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首页> 外文期刊>Acta Radiologica >Minimizing contrast medium doses to diagnose pulmonary embolism with 80-kVp multidetector computed tomography in azotemic patients.
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Minimizing contrast medium doses to diagnose pulmonary embolism with 80-kVp multidetector computed tomography in azotemic patients.

机译：在无氧血症患者中使用80 kVp多探测器计算机断层扫描，以最小化造影剂剂量来诊断肺栓塞。

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BACKGROUND: In diagnosing acute pulmonary embolism (PE) in azotemic patients, scintigraphy and magnetic resonance imaging are frequently inconclusive or not available in many hospitals. Computed tomography is readily available, but relatively high doses (30-50 g I) of potentially nephrotoxic iodine contrast media (CM) are used. PURPOSE: To report on the diagnostic quality and possible contrast-induced nephropathy (CIN) after substantially reduced CM doses to diagnose PE in azotemic patients using 80-peak kilovoltage (kVp) 16-row multidetector computed tomography (MDCT) combined with CM doses tailored to body weight, fixed injection duration adapted to scan time, automatic bolus tracking, and saline chaser. MATERIAL AND METHODS: Patients with estimated glomerular filtration rate (eGFR) <50 ml/min were scheduled to undergo 80-kVp MDCT using 200 mg I/kg, and those with eGFR >or=50 ml/min, 120-kVp MDCT with 320 mg I/kg. Both protocols used an 80-kg maximum dose weight and a fixed 15-s injection time. Pulmonary artery density and contrast-to-noise ratio were measured assuming 70 Hounsfield units (HU) for a fresh clot. CIN was defined as a plasma creatinine rise >44.2 micromol/l from baseline. RESULTS: 89/148 patients (63/68 females) underwent 80-/120-kVp protocols, respectively, with 95% of the examinations being subjectively excellent or adequate. Mean values in the 80-/120-kVp cohorts regarding age were 82/65 years, body weight 66/78 kg, effective mAs 277/117, CM dose 13/23 g I, pulmonary artery density 359/345 HU, image noise (1 standard deviation) 24/21 HU, contrast-to-noise ratio 13/13, and dose-length product 173/258 mGy x cm. Only 1/65 and 2/119 patients in the 80- and 120-kVp cohorts, respectively, with negative CT and no anticoagulation suffered non-fatal thromboembolism during 3-month follow-up. No patient developed CIN. CONCLUSION: 80-kVp 16-row MDCT with optimization of injection parameters may be performed with preserved diagnostic quality, using markedly reduced CM doses compared with common routine practice, which should be to the benefit of patients at risk of CIN.
机译：背景：在诊断无足轻重的患者中的急性肺栓塞（PE）时，闪烁显像和磁共振成像常常是不确定的，或者在许多医院中不可用。计算机断层扫描很容易获得，但是使用了相对较高剂量（30-50 g I）的潜在肾毒性碘造影剂（CM）。目的：报告在使用80峰千伏（kVp）16行多探测器计算机断层扫描（MDCT）结合量身定制的CM剂量的无症状患者中CM剂量大幅度降低以诊断PE后的诊断质量和可能的对比诱发肾病（CIN）根据体重，固定的注射持续时间适合扫描时间，自动推注跟踪和盐水追踪器。材料与方法：预计肾小球滤过率（eGFR）<50 ml / min的患者计划接受200 mg I / kg的80-kVp MDCT，eGFR> or = 50 ml / min的患者接受120-kVp MDCT 320毫克I / kg。两种方案均使用80千克最大剂量重量和固定的15秒注射时间。假设新鲜凝块的肺动脉密度和对比度噪声比假定为70 Hounsfield单位（HU），则进行测量。 CIN被定义为血浆肌酐比基线升高> 44.2微摩尔/升。结果：分别对89/148例患者（63/68例女性）进行了80- / 120 kVp方案，其中95％的检查在主观上良好或足够。在80- / 120-kVp队列中，年龄的平均值为82/65岁，体重为66/78 kg，有效mAs 277/117，CM剂量为13/23 g I，肺动脉密度为359/345 HU，图像噪声（1个标准差）24/21 HU，对比度-噪声比13/13，剂量长度乘积173/258 mGy x cm。在80 kVp和120 kVp的队列中，分别仅有1/65和2/119例患者的CT阴性且无抗凝治疗在3个月的随访期间发生了非致命性血栓栓塞。没有患者发生CIN。结论：与常规常规操作相比，使用显着降低的CM剂量可以在不影响诊断质量的情况下执行具有最佳注射参数的80kVp 16行MDCT，这应有利于有CIN风险的患者。

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