Study on the Value of Individualized Contrast Agent Injection Scheme in Improving the Biosafety of Pulmonary Artery CTA
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摘要: 目的：研究个性化造影剂注射方案在提升肺动脉CTA生物应用安全性的价值。资料与方法：前瞻性纳入亭林医院2018年1月至2020年6月临床怀疑肺动脉栓塞的患者50例作为研究对象，将患者分配到A组和B组。A组为常规组，注射方案为：20 mL生理盐水+50 mL造影剂+30 mL生理盐水，注射速率均为4.5 mL/s。B组为个性化组，注射方案为：20 mL生理盐水+（造影剂注射剂量=体重×0.6 mL）+30 mL生理盐水，造影剂注射速率=造影剂注射剂量/10 s；生理盐水注射速率均为4.5 mL/s。采用独立样本的t检验，比较两组间的年龄、身高、体重、造影剂注射剂量和注射速率、肺动脉主干及左右肺动脉内的CT值、图像质量主观评分等数据。采用Kappa检验评价两名医师间对所得图像质量主观评价的一致性。结果：两组间年龄、身高、体重差异无统计学意义；两组间的造影剂注射剂量和速率差异有统计学意义；两组间肺动脉主干及左右肺动脉内的CT值、图像质量主观评分无统计学意义；Kappa检验评价两名医师图像质量主观评分一致性高度一致，Kappa=0.80。结论：在保证肺动脉CTA图像质量的前提下，给体重≤ 75 kg的患者采用个性化注射方案，可以有效减少造影剂注射剂量，减缓注射速率，从而降低造影剂给患者带来的潜在生物应用安全性风险。Abstract: Objective: To study the value of individualized contrast medium injection scheme in improving the biosafety of pulmonary artery CTA. Materials and methods: 50 patients clinically suspected of pulmonary embolism from January 2018 to June 2020 were randomly assigned into groups A and B. Group A was the routinely group, the injection scheme was 20mL of normal saline, 50 mL of contrast agent and 30 mL of saline, with the injection rate of 4.5 mL/s. Group B was the individualized group, and the injection scheme was 20 mL of normal saline, (contrast medium dosage=weight×0.6 mL) and 30 mL of normal saline, the injection rate of contrast medium=dosage of contrast agent/10 s while the injection rate of physiological saline was 4.5 mL/s. We adopted t-test of independent samples to compare the data of age, height, weight, dosage and rate of contrast agent injection, CT value of main pulmonary artery and left and right pulmonary arteries and subjective evaluation of image quality between the two groups. Kappa test was used to evaluate the consistency of subjective evaluation of the image quality between the two doctors. Results: There was no statistical significance in the difference of age, height and weight between the two groups; the difference between the two groups in the dosage and rate of contrast mediumt injection was statistically significant; there was no statistical significance in CT value of main pulmonary artery and left and right pulmonary arteries and subjective evaluation of image quality between the two groups; Kappa test indicated that the two doctors held high consistency in subjective evaluation of image quality, with Kappa=0.80. Conclusion: On the premise of ensuring the quality of CTA images of pulmonary artery, personalized injection scheme can effectively reduce the dosage of contrast medium and slow down the injection rate for patients with weight less than 75 kg, thus reduces the potential risk of biological safety for patients.
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Keywords:
- pulmonary CTA /
- individualized /
- contrast agent /
- biosafety
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[1] 黄计贤, 林坚全, 黄冀睿, 等.双低MSCT肺血管成像在肺动脉栓塞诊断中的应用价值[J]. 中外医学研究, 2021, 19(3):51-53. HUANG J X, LIN J Q, HUANG J R, et al. Application value of double low MSCT pulmonary angiography in the diagnosis of pulmonary embolism[J]. Chinese and Foreign Medical Research, 2021, 19(3):51-53. (in Chinese).
[2] JAMALI L,ALIKHANI B,GETZIN T, et al. Arterial attenuation in individualized computed tomography pulmonary angiography injection protocol adjusted based on the patient's body mass index[J]. Journal of Research in Medical Sciences, 2020, 25:94.
[3] 钱会绒, 王青云, 朱刚明, 等. 小剂量团注测试法在肺动脉"双低"成像中的技术探讨[J]. 实用医学影像学杂志, 2019, 20(2):119-122. QIAN H R, WANG Q Y, ZHU G M, et al. Preliminary study of test bolus in CT pulmonary angiography with lower radiation dose and lower contrast medium[J]. Journal of Practical Medical Imaging, 2019, 20(2):119-122. (in Chinese).
[4] 梁田, 刘会, 谢晟, 等. 肺动脉CTA漏诊亚段肺栓塞原因分析[J]. 中国医学影像技术, 2018, 34(8):1220-1223. LIANG T, LIU H, XIE S, et al. Analysis of missed diagnosis of sub-segmental pulmonary embolism with pulmonary CTA[J]. Chinese Journal of Medical Imaging Technology, 2018, 34(8):1220-1223. (in Chinese).
