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探討64層螺旋CT對冠狀動脈畸形的診斷價值
【摘要】 【目的】 評價64層螺旋CT在診斷冠狀動脈畸形方面的臨床應用價值。【方法】 對38例冠狀動脈畸形的64層螺旋CT資料進行回顧性分析，將原始數據傳至工作站，行多平面重建（MPR）、容積再現（VR）、最大密度投影（MIP）和血管探針等后處理。10例同時行傳統冠脈造影（CAG），3例行手術�！窘Y果】 38例患者畸形血管在CT圖像上得以清晰顯示。冠狀動脈開口起源異常6例，單支冠狀動脈畸形2例，冠狀動脈瘺2例，冠狀動脈肌橋20例，副冠狀動脈8例，10例CAG結果9例與CT一致，1例右側冠狀動脈高位開口CAG誤診為缺如，3例手術結果與CT一致。【結論】 64層螺旋CT冠狀動脈造影清晰顯示了畸形血管的起源、行程、終止及腔內情況，可作為冠狀動脈畸形首選的檢查方法。【關鍵詞】 體層攝影術，X線計算機； 血管造影術； 冠狀動脈； 血管畸形
Abstract: 【Objective】 To evaluate the clinical application of 64-slice spiral computed tomography in the diagnosis of coronary artery anomalies (CAAs). 【Methods】 The 64-slice spiral computed tomography images of 38 patients with CAAs were retrospectively analyzed. The raw data were transferred to the work station（vitrea@2 version 3.7.0）, and then multi-planar reconstruction (MPR), volume render (VR), maximum intensity projection (MIP)，curved-planar reconstruction (CPR) and blood vessel probe were performed. Ten patients were performed conventional coronary artery angiography (CAG) and 3 patients were performed surgery. 【Results】 The origin and course of anomalous CA in 38 patients were displayed clearly by 64-slice spiral computed tomography. Six patients were anomalous origin of CA trunk; 2 were single CA anomaly; 2 were the branch of RCA fistula (1 to the pulmonary artery, 1 to the right atrium); 20 were mural coronary artery; 8 were para coronary artery, which is the branch of arterial conus origins directly from the right coronary sinus. Nine results of the 10 CAG were accordant with CT, 1 high origin of RCA was mistaken for congenital absence in CAG. Three operation results were accordant with CT. 【Conclusion】 The 64-slice spiral computed tomography displayed the origins, course and the condition of intralumens of CA clearly. It’s better than CAG on some degree. 64-slice spiral computed tomography could be used as the first choose of imaging tools for suspected CAAs.
Key words：tomography, X-ray computed; angiography; coronary artery; vessel anomalies
冠狀動脈（簡稱冠脈）畸形是指冠脈起源、走行及終止的異常。冠脈畸形可以引起心肌缺血,心功能不全,甚至猝死；早期發現至為重要。傳統冠脈造影一直被以為診斷冠脈畸形的金標準，但由于國內接受此項檢查的患者較少，畸形的發現率不高[1，2]。多層螺旋CT（multi-slice spiral computed tomography，MSCT）及其后處理技術的發展，能清晰顯示畸形血管的起源、形程及終止，得到越來越多的重視[3]。64層螺旋CT作為目前最先進的MSCT，以其更快的掃描速度和更薄的掃描層厚而獲得更加清晰的圖像。冠脈畸形表現多樣，本文報道一組冠脈畸形的64層螺旋CT表現，并評價其在診斷冠脈畸形方面的價值。
1 材料與方法
1.1 臨床資料
2005年10月至2006年7月在我院共行64層螺旋CT冠脈造影510例，對其中的38例冠狀動脈畸形進行回顧性分析，患者年齡9～71歲，平均51.6歲；其中男27例，女11例。2例小兒為復雜先天性心臟病；余36例成人1例體檢發現心動過緩，2例心律不齊，余均系胸悶、氣促、心悸查因。
1.2 CT檢查
患者檢查前測量心率和血壓。心率大于70/min且血壓不低者給予美托洛爾50 mg口服；另外訓練呼吸，保證正確的吸氣屏氣方法。使用東芝Aquilion 64層螺旋CT機結合心電門控采集圖像，掃描前給予液態硝酸甘油舌下噴霧。掃描參數：準直器64 mm×0.5 mm，螺距11.2～14.4 mm ，管電壓135 kV，掃描速度每圈400 ms，掃描范圍為氣管分叉下至膈下2.0 cm。掃描采用Sur
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