冠状静脉系统解剖的多层螺旋CT成像研究

发布时间：2018-05-08 07:43

本文选题：多层螺旋CT + 冠状窦　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过回顾性分析我院行多层螺旋CT冠状动脉造影检查的病例材料,选取冠状静脉系统显像良好的期相,探讨冠状静脉系统的解剖、变异及其影响因素。方法:收集2016年01月~2016年04月在我院因胸痛、胸闷等症状而就诊并行多层螺旋CT冠状动脉造影检查的199名患者,男性为106例,女性为93例,年龄范围为26~80岁,平均为53岁。所有患者均行多层螺旋CT(Multi-slice spiral computed tomography,MSCT)冠状动脉造影检查。以获得的MSCT图像原始数据为基础,在西门子工作站上进行以10%为间隔的10~100%不同期相重建,传至图像存储与传输系统(Picture archiving and communication system,PACS)并获取容积再现图像,进行冠状静脉图像评分并以评分最佳期相为准。在PACS上进行多平面重组(Multiplanar reformation,MPR)及容积再现(Volume reconstruction,VR)成像,在MPR及VR像上观察并测量冠状窦及其分支的形态、位置、直径、角度及长度。分别从年龄、性别及有无冠状动脉狭窄因素方面,利用SPSS17.0软件对上述测得的数值进行统计学分析,统计方法选用方差分析及独立样本t检验。当检验结果P0.05时,则认为该因素差异有统计学意义。结果:1、冠状静脉系统图像的影像质量评价及冠状窦及其分支显像情况:30%、40%、60%、70%期相显影较好,且之间无统计学差异,本研究均选择以40%期相为准。冠状窦(Coronary sinus,CS)显示199例,显示率100%;心中静脉(Middle cardiac vein,MCV)显示199例,显示率100%;心大静脉(Great cardiac vein,GCV)显示199例,显示率100%;侧壁静脉显示189例,显示率94.97%;左室后静脉(Posterior ventricular left vein,PVLV)显示192例,显示率96.48%;心小静脉(Small cardiac vein,SCV)显示42例,显示率21.11%;马歇尔静脉显示2例,显示率1.01%。左室后静脉199例患者中有160例(80.0%)可见1~3支,缺如者有7例(3.5%)。侧壁静脉199例患者中有181例(91%)可见1~4支,缺如者有10例(5%)。2、冠状窦与二尖瓣环的位置关系及形态:冠状窦位于二尖瓣环上方者有186例(93.5%),位于二尖瓣环同水平者有13例(6.5%);冠状窦的形态呈管状者有119例(60%),呈喇叭状者有80例(40%)。3、冠状静脉与冠状动脉的毗邻关系:右冠状动脉(Right coronary artery,RCA)199例患者中有86例(43.22%)患者与心中静脉相交,有41例(20.60%)与心中静脉伴行;冠状动脉左旋支(Left circumflex coronary artery,LCX)199例患者中有85例(42.71%)与心大静脉且与侧壁静脉相交;左前降支(Left anterior descending artery,LAD)199例患者中有101例(50.75%)与心大静脉伴行者且与第1对角支相交。4、冠状静脉汇入处的变异:有20例心小静脉注入冠状窦,占总例数的10%;有22例注入心中静脉,占总例数的11%;有1例患者可见永存左上腔静脉,占总例数的0.5%。5、性别、年龄及冠状动脉狭窄程度对冠状静脉解剖的影响:性别因素对冠状静脉解剖及变异的差异无显著性;无狭窄组组内两两比较年龄"f44与年龄"g60在左室后静脉直径上差异有统计学意义(P=0.012,);狭窄组组内两两比较45"f年龄"f59与年龄"g60在左室后静脉直径上差异有统计学意义(P=0.043);狭窄组组内两两比较年龄"f44与45"f年龄"f59在侧壁静脉角度上差异有统计学意义(P=0.027);狭窄组与无狭窄组在心中静脉直径、左室后静脉角度上的差异有显著性(P值分别为0.044,0.002);不同程度狭窄组之间对冠状静脉解剖及变异的差异无显著性。结论:1、多层螺旋CT冠状动脉造影检查可以较好显示冠状静脉系统的解剖及变异,并能观察冠状静脉系统与周围邻近动脉血管的解剖关系,为心脏电生理治疗提供有用信息;2、性别因素对冠状静脉系统解剖及变异的影响无统计学意义;年龄、有无冠状动脉狭窄因素对部分冠状静脉属支解剖及变异的影响有统计学意义。
[Abstract]:Objective: through retrospective analysis of the case materials of multislice spiral CT coronary angiography in our hospital, select the phase of good coronary vein system imaging, explore the anatomy, variation and influencing factors of the coronary vein system. Methods: collect the parallel multi-slice CT in our hospital for the symptoms of chest pain and chest tightness in 04 months of 2016, in our hospital. 199 patients with coronary angiography, 106 in males and 93 in women, were 26~80 years old and 53 years old. All patients underwent multi-slice CT (Multi-slice spiral computed tomography, MSCT) coronary angiography. Based on the original MSCT image data obtained, 10% for the SIEMENS workstation. The 10~100% separated phase was reconstructed to the image storage and transmission system (Picture archiving and communication system, PACS) and the volume reproduction image was obtained. The coronary vein image score was scored and the optimal phase was evaluated. The multiplane recombination (Multiplanar reformation, MPR) and volume reproduction on PACS (Volume reproduction) N, VR) imaging, observation and measurement of the morphology, location, diameter, angle and length of the coronary sinus and its branches on the MPR and VR images. Statistical analysis was made on the values measured by SPSS17.0 software from age, sex and without coronary artery stenosis. The analysis method selected variance analysis and independent sample t test. When fruit P0.05, the difference was statistically significant. Results: 1, the image quality evaluation of coronary venous system and the imaging of coronary sinus and its branch: 30%, 40%, 