉成像效果主观评价无统计学差异(P0.05)。结论使用45ml对比剂对大体重人群行头颈部联合CTA扫描是可行的。     

超小剂量对比剂团注测试进行肺动脉CT成像的可行性研究

目的探讨肺动脉CT成像中使用超小剂量对比剂团注测试法的可行性。方法试验组(A组)小剂量团注测试对比剂剂量使用5ml,对照组(B组)小剂量团注测试对比剂剂量使用10ml,测试后2组均注入20ml对比剂及30ml生理盐水进行肺动脉成像,然后分别测量A组与B组的肺动脉主干、上腔静脉及左心房的平均CT值,分析A、B两组数据有无统计学差异。结果 A、B两组肺动脉主干、上腔静脉、左心房平均CT值无统计学差异。结论小剂量对比剂团注测试进行肺动脉CT成像中,减少测试对比剂剂量是可行的。     

CTP预测急性缺血性卒中患者脑动脉机械取栓术后对比剂外渗风险的初步研究

目的 通过评价急性缺血性卒中患者CT灌注成像病变区流量提取乘积(FED)和相对流量提取乘积(r FED与脑动脉取栓术后对比剂外渗的相关性,探讨其对对比剂外渗风险的预测价值。方法 选取责任血管为单侧大脑中动脉,行脑动脉机械取栓术成功再通的急性缺血性卒中患者,术前行CTP检查获得灌注参数FED、r FED(r FED等于患侧FED值/健侧FED值)。术后24 h内行双能头颅CT检查,按照结果分为无对比剂外渗组和对比剂外渗组。结果 37例患者纳入分析观察,对比剂外渗组13例、无对比剂外渗组24例。无对比剂外渗组中位FED值为7.17 ml/100 ml×min,中位r FED值为3.83;外渗组中位FED值为8.94 ml/100 ml×min,中位r FED值为7.39,外渗组的中位FED、中位r FED值均高于无对比剂外渗组,二组间差异均有统计学意义(P <0.05)。ROC分析显示FED的cutoff值为6.32,敏感度为100%,特异度为46.0%; r FED的cutoff值为4.79,敏感度为84.6%,特异度为75.0%。结论 r FED用于预测急性卒中患者动脉机械取栓术...     

双源CT低管电压及低剂量等渗对比剂在头颈部CTA中的初步研究

目的评估双源CT低管电压及低剂量等渗对比剂对头颈部CT血管造影图像质量和辐射剂量的影响。方法选取头颈部CTA患者60例,随机分成两组(各30例)。A组:管电压80/Sn140 k Vp,对比剂32ml(270mg I/ml)。B组:管电压100/Sn140 k Vp,对比剂40ml(370mg I/ml)。记录各段动脉CT值、噪声值、对比噪声比、信噪比,以及辐射剂量、碘摄入量、图像质量主观评分等,进行统计分析。结果除了A组的升主动脉噪声值明显高于B组(P0.01),两组图像的血管CT值、噪声值、信噪比、对比噪声比无统计学差异(P值均0.05)。A组辐射剂量明显低于B组,减少了23.8%(P0.001)。A组每例患者的碘摄入量较B组下降了41.6%。两组图像质量评分无统计学差异(P=0.844)。两名医生对图像质量一致性检验的Kappa值为0.663(P0.001)。结论双源CT低管电压及低剂量等渗对比剂可以用于头颈部CT血管造影,在满足诊断要求的基础上,能同时减少辐射剂量及碘摄入量。     

Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma

OBJECTIVE: The aim of this study was to determine the imaging findings and the prevalence of active hemorrhage on contrast-enhanced multidetector CT in patients with blunt abdominal trauma. MATERIALS AND METHODS: Contrast-enhanced multidetector CT images of 165 patients with blunt abdominal trauma were reviewed for the presence of extravasated contrast agent, a finding that represents active hemorrhage. The site and appearance of the hemorrhage were noted on multidetector CT images. These findings were compared with surgical and angiographic results or with clinical follow-up. RESULTS: On multidetector CT images, active hemorrhage was detected in 22 (13%) of 165 patients with a total of 24 bleeding sites (14 intraperitoneal sites and 10 extraperitoneal sites). Active hemorrhage was visible most frequently as a jet of extravasated contrast agent (10/24 bleeding sites [42%]). Diffuse or focal extravasation was less frequently seen (nine [37%] and five [21%] bleeding sites, respectively). CT attenuation values measured in the aorta (mean, 199 H) were significantly higher than those measured in extravasated contrast material (mean, 155 H) (p < 0.001). Sixteen (73%) of 22 patients with active bleeding on multidetector CT images underwent immediate surgical or angiographic intervention. One patient received angiographic therapy 10 hr after undergoing multidetector CT, and five patients died between 1 and 3 hr after multidetector CT examination. CONCLUSION: Active hemorrhage in patients after blunt abdominal trauma is most frequently visible as a jet of extravasated contrast agent on multidetector CT. When extravasation is detected, immediate surgical or angiographic therapy is required.     

Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections

PURPOSE: To determine retrospectively the frequency, management, and outcomes of extravasations of intravenously injected nonionic iodinated contrast medium. MATERIALS AND METHODS: Institutional review board approval was obtained, and the requirement for informed consent was waived. The study was HIPAA compliant. For 69,657 intravenous injections of nonionic iodinated contrast medium for computed tomographic examinations between January 1, 2000, and March 31, 2005, the incident reports, radiology reports, and medical records of patients in whom contrast medium extravasations occurred were reviewed. Data collected included patient age, catheter gauge, injection site, volume extravasated, patient symptoms, severity of injury, treatment, whether or not the plastic surgery service was consulted and any additional treatment that service instituted, and patient outcome. RESULTS: Extravasations occurred in 475 (0.7%) of 69 657 patients, and follow-up information was available for 442 adults (280 women, 162 men; mean age, 57 years) and 17 children (nine girls, eight boys; mean age, 6 years). Extravasated volumes ranged from 3 to 150 mL. Symptoms usually consisted of swelling and/or pain. The plastic surgery service was consulted for 38 adults and six children and provided additional treatment in eight patients (seven adults, one child). Among adults, 432 had minimal or no adverse effects, nine had moderate adverse effects, and one had a severe complication (75 mL of contrast material extravasated into the hand, causing compartment syndrome). Only one moderate or severe complication in an adult resulted from an extravasation of less than 50 mL. Fifteen children had minimal or no adverse effects, one had moderate adverse effects, and one had a severe complication (18 mL of contrast material extravasated into the arm, causing brachial plexopathy). CONCLUSION: Extravasation of nonionic iodinated contrast medium results only rarely in moderate or severe adverse effects, and these usually occur only when large volumes of contrast medium are involved.     

不同碘浓度对比剂在肾脏MSCT增强扫描中的作用对比

目的:探讨300mgI/ml对比剂与400mgI/ml对比剂对肾脏MSCT多期增强扫描的强化作用。方法:将40例疑肾脏病变的患者随机分成两组,每组20例,分别行肾脏平扫及给予碘必乐300(300mg I/ml)与碘迈伦400(400mg I/ml)的多期增强MSCT扫描。在对比剂开始注射后18s、30s、80s、3~5min扫描。测量各期增强扫描腹主动脉、双肾动脉、双肾静脉、双肾皮质、双肾髓质、双肾盂、肾脏病变的CT强化值。观察上述结构的强化情况。结果:使用400mgI/ml对比剂组在18s与30s采集,所检测的血管与肾各结构强化均值与300mgI/ml对比剂组相比,差异有显著性意义(P<0.01),80s采集,肾动脉、肾静脉、肾髓质强化均值与300mgI/ml对比剂组相比,差异有显著性意义(P<0.01),3~5min采集,肾静脉与肾盂强化均值与300mgI/ml对比剂组相比,差异有显著性意义(P<0.01)。结论:高碘浓度对比剂对肾血管的显示优于标准碘浓度对比剂,并可降低对比剂用量。肾脏MSCT高碘浓度对比剂增强扫描在对比剂开始注射后30s与延时3~5min采集较合理。     

碘对比剂外渗皮肤反应不同治疗方案的对照研究

目的:比较不同治疗方案对碘对比剂皮肤外渗反应的治疗效果。方法:自2010年1月至2012年1月,对84例碘对比剂皮肤外渗反应病例随机使用硫酸镁敷剂+冷敷、磺胺嘧啶银敷剂+冷敷和单纯冷敷治疗。分别在反应后第1、2、3、7天评估皮肤颜色、肢体肿胀程度、局部循环以及患肢功能状况。比较不同治疗方案的治疗效果。结果:45例外渗反应在1天后、18例在2天后、11例在3天后基本痊愈,仅1例出现骨筋膜室综合征,经切开治疗后痊愈,病程超过7天。其中磺胺嘧啶银+冷敷组痊愈最快(χ2a-b=32.56,Pa-b=0.001,χ2b-c=41.02,Pb-c<0.001)。出现反应后1～3天内磺胺嘧啶银组皮肤颜色恢复显著快于其他两组(χ2皮肤a-b=23.10,P皮肤a-b=0.006;χ2皮肤b-c=24.87,P皮肤b-c=0.003);反应后7天,三组在各项评分方面无显著差异(P>0.05)。结论:绝大部分碘对比剂皮肤外渗反应在1天内均有显著好转,7天内基本可痊愈;外渗反应可引起骨筋膜室综合征,宜早诊断并手术治疗;磺胺嘧啶银+冷敷治疗效果更佳。     

Extravasation of nonionic radiologic contrast media: efficacy of conservative treatment

The authors report four large-volume (greater than 20-mL) extravasations in adults and one intermediate-volume (18-mL) extravasation in an infant of iopamidol, a nonionic contrast medium, that occurred during dynamic enhanced computed tomography. The largest volume that extravasated (in two patients) was 150 mL. Although all five patients initially had swelling, erythema, and/or pain after extravasation, all recovered uneventfully. The authors suggest that emergent surgical drainage of all large-volume extravasations, a procedure that was recently recommended, is unnecessary. Large extravascular collections of nonionic contrast media can be well tolerated and are often resorbed without adverse sequelae.     

