CAJ | 학술논문

目的：比较不同造影剂注射方案，以选择最佳的64层螺旋CT冠状动脉造影剂注射方案。方法将150例患者按数字表法随机分为五组：A组为单时相（单纯注射造影剂），B组为双时相（造影剂注射完后注射生理盐水），C、D、E组为三时相（在造影剂和生理盐水注射时相之间加入稀释造影剂注射时相，即同时注射造影剂和生理盐水，其比例依次为3：7、5：5、7：3）。各组患者造影剂均使用碘海醇（350 mgI/ml），分别测量右心房、右心室、左心房、左心室、升主动脉、左右冠状动脉CT值，采用单因素分析（ anova）比较其差异。评估图像质量和上腔静脉伪影，采用卡方检验比较其差异。结果 D 组总造影剂用量与 A、E 组比较差异无统计学意义（ P =0.18，P =0.25），B组与C组造影剂注射总量比较差异也无统计学意义（P=0.06），其余各组两两比较差异均有统计学意义（ P﹤0.05）。B组造影剂用量最少，为59 ml，其次为C组62 ml。五组冠状动脉图像质量比较差异有统计学意义（χ2=18.81，P=0.016）。A组质量最佳，评分为4分者22例，其次为B组和C组；图像质量评分为3分和4分，分别为26例24例，两组图像质量比较差异无统计学意义（χ2=0.48，P=0.79）。各组产生的上腔静脉伪影比较差异有统计学意义（ F=31.44，P﹤0.01）。产生伪影以A组最多，共21例；B组最少，仅1例。B组冠状动脉CT值较其他组明显增高（F=29.41，P﹤0.01），其余各组间左右冠状动脉CT值比较差异无统计学意义（P﹥0.05）。结论在64层冠状动脉造影扫描中，双时相和三时相注射方案优于单时相注射方案；在显示右心系统方面，三时相注射方案优于双时相注射方案。
목적：비교불동조영제주사방안，이선택최가적64층라선CT관상동맥조영제주사방안。방법장150례환자안수자표법수궤분위오조：A조위단시상（단순주사조영제），B조위쌍시상（조영제주사완후주사생리염수），C、D、E조위삼시상（재조영제화생리염수주사시상지간가입희석조영제주사시상，즉동시주사조영제화생리염수，기비례의차위3：7、5：5、7：3）。각조환자조영제균사용전해순（350 mgI/ml），분별측량우심방、우심실、좌심방、좌심실、승주동맥、좌우관상동맥CT치，채용단인소분석（ anova）비교기차이。평고도상질량화상강정맥위영，채용잡방검험비교기차이。결과 D 조총조영제용량여 A、E 조비교차이무통계학의의（ P =0.18，P =0.25），B조여C조조영제주사총량비교차이야무통계학의의（P=0.06），기여각조량량비교차이균유통계학의의（ P﹤0.05）。B조조영제용량최소，위59 ml，기차위C조62 ml。오조관상동맥도상질량비교차이유통계학의의（χ2=18.81，P=0.016）。A조질량최가，평분위4분자22례，기차위B조화C조；도상질량평분위3분화4분，분별위26례24례，량조도상질량비교차이무통계학의의（χ2=0.48，P=0.79）。각조산생적상강정맥위영비교차이유통계학의의（ F=31.44，P﹤0.01）。산생위영이A조최다，공21례；B조최소，부1례。B조관상동맥CT치교기타조명현증고（F=29.41，P﹤0.01），기여각조간좌우관상동맥CT치비교차이무통계학의의（P﹥0.05）。결론재64층관상동맥조영소묘중，쌍시상화삼시상주사방안우우단시상주사방안；재현시우심계통방면，삼시상주사방안우우쌍시상주사방안。
Objective To compare the different contrast agent injection scheme,and choose the best 64 slice spiral CT coronary artery contrast agent injection scheme. Methods One hundred and fifty patients were randomly divided into 5 groups:group A for single phase( simple injection of contrast a-gent),group B for two phase( dual phase contrast agent injection after injection of saline),group C,D, E,for the three phase( in contrast agents and saline injection phase between the accession of diluted con-trast medium injection phase,i. e. ,simultaneous injection of contrast agent and saline,the ratio of 3:7, 5:5,7:3). The case contrast agents were iohexol(350 mgI/ml). The CT value of right atrium,right ventricle,the left atrium,the left ventricle,the ascending aorta,left and right coronary artery were measured respectively,and the differences were compared by single factor analysis( ANOVA). The image quality and superior vena cava artifact was assessed,and the chi-square test was used to compare their differences. Results The differences of total dosage of contrast had no statistically significant difference between group C and group A,E(P =0. 18,P =0. 25),group B and group C(P =0. 06),but the differences between other groups were statistically significant( P﹤0. 05 ). The amount of contrast agent of group B was least(59 ml),the next was group C(62 ml). The differences of coronary artery image quali-ty among the 5 groups were statistically significant(χ2 =18. 81 ,P=0. 016 ). Group A had the best qual-ity,a score of 4 for 22 cases. Followed by the group B and group C,image quality score of 3 and 4 for 26 and 24 cases,respectively,but there was no significant difference between the two groups(χ2 =0. 48, P=0. 79 ). The differences of produce superior vena cava artifact among the 5 groups were statistically significant(F=31. 44,P﹤0. 01). Group A was the most,with a total of 21 cases,and group B was the least,only 1 case. Coronary CTA value in group B was significant higher than that in other groups( F=29. 41 ,P﹤0. 01 ),but there was no significant difference among the other groups( P﹥ 0. 05 ). Conclu-sions In 64 layers of coronary angiography,two phase and three phase injection scheme is superior to single phase injection scheme. For the display of right heart system, three phase injection scheme is better than the two phase injection scheme.