60%, 70% phases were better, and there was no statistical difference between the two phases. This study chose 40% phase. The coronary sinus (Coronary sinus, CS) showed 199 cases, and the display rate was 100%. The Middle cardiac vein (MCV) showed 199 cases, the display rate was 100%, the great vein (Great cardiac vein, GCV) showed 199 cases, the display rate was 100%, the lateral wall vein showed 189 cases, the display rate was 94.97%, and the left posterior vein (Posterior ventricular left vein) showed 192 cases, and the display rate was 96.48%; the venule of the heart was 96.48%, 42 cases showed the venule of the heart. The display rate was 21.11%; the Marshall vein was shown in 2 cases. There were 160 cases (80%) in 199 cases of 1.01%. left posterior vein (80%), 7 cases (3.5%), 181 (91%) in 199 cases of lateral wall vein (91%), 10 cases (5%).2, coronary sinus and mitral annulus above the mitral annulus. There were 186 cases (93.5%), 13 cases (6.5%) at the same level of mitral annulus, 119 cases (60%) in the shape of the coronary sinus, 80 (40%).3 in the horn, and the adjacent relationship between the coronary vein and the coronary artery: the right coronary artery (Right coronary artery, RCA) in 199 patients with 86 (43.22%) patients with the heart vein, 41 cases (20.60). In 199 patients with Left circumflex coronary artery (LCX), there were 85 cases (42.71%) of the coronary artery and the great vein of the heart and the lateral wall veins; 101 cases (50.75%) of the left anterior descending (Left anterior descending artery, LAD) were associated with the great vein of the heart and intersected with first diagonal branches in.4, coronary vein Variation in the remittance: 20 cases were injected into the coronary sinus in 20 cases, accounting for 10% of the total number of cases; 22 cases were injected into the heart vein, accounting for 11% of the total number. There were 1 cases of persistent left superior vena cava, which accounted for the total number of 0.5%.5, sex, age and the influence of the degree of coronary artery stenosis on the anatomy of the coronary veins: the anatomy and variation of the coronary veins to the sex factors There was no significant difference in the difference of the 22 age "f44 and age" G60 in the left ventricular posterior vein diameter in the group without stenosis (P=0.012,); in the stenosis group, 22 compared 45 "f age" f59 and age "G60 in left ventricle posterior vein diameter (P=0.043), and 22 age f44 and 45" f age within the narrow group. "F59 was statistically significant in the lateral wall venous angle (P=0.027); there was a significant difference in the diameter of the vein in the heart and the angle of the left posterior vein in the stenosis group and the non stenosis group (P value was 0.044,0.002, respectively). There was no significant difference in the anatomy and variation of the coronary veins between different degrees of stenosis. Conclusion: 1, multislice spiral CT coronary artery The anatomy and variation of the coronary vein system can be shown well, and the anatomical relationship between the coronary vein system and the adjacent arterial vessels can be observed, and the useful information is provided for the electrophysiological treatment of the heart. 2, the influence of sex factors on the anatomy and variation of the coronary vein system has no systematic significance; there is no coronary stenosis factor for age. The effect of partial coronary vein branches on anatomy and variation was statistically significant.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R54;R816.2

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