Ischemic heart disease is one of the most popular and lethal diseases for aged peoples in the world, and is usually diagnosed by transarterial selective coronary arteriography. However, it is rather invasive and somewhat dangerous, so that the selective coronary arteriography is not feasible for prospective screening of coronary occlusive heart disease. Conventional digital subtraction angiography (DSA) is widely known as a relatively noninvasive and useful technique is making a diagnosis of arterial occlusive disease, especially in making the diagnosis of ischemic heart disease. Conventional intravenous subtraction angiography by temporal subtraction, however, has several problems when applying to the moving objects. Digital subtraction method using high-speed switching above and below the K edge could be the ideal approach to this solution. We intend to make a synchrotron radiation digital K-edge subtraction angiography in the above policy, and to apply it to the human coronary ischemic disease on an outpatient basis. The principles and experimental systems have already been described in detail by our coworkers. Our prototype experimental system is situated at the AR (accumulation ring) for TRISTAN project of high energy physics. The available beam size is 70 mm by 120 mm. The electron energy of AR is 6.5 GeV and average beam current is approximately 10 mA. This paper will show the animal experiments of our K-edge subtraction system, and discuss some problems and technical difficulties. Three dogs, weighing approximately 15 kg, were examined to evaluate the ability of our prototype synchrotron radiation DSA unit, that we are now constructing. The dogs were anaesthetized with pentobarbital sodium, intravenously (30 mg/kg). Six french-sized (1.52 mm i.d.) pigtail catheter with multiple side holes were introduced via the right femoral vein into the right atrium by the cutdown technique under conventional x-ray fluoroscopic control. Respiration of the dogs was controlled by a mechanical ventilator. The respirations were held for several seconds when taking the images. Approximately 10 to 15 mℓ of 76% water soluble iodinated contrast medium (Urografin 76, Schering) was injected by an automatic electronic injector at the rate of approximately 10 mℓ/s. Three or four times injections were done so as not to exceed the normal renal excretion threshold. Intravenous drip infusion of saline (500 mℓ/2 h) was used to accelerate the washout of contrast medium via renal system. One hundred micrograms of nitroglycerin were administered, intravenously to dilate the coronary arteries, approximately 3 min prior to contrast injection. Sometimes we used 0.1 mg/kg of beta blockage agent (Propranorol) to decrease the heart rate. Subsequently, the heart rate of the dogs was decreased from approximately 200/s to 100/s. These techniques are commonly used in human examinations. Materials are positioned at left anterior oblique view. The sequential images are now detected above the iodine K edge by an image intensifier (RTP 9240F, Toshiba) and recorded at high signal-to-noise ratio analog video recording system (C1900, Hamamatsu Photonics, S/N 45 dB). Proximal coronary arteries are well visualized, however the distal portions are unsatisfactory, because of the overlapping of the contrast-filled dense heart chambers and pulmonary vessels. Bolus injection of contrast medium is also necessary, unless overlapping is inevitable, so are the same in conventional intravenous DSA. The energy above and below the K edge is now changed by tilting the angle of crystal, mechanically, so it has not sufficient speed to subtract the moving material. Real time A/D converter and frame buffering memories have not been available, until now. Even though there are many limitations in the hardware and many problems to overcome, our preliminary animal experiments allow us to have high expectations.
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Feb 1, 1996
Maria Teresa Farrés + 6
