64排螺旋CT冠状动脉成像时不同对比剂注射方案的特点

目的:探讨64排螺旋CT冠状动脉成像时不同对比剂注射方案的特点。方法:冠状动脉CT成像患者297例,随机分为3组。A组,双时相组,97例,第1时相注射对比剂60～70ml;第2时相注射生理盐水20ml。B组,3时相组,又分B1组及B2组。B1组101例,第1时相注射对比剂40～50ml;第2时相对比剂与生理盐水按6∶4比例混合注射20～30ml;第3时相注射生理盐水20ml。B2组99例,第1时相及第3时相注射方案同B1组,第2时相对比剂与生理盐水混合比例为7∶3,注射20～30ml。注射速率4.5～5.0ml/s。评价内容包括冠状动脉成像质量、上腔静脉及右心室伪影、右心室壁及肺动脉显示情况,所得结果进行统计学处理。结果:3组间,冠状动脉成像质量差异无统计学意义。上腔静脉及右心室伪影A组与B组间差异有统计学意义,A组伪影较明显。B1组与B2组间差异无统计学意义。右心室壁评价A组最佳,与B组间差异有统计学意义。B2组优于B1组,两者差异有统计学意义。肺动脉显示A组最佳,与B组间差异有统计学意义。B组中,B2组肺动脉显示率约63.64%,高于B1组。结论:3种注射方案均可提供良好的冠状动脉图像。双时相注射可较好显示右心室壁及肺动脉,但上腔静脉及右心室伪影较明显。6∶4比例的3时相注射上腔静脉及右心室伪影最小,但右心室壁显示较差,基本不能观察肺动脉。7∶3比例的3时相注射方案上腔静脉及右心室伪影小,可进行右心室评价,但肺动脉显影不可靠。可根据临床需求选择不同的注射方案。

The virtue of each contrast agent injection scheme in coronary artery angiography with 64-detector row spiral CT

Objective： To explore the virtue of each contrast agent injection scheme in coronary artery angiography with 64-detector row spiral CT.Methods： A total of 297 patients undergoing coronary angiography by 64-detector row spiral CT were divided into three groups.Group A（two phases,97 patients）were injected 60-70 ml contrast agent first,then followed by 20 ml saline flush.Group B1（three injection phases,101 patients）were injected 40-50 ml contrast agent first,then injected 20-30 ml contrast-saline mixture at 6：4 ratio,then followed by 20 ml saline flush.Group B2（three phases,99 patients）were injected 40-50 ml contrast agent first,then injected 20-30 ml contrast-saline mixture at 7：3 ratio,then followed by 20 ml saline flush.Injection speed was 4.5-5.0 ml/s.The image quality of coronary,the artifacts of superior vena cava and right ventricle,the visualization of the wall of right ventricle and pulmonary artery were evaluated.Results： The difference of the image quality of coronary between group A,group B1 and group B2 was not significant.The artifacts of superior vena cava and right ventricle in group A was more obvious than group B,but there was no significant difference in group B1 and group B2.Group A was the best in the visualization of the right ventricle wall,and group B2 was better than that of group B1.Group A was better in the visualization of pulmonary artery than that of group B.The display rate of pulmonary artery in Group B2 was 63.64%,better than that of group B1.Conclusion： In coronary CTA,image quality of coronary artery was almost same in each injection plan.Two phase injection plan can provide clear visualization of the wall of right ventricle and pulmonary artery,but the artifacts of superior vena cava and right ventricle was obvious.A contrast-saline mixture at 6：4 ratio after contrast bolus can provide least artifacts of superior vena cava and right ventricle,but the wall of right ventricle and pulmonary artery could not be visualized clearly.A contrast-saline mixture at 7：3 ratio after contrast bolus can provide least artifacts of superior vena cava and right ventricle,and clear visualization of the wall of right ventricle,but pulmonary artery could not be visualized clearly in a majority of cases.We should select the suitable injection plan according to the clinic needs.