本文選題：多層螺旋CT + 冠狀竇　； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:通過回顧性分析我院行多層螺旋CT冠狀動(dòng)脈造影檢查的病例材料,選取冠狀靜脈系統(tǒng)顯像良好的期相,探討冠狀靜脈系統(tǒng)的解剖、變異及其影響因素。方法:收集2016年01月~2016年04月在我院因胸痛、胸悶等癥狀而就診并行多層螺旋CT冠狀動(dòng)脈造影檢查的199名患者,男性為106例,女性為93例,年齡范圍為26~80歲,平均為53歲。所有患者均行多層螺旋CT(Multi-slice spiral computed tomography,MSCT)冠狀動(dòng)脈造影檢查。以獲得的MSCT圖像原始數(shù)據(jù)為基礎(chǔ),在西門子工作站上進(jìn)行以10%為間隔的10~100%不同期相重建,傳至圖像存儲(chǔ)與傳輸系統(tǒng)(Picture archiving and communication system,PACS)并獲取容積再現(xiàn)圖像,進(jìn)行冠狀靜脈圖像評(píng)分并以評(píng)分最佳期相為準(zhǔn)。在PACS上進(jìn)行多平面重組(Multiplanar reformation,MPR)及容積再現(xiàn)(Volume reconstruction,VR)成像,在MPR及VR像上觀察并測(cè)量冠狀竇及其分支的形態(tài)、位置、直徑、角度及長(zhǎng)度。分別從年齡、性別及有無冠狀動(dòng)脈狹窄因素方面,利用SPSS17.0軟件對(duì)上述測(cè)得的數(shù)值進(jìn)行統(tǒng)計(jì)學(xué)分析,統(tǒng)計(jì)方法選用方差分析及獨(dú)立樣本t檢驗(yàn)。當(dāng)檢驗(yàn)結(jié)果P0.05時(shí),則認(rèn)為該因素差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、冠狀靜脈系統(tǒng)圖像的影像質(zhì)量評(píng)價(jià)及冠狀竇及其分支顯像情況:30%、40%、60%、70%期相顯影較好,且之間無統(tǒng)計(jì)學(xué)差異,本研究均選擇以40%期相為準(zhǔn)。冠狀竇(Coronary sinus,CS)顯示199例,顯示率100%;心中靜脈(Middle cardiac vein,MCV)顯示199例,顯示率100%;心大靜脈(Great cardiac vein,GCV)顯示199例,顯示率100%;側(cè)壁靜脈顯示189例,顯示率94.97%;左室后靜脈(Posterior ventricular left vein,PVLV)顯示192例,顯示率96.48%;心小靜脈(Small cardiac vein,SCV)顯示42例,顯示率21.11%;馬歇爾靜脈顯示2例,顯示率1.01%。左室后靜脈199例患者中有160例(80.0%)可見1~3支,缺如者有7例(3.5%)。側(cè)壁靜脈199例患者中有181例(91%)可見1~4支,缺如者有10例(5%)。2、冠狀竇與二尖瓣環(huán)的位置關(guān)系及形態(tài):冠狀竇位于二尖瓣環(huán)上方者有186例(93.5%),位于二尖瓣環(huán)同水平者有13例(6.5%);冠狀竇的形態(tài)呈管狀者有119例(60%),呈喇叭狀者有80例(40%)。3、冠狀靜脈與冠狀動(dòng)脈的毗鄰關(guān)系:右冠狀動(dòng)脈(Right coronary artery,RCA)199例患者中有86例(43.22%)患者與心中靜脈相交,有41例(20.60%)與心中靜脈伴行;冠狀動(dòng)脈左旋支(Left circumflex coronary artery,LCX)199例患者中有85例(42.71%)與心大靜脈且與側(cè)壁靜脈相交;左前降支(Left anterior descending artery,LAD)199例患者中有101例(50.75%)與心大靜脈伴行者且與第1對(duì)角支相交。4、冠狀靜脈匯入處的變異:有20例心小靜脈注入冠狀竇,占總例數(shù)的10%;有22例注入心中靜脈,占總例數(shù)的11%;有1例患者可見永存左上腔靜脈,占總例數(shù)的0.5%。5、性別、年齡及冠狀動(dòng)脈狹窄程度對(duì)冠狀靜脈解剖的影響:性別因素對(duì)冠狀靜脈解剖及變異的差異無顯著性;無狹窄組組內(nèi)兩兩比較年齡"f44與年齡"g60在左室后靜脈直徑上差異有統(tǒng)計(jì)學(xué)意義(P=0.012,);狹窄組組內(nèi)兩兩比較45"f年齡"f59與年齡"g60在左室后靜脈直徑上差異有統(tǒng)計(jì)學(xué)意義(P=0.043);狹窄組組內(nèi)兩兩比較年齡"f44與45"f年齡"f59在側(cè)壁靜脈角度上差異有統(tǒng)計(jì)學(xué)意義(P=0.027);狹窄組與無狹窄組在心中靜脈直徑、左室后靜脈角度上的差異有顯著性(P值分別為0.044,0.002);不同程度狹窄組之間對(duì)冠狀靜脈解剖及變異的差異無顯著性。結(jié)論:1、多層螺旋CT冠狀動(dòng)脈造影檢查可以較好顯示冠狀靜脈系統(tǒng)的解剖及變異,并能觀察冠狀靜脈系統(tǒng)與周圍鄰近動(dòng)脈血管的解剖關(guān)系,為心臟電生理治療提供有用信息;2、性別因素對(duì)冠狀靜脈系統(tǒng)解剖及變異的影響無統(tǒng)計(jì)學(xué)意義;年齡、有無冠狀動(dòng)脈狹窄因素對(duì)部分冠狀靜脈屬支解剖及變異的影響有統(tǒng)計(jì)學(xué)意義。
[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.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R54;R816.2

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