碘禁忌证患者应用钆剂冠脉CTA的探讨

目的：探讨碘禁忌证患者应用钆剂行冠状动脉CTA的可行性。方法：30例不宜使用碘剂患者用钆剂替代行冠脉CTA检查,0.3mmol/kg给药,总量25～52ml不等,注射速率4～5ml/s,应用双源CT7～10s完成扫描。结果：30例均见冠状动脉主干及分支强化显示,主干内CT值为（130.73±26.95）HU,最大值为187HU,最小值为55HU。共有402个节段显示,占总节段数的83.75%（402/480）。显示欠清节段主要是：右冠第4段、前降支第8、10段及旋支第14、15段,全部患者检查前后血清肌酐值均未见异常改变。结论：对不宜使用碘剂而临床病情必需行冠脉CTA检查的患者,利用钆剂替代同样能取得预期效果,迅速明确病因对症治疗,检查前、后应确定肾功能正常,以防肾源性系统纤维化（NSF）发生的可能。

Discussion of gadolinium-enhanced CT coronary angiography in patients with contraindication to iodinated contrast medium

Objective：To discuss the feasibility of gadolinium-enhanced CT coronary angiography in patients with contraindication to iodinated contrast medium. Methods：Thirty patients with contraindication to iodine underwent CT coronary angiography with Gadolinium. Each patient received a dose of 0.3 mmol Gd/kg of body weight at a flow rate of 4～5 ml/s. Total volume of Gadolinium was 25～52 ml. All CT examinations were performed with a dual-source CT scanner,with total scan time ranging from 7 to 10 seconds. Results：Enhancement of trunks and branches of coronary artery could be seen in all thirty patients. The attenuation within trunks was 130.73±26.95 HU （range,55～187 HU）. In total,there were 402 segments. Not-evaluative image quality was found in segment 8,segment 10,segment 14 and segment 15. Serum creatinine levels of all cases were normal before and after CT exam. Conclusion：Gadolinium-enhanced CT coronary angiography is technically feasible and is valuable in coronary heart disease patients with contraindications to iodinated contrast material. Renal function should be identified normal before injection of Gadolinium to prevent nephrogenic systemic fibrosis （NSF）.