多排螺旋CT冠状动脉成像在冠状动脉变异临床应用的价值

发布时间：2018-11-29 09:00

【摘要】：目的：探讨多排螺旋CT冠状动脉成像对冠状动脉变异临床应用中的价值。方法：回顾性分析2012年8月-2014年3月间在江苏省中医院放射科行冠状动脉CTA检查的患者数目,共1356人,其中发现冠状动脉变异者共69人,发现存在变异的数目有82处;69名患者中男性37人,女性32人,年龄43-76岁,平均58.7±10.3岁。其中5人患者无任何症状,52人患者自感胸闷、气短,55人有心悸病史,57人有高血压病史,35人有冠心病病史,4人检查前曾被超声心动图诊断先天性心脏病。检查完后由两名放射科CTA专项高年质医生对图像质量进行评分后,再在飞利浦CT后处理工作站用冠状动脉CTA分析专用软件包对原始图像进行后处理重建,对患者多期图像分别进行容积重现(VR)、多平面重建(MPR)、最大密度投影(MIP)和曲面重建(CPR)等多种方法重建观察,选取显示最佳的一期或多期图像进行仔细观察分析,最终判定患者冠状动脉变异的数目、位置及类型。结果：在本组病例中我们发现右冠状动脉高位开口的病例2例,右侧冠状动脉开口在左冠窦的3例,并且这三例患者均合并有右侧冠状动脉起始部壁内冠状动脉变异,右侧副冠状动脉15例；左冠状动脉主干高位开口4例,左冠状动脉主干缺如的5例,左冠状动脉旋支开口于右冠状窦2例；心肌桥42例,其中有7人存在不止1处的心肌桥,浅表型心肌桥37例,有5例为深埋型心肌桥；冠状动脉瘘2例,一例为左冠状动脉前降支肺动脉瘘,另一例为左冠前降支右心室瘘；冠状动脉未发育及发育不良共9例,其中左旋支发育不良最多见,为4例。所有类型冠脉变异均在多期重建图像上得到二位医生的证实。结论：128层MSCT冠状动脉成像可清晰显示冠状动脉变起源、行程、终止等各项变异表现,可为临床医生提供具有很高诊断价值的影像图片,使临床医生可以直观、清晰、准确、方便的对患者冠状动脉变异的情况进行判定,引导临床进行合理诊疗。
[Abstract]:Objective: to evaluate the clinical value of multislice spiral CT coronary angiography in coronary artery variation. Methods: from August 2012 to March 2014, the number of patients who underwent coronary artery CTA examination in radiology department of Jiangsu Provincial Hospital of traditional Chinese Medicine was retrospectively analyzed. There were 69 cases of coronary artery variation and 82 cases of abnormal coronary artery. Of the 69 patients, 37 were male and 32 were female, aged 43 to 76 years (mean 58.7 卤10.3 years). Among them, 5 patients had no symptoms, 52 patients had chest tightness and shortness of breath, 55 patients had a history of palpitation, 57 patients had a history of hypertension, 35 patients had a history of coronary heart disease, and 4 patients had been diagnosed by echocardiography for congenital heart disease before examination. After the examination, the image quality was scored by two senior radiology CTA specialists, and then the original image was reconstructed with the special software package of coronary artery CTA analysis at Philips CT post-processing workstation. The multiphase images of patients were reconstructed by volume reconstruction (VR), multiplanar reconstruction (MPR), maximum density projection (MIP) and curved surface reconstruction (CPR) respectively. After careful observation and analysis, the number, location and type of coronary artery variation were determined. Results: we found 2 cases with high right coronary artery opening and 3 cases with right coronary artery opening in left coronary sinus. 15 cases of right accessory coronary artery; There were 4 cases with the high opening of the left coronary artery, 5 cases with the absence of the left coronary artery, and 2 cases with the left coronary circumflex branch opening in the right coronary sinus. There were 42 cases of myocardial bridge, of which 7 cases had more than one myocardial bridge, 37 cases had superficial myocardial bridge, and 5 cases had deep buried myocardial bridge. Two cases of coronary artery fistula, one case of left coronary artery anterior descending branch pulmonary artery fistula, the other case of left coronary artery anterior descending branch right ventricular fistula, coronary artery undeveloped and dysplasia in 9 cases, left circumflex branch dysplasia occurred in 4 cases. All types of coronary variations were confirmed by two doctors on multi-phase reconstruction images. Conclusion: 128-slice MSCT coronary angiography can clearly show the origin, course and termination of coronary artery degeneration, and can provide clinicians with high diagnostic value of imaging images, so that clinicians can be intuitive, clear and accurate. It is convenient to judge the variation of coronary artery and guide clinical diagnosis and treatment.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R543.3;R816.2

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