两段式对比剂注射结合团注跟踪技术在肺动脉CTA检查中的应用研究

刘云福; 康天良; 张永县; 李伟; 许庆刚; 王新艳; 鲜军舫; 牛延涛

doi:10.15953/j.ctta.2023.075

两段式对比剂注射结合团注跟踪技术在肺动脉CTA检查中的应用研究

doi: 10.15953/j.ctta.2023.075

首都医科大学附属北京同仁医院放射科, 北京100730

基金项目: 北京市医院管理局临床医学发展专项（眼耳鼻喉影像（ZYLX201704））；北京市医院管理中心“登峰”计划专项（DFL20190203）。

详细信息

作者简介:
刘云福：男，首都医科大学附属北京同仁医院主管技师，主要从事头颈部CT、MRI扫描和图像后处理，E-mail：bzliuyf@163.com

通讯作者:
男，首都医科大学附属北京同仁医院主任技师，主要从事医学影像技术基础理论和质量控制，E-mail：ytniu163@163.com

中图分类号: R 814
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出版历程
- 收稿日期: 2023-03-23
- 修回日期: 2023-04-19
- 录用日期: 2023-04-25
- 网络出版日期: 2023-05-31
- 刊出日期: 2023-07-31

Study of Two-stage Injection of Contrast Agent in Combination with Bolus Tracking Technique in Computed Tomography Pulmonary Angiography

Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China

摘要

摘要: 目的：探讨两段式对比剂注射结合团注跟踪技术在肺动脉CTA成像中的应用价值。方法：收集2022年7月至12月在首都医科大学附属北京同仁医院因怀疑肺栓塞行肺动脉CT增强检查的30例患者为试验组，使用两段式对比剂注射结合团注跟踪技术的方法。兴趣区（ROI）置于肺动脉主干，设定阈值为100 HU。对比剂和生理盐水注射顺序：①对比剂 10 mL；②生理盐水 30 mL；③对比剂 20 mL；④生理盐水 30 mL，注射流率均为5 mL/s。跟踪肺动脉主干CT值，达到设定阈值后延迟10 s开始扫描。收集2021年1月至2021年12月间30例患者为对照组，采用小剂量团注测试技术。先注射对比剂10 mL+生理盐水30 mL测量肺动脉主干达峰时间，再注射对比剂20 mL+生理盐水30 mL，以达峰时间+1 s作为延迟时间扫描。测量两组图像肺动脉、肺静脉、锁骨下静脉、升主动脉的CT值，并对两组图像肺动脉图像质量和上腔静脉硬化伪影进行评分。两组图像血管CT值的比较采用独立样本t检验；肺动脉图像质量评分、上腔静脉硬化伪影评分的比较采用非参数Mann-Whitney U检验。结果：试验组左肺动脉、右肺上叶动脉、右肺中叶动脉、右肺下叶动脉、左肺上叶动脉、升主动脉CT值大于对照组，差异有统计学意义；试验组和对照组肺动脉主干、右肺动脉、左肺下叶动脉、右上肺静脉、右下肺静脉、左上肺静脉、左下肺静脉、锁骨下静脉、右侧动静脉CT值差值、左侧动静脉CT值差值差异无统计学意义；试验组和对照组肺动脉影像质量评分差异无统计学意义；试验组和对照组上腔静脉硬化伪影评分差异无统计学意义。结论：肺动脉CTA检查使用两段式对比剂注射结合团注跟踪技术可获得稳定的图像质量，且操作步骤简单易行，过渡延迟时间适用于大多数CT设备，值得在临床推广。
- 体层摄影术 /
- X线计算机 /
- 肺动脉 /
- 对比剂
Abstract: Objective: To investigate the utility of a two-stage injection of contrast agent combined with a bolus tracking technique in computed tomography (CT) pulmonary angiography. Methods: We recruited 30 patients undergoing CT pulmonary angiography due to suspected pulmonary embolism at Beijing Tongren Hospital affiliated to Capital Medical University from February to April 2022 as the experimental group, using a two-stage injection of contrast agent combined with bolus tracking technique. The region of interest (ROI) was placed in the pulmonary trunk with a threshold of 100HU. Contrast agent and normal saline injection sequence: (1) contrast agent 10 mL; (2) normal saline 30 mL; (3) contrast agent 20 mL; (4) normal saline 30 mL; the injection rate for all was 5 mL/s. The CT value of the pulmonary trunk was tracked, and scanning was delayed for 10 s after reaching the set threshold. Using the test bolus technique, we recruited 30 patients from January to December 2021 as the control group. First, 10 mL of contrast plus 30 mL of normal saline was injected to measure the peak time of the main pulmonary artery. Then, 20 mL of contrast plus 30 mL of normal saline was injected, and the peak time +1 s was used as the delay time for the scan. CT values were measured for the pulmonary artery, pulmonary vein, subclavian vein, and ascending aorta in both groups. Both groups scored the quality of the pulmonary artery images and the sclerotic artifacts of the superior vena cava. We compared the CT values of the vessels in the two groups using independent sample t-tests. We compared the pulmonary artery image quality scores and the sclerotic artifact scores of the superior vena cava using a non-parametric Mann–Whitney U-test. Results: CT values of the left pulmonary artery, right upper lobe artery, right middle lobe artery, right lower lobe artery, left upper lobe artery, and ascending aorta of the experimental group were higher than those of the control group, and the difference was statistically significant. There was no significant difference in the main pulmonary artery, right pulmonary artery, left inferior pulmonary artery, right upper pulmonary vein, right lower pulmonary vein, left upper pulmonary vein, left lower pulmonary vein, subclavian vein, right arteriovenous difference, and left arteriovenous difference between both groups. Also, there was no significant difference in pulmonary artery image quality scores between both groups, likewise in the sclerosis artifact score of superior vena cava sclerosis. Conclusions: The two-stage contrast agent injection with the bolus tracking technique for CT pulmonary angiography provides stable image quality with a simple and easy procedure. The transition delay time suits most CT devices and deserves a clinical generalization.
- tomography /
- X-ray computed /
- pulmonary artery /
- contrast agent