[5] 朱宏伟, 王素娟, 王晔. 不同浓度对比剂在肺动脉CTA中的应用研究[J]. 医学影像学杂志, 2015, 25(4):633-236. ZHOU H W, WANG S J, WANG Y. The application with low concentration of contrast media in the pulmonary angiography[J]. Journal of Medical Imaging, 2015, 25(4):633-236. (in Chinese).
[6] 刘军波, 张计旺, 张晓浩, 等. 个体化对比剂双低注射方案单心动周期冠状动脉CT成像可行性[J]. 中华放射学杂志, 2020, 11(24):3448-3452. LIU J B, ZHANG J W, ZHANG X H, et al. Feasibility study of contrast injection scheme based on body mass and iodine flow rate in coronary computed tomography angiography with wide detector CT[J]. Chinese Journal of Radiology, 2020, 11(24):3448-3452. (in Chinese).
[7] ZHANG F F,LU Z Y, WANG F. Advances in the pathogenesis and prevention of contrast-induced nephropathy[J]. Life Sciences, 2020, 259(6):118379. DOI: 10.1016/j.lfs.2020.118379.
[8] 王鸣鹏. 医学影像技术学CT检查技术卷[M]. 北京:人民卫生出版社, 2012:221. [9] REMY-JARDIN M, PISTOLESI M, GOODMAN LR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography:A statement from the fleischnersociety[J]. RSNA, 2007, 245:315-329.
[10] MCCULLOUGH P A, CHOI J P, FEGHALI G A, et al. Contrast-induced acute kidney injury[J]. Journal of the American College of Cardiology, 2016, 68(13):1465-1473.
[11] DUGBARTEY G J, REDINGTION A N. Prevention of contrast-induced nephropathy by limb ischemic preconditioning:Underlying mechanisms and clinical effects[J]. American Journal of physiology, Renal Physiology, 2017, 14(3):ajprenal.00130. DOI: 10.1152/ajprenal.00130.2017.
[12] 何霖, 尹喜, 王成伟, 等. 80 kV, 低剂量对比剂结合ASIR重建在肺动脉CTA中的初步研究[J]. 医学影像学杂志, 2017, 27(2):254-258. HE L, YIN X, WANG C W, et al. Preliminary study of 80 kVp, low dose contrast agent combined with ASIR reconstruction in pulmonary CTA[J]. Journal of Medical Imaging, 2017, 27(2):254-258. (in Chinese).
[13] 董艳. 造影剂肾病的研究进展[J]. 药学研究, 2014, 33(4):244-247. DONG Y. Research progress of contrast induced nephropathy[J]. Pharmaceutical Research, 2014, 33(4):244-247. (in Chinese).
[14] 张文明, 陈彬, 胡吉波, 等. 比较团注对比剂跟踪技术和小剂量团注测试技术在双能量CT肺灌注扫描中的应用[J]. 中华放射学杂志, 2013, 10(47):892-897. ZHANG W M, CHEN B, HU J B, et al. Comparison of test bolus and bolus tracking techniques for dual-energy CT lung perfusion scan[J]. Chinese Journal of Radiology, 2013, 10(47):892-897. (in Chinese).
[15] SZUCS-FARKAS Z, SCHALLER C, BENSLER S, et al. Detection of pulmonary emboli with CT angiography at reduced radiation exposure and contrast material volume comparison of 80kVp and 120kVp protocols in a matched cohort[J]. Investigative Radiology, 2009, 44:793-799.
[16] ROGGENLAND D, PETERS SA, LEMBURG SP, et a1. CT angiography in suspected pulmonary embolism:Impact of patient characteristics and different venous lines on vessel enhancement and image quality[J]. American Journal of Roentgenology, 2008, 190:W351-W359.
[17] 中华医学会放射学分会心胸学组, 《中华放射学杂志》心脏冠状动脉多排CT临床应用指南写作专家组. 心脏冠状动脉CT血管成像技术规范化应用中国指南[J]. 中华放射学杂志, 2017, 51(10):732-743. [18] ABBARA S, BLANKE P, MAROULES CD, et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography:A report of the society of Cardiovascular Computed Tomography Guidelines Committee:Endorsed by the North American Society for Cardiovascular Imaging (NASCI)[J]. Journal of Cardiovascular Computed Tomography, 2016, 10(6):435-449. DOI: 10.1016/j.jcct.2016.10.002.
[19] 胡茂清, 龙昉, 龙晚生, 等. 身体指数与主动脉和肝脏CT强化程度的相关性研究[J]. 中华放射学杂志, 2020, 54(2):101-106. HU M Q, LONG F, LONG W S, et al. The aortic and hepatic contrast enhancement at CT and its correlations with various body size index[J]. Chinese Journal of Radiology, 2020, 54(2):101-106. (in Chinese).
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