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目的:探讨64层螺旋CT心脏检查中应用三时相一次扫描获得理想的冠状动脉图像、心脏形态和功能分析的对比剂优化注射方案。方法:将326例患者以不同注射方案随机分成5组:方案A,30例,单期注射,仅团注80～90 ml对比剂。方案B 30例,双期注射,团注60～80 ml对比剂后于第二时相注射30 ml生理盐水。方案C、D、E共266例,均行三期注射。其中,方案C 92例;方案D 83例;方案E 91例。第一时相团注50～60 ml对比剂,第二时相分别以不同比率(方案C50%,方案D40%,方案E30%)注射30～40 ml对比剂-生理盐水混合液,第三时相注射30 ml生理盐水。分别测量升主动脉根部、同层面胸主动脉、主肺动脉、左心室及右心室的CT值,计算心室腔-心室壁的对比噪声比(CNR)。比较不同对比剂注射方案冠状动脉各级分支显示情况及右心室内对比剂均匀性。结果:CNR左心室各组间差异无统计学意义(P>0.05);CNR右心室各组间有显著性差异(P<0.01),C组CNR右心室明显高于其他各组(P<0.01)。左心室、升主动脉根部和降主动脉的平均CT值差异无统计学意义(P>0.05);主肺动脉和右心室的平均CT值有显著性差异(P<0.01),其中,右心室CT值C组高于其他各组(P<0.01)。各组在冠状动脉的显示方面无统计学意义(P>0.05)。右心室的均匀性各组间存在显著性差异(P<0.01),C组优于A、B、D组(P<0.05),与E组间差别无明显统计学意义(P>0.05)。结论:应用三时相注射方案,先团注50～60 ml对比剂(第一时相),再以50%的比率注射30～40 ml对比剂-生理盐水混合液(第二时相),随后注射30 ml生理盐水(第三时相),一次扫描不仅可以在清晰显示冠状动脉的同时行心脏形态和功能分析,而且减少了对比剂的用量,可以为临床冠心病的筛查提供相应的综合信息。
OBJECTIVE: To investigate the ideal contrast-agent injection protocol for coronary artery imaging, cardiac morphological and functional analysis using 64-slice spiral CT in cardiac examinations. Methods: 326 patients were randomly divided into 5 groups according to different injection regimens: regimen A, 30 cases, single injection, bolus injection only 80 ~ 90 ml contrast agent. Program B 30 cases, two-phase injection, the group note 60 ~ 80 ml contrast agent in the second phase injection of 30 ml of normal saline. A total of 266 cases C, D, E, were injected three. Among them, the program C 92 cases; the program D 83 cases; the program E 91 cases. The first phase of grouping 50-60 ml of contrast medium, the second phase were injected with 30-40 ml of contrast-saline solution at different rates (Protocol C50%, Protocol D40%, Protocol E30%), respectively Phase injection of 30 ml saline. The CT values of the ascending aorta, the same thoracic aorta, the main pulmonary artery, the left ventricle and the right ventricle were measured respectively to calculate the ratio of venous and ventricular wall contrast-to-noise ratio (CNR). Comparison of different contrast agent injection program at all levels of coronary artery branches show the situation and right ventricular contrast agent uniformity. Results: There was no significant difference in the CNR left ventricle among all groups (P> 0.05). There was significant difference between the CNR right ventricle groups (P <0.01). CNR right ventricle was significantly higher in the C group than in other groups (P <0.01) ). The average CT values of left ventricle, ascending aorta and descending aorta were not statistically different (P> 0.05). The mean CT values of the main pulmonary artery and right ventricle were significantly different (P <0.01). Among them, Value C group was higher than other groups (P <0.01). There was no significant difference in the display of coronary arteries in each group (P> 0.05). There were significant differences in the homogeneity of the right ventricle between the groups (P <0.01). The C group was superior to the A, B and D groups (P <0.05). There was no significant difference between the two groups (P> 0.05). CONCLUSIONS: The three-phase injection protocol is used to first administer 50-60 ml of contrast medium (first phase) and then inject 30-40 ml of contrast medium-saline mixture (second phase) at a rate of 50% Subsequent injection of 30 ml of saline (third phase), a scan not only shows the coronary arteries clear at the same time the morphology and function of the heart, but also reduces the amount of contrast agent, clinical coronary heart disease screening can provide the appropriate General Information.