HTML全文

图 1 两段式对比剂注射方法，注射流率均为5 mL/s，两段对比剂开始注射时间间隔8 s，第1段对比剂达到设定阈值后10 s相当于第2段对比剂达到阈值后2 s

Figure 1. In the two-stage injection method, the injection flow rate was 5 mL/s, and the interval between the start of the two-stage contrast injection was 8 s; 10 s after the first stage of contrast reaches the set threshold is equivalent to 2 s after the second stage of contrast reaches the threshold

下载: 全尺寸图片幻灯片

图 2 对照组患者使用小剂量团注测试技术，试验组患者使用两段式对比剂注射结合团注跟踪技术

（a）和（b）为对照组组患者，（a）横轴位厚层MIP图像，（b）冠状位厚层MIP图像，因扫描启动过晚导致肺静脉强化，肺动脉与肺静脉CT值差值小于150 HU，图像质量评分为3分；（c）和（d）为试验组患者，（c）横轴位厚层MIP图像，（d）冠状位厚层MIP图像，肺静脉略显影，肺动脉处于强化峰值，与肺静脉有良好的对比，CT值差值大于150 HU，图像质量评分为4分。

Figure 2. The control groups, using the test bolus technique, and the experimental groups, using a two-stage injection of contrast agent combined with bolus tracking technique

下载: 全尺寸图片幻灯片

表 1 试验组和对照组测量血管的平均值、最小值和最大值的比较

Table 1. Comparison of mean, minimum, and maximum values of measured vessels between the experimental and control groups

测量血管	CT值/HU		统计检验
测量血管	试验组$\bar{x}\pm s$（min～max）	对照组$\bar{x}\pm s$（min～max）	t	P
肺动脉主干	340±50（264～431）	312±65（183～483）	1.86	0.067
右肺动脉	339±51（251～435）	313±58（180～463）	1.86	0.068
左肺动脉	345±54（252～431）	314±57（188～466）	2.21	0.031
右肺上叶动脉	367±62（281～498）	329±61（185～497）	2.40	0.020
右肺中叶动脉	359±61（269～468）	322±58（202～472）	2.39	0.020
右肺下叶动脉	363±58（268～511）	329±61（206～469）	2.19	0.033
左肺上叶动脉	362±54（258～441）	330±59（197～467）	2.18	0.033
左肺下叶动脉	362±57（259～457）	332±63（195～474）	1.89	0.064
右上肺静脉	137±39（85～225）	128±57（40～263）	0.74	0.462
右下肺静脉	132±30（86～192）	122±53（45～225）	0.86	0.392
左上肺静脉	137±37（89～226）	134±56（42～265）	0.20	0.841
左下肺静脉	135±35（91～228）	124±52（40～244）	0.90	0.375
锁骨下静脉	935±250（469～1728）	840±303（317～1645）	1.32	0.193
升主动脉	120±21（84～165）	71±19（44～120）	9.50	0.000
右侧动静脉CT值差值	204±57（86～289）	188±89（-17～374）	0.87	0.389
左侧动静脉CT值差值	210±61（70～301）	184±86（6～376）	1.31	0.195
注：$\bar{x}\pm s$为平均值±标准差，min为最小值，max为最大值。

下载: 导出CSV

表 2 两名医师对试验组和对照组肺动脉影像质量、上腔静脉伪影评分分布和一致性分析结果

Table 2. Distribution and consistency of pulmonary artery image quality and superior vena sclerotic artifact scores analyzed by two physicians in the experimental and control groups

组别	医师1/例				医师2/例				评分 $({M}({Q}_{1}, t{Q}_{3} ))$	一致性分析
组别	4分	3分	2分	1分	4分	3分	2分	1分	评分 $({M}({Q}_{1}, t{Q}_{3} ))$	Kappa值	P
肺动脉图像质量评分
试验组	22	8	0	0	23	7	0	0	4.0（3.5,4.0）	0.73	＜0.001
对照组	15	13	2	0	19	11	0	0	3.75（3.0,4.0）	0.62	＜0.001
上腔静脉硬化伪影评分
试验组	4	22	4	0	2	24	4	0	3.0（3.0,3.0）	0.66	＜0.001
对照组	2	24	4	0	2	19	9	0	3.0（2.5,3.0）	0.63	＜0.001

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