心房颤动16层螺旋CT肺静脉造影两种增强方案对比研究

目的:探讨两种增强方案对心房颤动16层螺旋CT肺静脉造影强化效果的影响.方法:随机选择心房颤动射频消融术前16层螺旋CT肺静脉造影患者共61例,分为两组,A组35例,使用智能触发技术,总对比剂量60 ml、注射流率4 ml/s、监测位置为左房中部、阈值100 HU;B组26例,使用固定延迟时间扫描,总对比剂量90 ml、注射流率3 ml/s、延迟时间25 s或28 s,其他扫描参数不变.扫描结束后,所有原始数据重组为1 mm层厚、0.5 mm层距图像后,传至工作站,采用容积成像及最大密度投影重组明确有无肺静脉变异后,在1 mm层厚图像,选择两侧肺门部肺动脉、左上及右下肺静脉孔处肺静脉、左房中部任意三点,测量兴趣区CT值,计算平均值,并得出肺静脉动脉强化差值.对比两组肺动脉、肺静脉、左房强化效果及肺静脉动脉强化差值.所有统计工作由SPSS软件完成.结果:A组肺动脉强化平均值低于B组,肺静脉、左房强化平均值高于B组.结论:房颤患者射频消融术前16层螺旋CT肺静脉造影,与固定延迟时间扫描相比,采用智能触发技术可选择性显示肺静脉及左房,更有利容积成像重组.     

国产非离子型对比剂碘佛醇安全性的临床研究

目的 研究国产非离子型对比剂碘佛醇的安全性. 资料与方法 对随机抽取的159例腹部增强CT检查资料进行分析,对比剂注射流率3～6 ml/s,剂量为80～100 ml.全部病例增强前2 h内、增强后即时、1 h、48 h分别进行生命体征、12导联心电图及注射部位观察,于增强前2 h内与增强后48 h分别抽血检测肾功能与血液生化指标,并于增强时、增强后即时、5～15 min、1 h与48 h分别观察与记录不良反应. 结果 159例患者注射对比剂后出现热感和潮红者占8.8%(14/159);轻度不良反应发生率为1.26%(2/159).未见中、重度不良反应出现. 结论 国产非离子型对比剂碘佛醇临床应用的安全性较高.     

CT检查患者采用实施预见性护理对降低造影剂外渗发生率及过敏反应发生率的影响分析

目的探讨将预见性护理运用到CT检查护理过程,对降低造影剂外渗和过敏反应发生率的可行性。方法选取2018年6月~2019年5月接受CT造影检查的患者,数字随机将其中的50例抽取为预见性护理组,抽取另外的50例作为一般护理组。观察比较两组患者经护理后的造影外渗发生率以及过敏反应发生率。结果预见性护理组造影外渗发生率及过敏反应发生率均优于一般护理组,P<0.05,有统计学意义。结论对CT检查患者采用实施预见性护理,可降低影外渗发生率及过敏反应发生率。     

Effect of Intravascular Iodinated Contrast Media on Natural Course of End-Stage Renal Disease Progression in Hemodialysis Patients: A Prospective Study

We evaluated the impact of intravascular iodinated contrast medium on residual diuresis in hemodialyzed patients. Two groups of clinically stable hemodialyzed patients with residual diuresis minimally 500 ml of urine per day were studied. The patients from the first group were given iso-osmolal contrast agent iodixanol (Visipaque, GE Healthcare, United Kingdom) in concentration of iodine 320 mg/ml with osmolality 290 mOsm/kg of water during the endovascular procedure. The second control group was followed without contrast medium administered. Residual diuresis and residual renal excretory capacity expressed as 24-h calculated creatinine clearance were evaluated in the both groups after 6 months. The evaluated group included 42 patients who were given 99.3 ml of iodixanol in average (range, 60–180 ml). The control group included 45 patients. There was no statistically significant difference found between both groups in daily volume of urine (P = 0.855) and calculated clearance of creatinine (P = 0.573). We can conclude that residual diuresis is not significantly influenced by intravascular administration of iso-osmolal iodinated contrast agent (iodixanol) in range of volume from 60 to 180 ml in comparison to natural course of urinary output and residual renal function during end-stage renal disease. This result can help the nephrologist to decide which imaging method/contrast medium to use in dialyzed patients in current practice.