高浓度对比剂在低剂量、低辐射条件下冠状动脉扫描的可行性

发布时间：2018-03-31 02:33

本文选题：对比剂　切入点：体层摄影术　出处：《山东大学》2017年硕士论文

【摘要】：CT血管内对比剂已经广泛应用于临床,如何应用最少的对比剂获得最佳强化效果至关重要,但由于很多年轻放射科医师对血管内对比剂基础知识的认识不够,以及对于不同对比剂应用参数的增强效果及规律未能深入了解,限制了对比剂应用研究的深度和广度,从而使对比剂在使用上陷入一些误区。本篇综述通过相关文献的复习并结合自身临床经验,详细阐述了对比剂的分类、理化特性及其影响因素,分析了影响肾安全性的相关因素及如何真正降低肾毒性,通过自身实验加强对高浓度对比剂的认识及在门静脉增强上的特殊性,希望对放射科医师的临床工作有所帮助。目的探究高浓度(400mgI/ml)对比剂与常规对比剂(350mgI/ml)在低kvp、降低25%碘总量条件下行冠状动脉扫描的优势。方法将60名病人平均分成两组(每组30人),两组的对比剂用量及扫描参数、重建方式分别为,A 组:400mgI/ml,100kv,210mgI/kg,迭代重建;B 组:350mgI/ml,120kv,280mgI/kg,滤波反投影法重建。测量主动脉根部(AR)、左冠状动脉主干(LMA)、右冠状动脉(RCA)、回旋支(LCX)以及胸壁肌肉的CT值。计算得到CT剂量指数体积(CTDI)、信噪比(SNR)、对比噪声比(CNR)。两位有经验的放射医师用五分法评价图像质量。结果两组的碘摄入量(A:15.0±1.54,B:19.7±3.0,P0.01)、注射速率(A:3.4±0.35,B:5.1±0.78,P0.01)相比,A组明显小于B组。A组的辐射剂量比B组降低48.5%(A:6.45±1.07,B:12.53±2.27,P0.01).CT值,除RCA 的信噪比(SNR)以外,其余血管各段的信噪比(SNR)和对比噪声比(CNR)没有明显差异(P0.05)。两组间图像质量没有明显差异(P0.01).结论在保证图像质量的前提下,与传统方案相比,利用高浓度对比剂(400mgI/ml)在降低25%碘对比剂用量、100kv管电压结合迭代重建的方案有明显优势。
[Abstract]:Ct intravascular contrast agents have been widely used in clinical practice. How to obtain the best enhancement effect with the least contrast agent is very important. However, many young radiologists do not know enough about the basic knowledge of intravascular contrast agents.Moreover, the enhancement effect and law of different contrast agent application parameters are not well understood, which limits the depth and breadth of contrast agent application research, and makes contrast agent fall into some misunderstandings in use.Based on the review of relevant literature and clinical experience, the classification, physicochemical properties and influencing factors of contrast agents were described in detail, and the related factors affecting renal safety and how to reduce renal toxicity were analyzed.To strengthen the understanding of high concentration contrast agent and the particularity of portal vein enhancement through self-experiment, we hope to be helpful to the clinical work of radiologists.Objective to investigate the advantages of high concentration of 400 mg I / ml contrast agent and 350mgI / ml of conventional contrast agent in coronary artery scanning under low KVP and reducing 25% total iodine content.The CT values of ARA, LMA, RCA, LCX and chest wall muscle were measured.The CT dose index volume and SNR were calculated, and the contrast noise ratio (CNR) was obtained.Two experienced radiologists evaluated image quality with a five-point method.There was no significant difference in image quality between the two groups (P 0.01).Conclusion on the premise of guaranteeing image quality, using high concentration contrast agent 400mgI / ml has obvious advantages in reducing 25% iodine contrast agent dosage to 100kv tube voltage and iterative reconstruction.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R816.2

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