使用超低造影剂 CT 主动脉造影术治疗主动脉瘤疾病。

IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiothoracic Surgery Pub Date : 2024-10-03 DOI:10.1186/s13019-024-03099-7
Philip Borkowski, Eugene Ng, Mauro Vicaretti, Noel Young
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引用次数: 0

摘要

目的:计算机断层扫描主动脉造影术(CTA)用于评估主动脉病变和制定手术干预计划。然而,CTA 对碘造影剂的依赖可能导致造影剂诱发急性肾损伤(CI-AKI)。对 CI-AKI 的潜在担忧促使人们研究在 CTA 检查中使用低造影剂的可能性,同时保持整体诊断吸引力。多项研究表明,使用低至 30 毫升(相当于 10.5 克碘)造影剂的 CTA 仍能获得具有诊断质量的扫描结果。我们进行了一项回顾性试验研究,评估在血管外科转诊的严重肾功能不全患者中使用超低剂量碘静脉注射造影剂进行胸腹主动脉 CTA 评估的可行性:这项回顾性试验研究对使用 20 毫升碘对比剂进行的 12 次 CTA 扫描进行了检查,并通过定量和定性指标对图像质量进行了评估。所有扫描均在西门子 SOMATOM Force 双源 CT 扫描仪上进行。定量评估值通过八个主动脉髂骨位置的衰减值进行测量,并用于计算每个位置的信噪比(SNR)和对比度-噪声比(CNR)。介入放射科医生和血管外科医生通过主观临床评估对图像质量和手术干预的可行性进行定性分析:获得的定量评估值包括平均衰减 189.9 HU、平均信噪比 9.6 和平均 CNR 8.0。所有 12 张扫描图像的单个平均信噪比值均高于预定的质量阈值,而只有 5 张扫描图像的单个平均 CNR 值高于阈值。12次扫描中,有11次被确定为足以进行诊断和手术干预计划:我们的研究结果表明,使用 20 毫升(6 克碘)的超低造影剂进行 CTA 扫描可获得高质量的诊断结果,用于血管外科干预的治疗决策。
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Use of ultra-low contrast dose CT aortography for the management of aortic aneurysmal disease.

Purpose: Computed tomography aortography (CTA) is used in the assessment of aortic pathologies and planning of surgical intervention. However, its dependence on iodinated contrast can result in development of contrast-induced acute kidney injury (CI-AKI). The potential concern of CI-AKI has spurred research into the potential of administration of low contrast volumes in CTA investigations while maintaining overall diagnostic appeal. Several studies have shown that CTA using contrast volumes as low as 30 mL (equivalent to 10.5 g of iodine) can still yield scans of diagnostic quality. We present a retrospective pilot study to evaluate the feasibility of utilising an ultra-low volume of iodinated intravenous contrast in a population of patients with severe renal insufficiency with referral from our vascular surgery unit for CTA evaluation of the thoracic and abdominal aorta.

Methods: This retrospective pilot study examined 12 CTA scans performed with 20 mLs of iodinated contrast and assessed image quality with both quantitative and qualitative markers. All scans were performed on a Siemens SOMATOM Force dual-source CT scanner. Quantitative assessment values were measured via attenuation values at eight aortoiliac locations and used to calculate a signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at each location. Qualitative analysis of image quality and viability for surgical intervention was obtained from subjective clinical assessment by an interventional radiologist and vascular surgeon.

Results: Obtained quantitative assessment values included mean attenuation 189.9 HU, mean SNR 9.6 and mean CNR 8.0. All 12 scans demonstrated individual mean SNR values above predetermined quality thresholds while only five scans produced individual mean CNR values above threshold. Eleven of 12 scans were determined to be of sufficient quality for diagnosis and planning of surgical intervention.

Conclusions: Our results suggest that CTA utilising an ultra-low contrast dose of 20 mLs (6 g iodine) yields scans of diagnostic quality for therapeutic decision-making in vascular surgical intervention.

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来源期刊
Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery 医学-心血管系统
CiteScore
2.50
自引率
6.20%
发文量
286
审稿时长
4-8 weeks
期刊介绍: Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
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