【摘要】：目的：探討多排螺旋CT冠狀動脈成像對冠狀動脈變異臨床應(yīng)用中的價(jià)值。方法：回顧性分析2012年8月-2014年3月間在江蘇省中醫(yī)院放射科行冠狀動脈CTA檢查的患者數(shù)目,共1356人,其中發(fā)現(xiàn)冠狀動脈變異者共69人,發(fā)現(xiàn)存在變異的數(shù)目有82處;69名患者中男性37人,女性32人,年齡43-76歲,平均58.7±10.3歲。其中5人患者無任何癥狀,52人患者自感胸悶、氣短,55人有心悸病史,57人有高血壓病史,35人有冠心病病史,4人檢查前曾被超聲心動圖診斷先天性心臟病。檢查完后由兩名放射科CTA專項(xiàng)高年質(zhì)醫(yī)生對圖像質(zhì)量進(jìn)行評分后,再在飛利浦CT后處理工作站用冠狀動脈CTA分析專用軟件包對原始圖像進(jìn)行后處理重建,對患者多期圖像分別進(jìn)行容積重現(xiàn)(VR)、多平面重建(MPR)、最大密度投影(MIP)和曲面重建(CPR)等多種方法重建觀察,選取顯示最佳的一期或多期圖像進(jìn)行仔細(xì)觀察分析,最終判定患者冠狀動脈變異的數(shù)目、位置及類型。結(jié)果：在本組病例中我們發(fā)現(xiàn)右冠狀動脈高位開口的病例2例,右側(cè)冠狀動脈開口在左冠竇的3例,并且這三例患者均合并有右側(cè)冠狀動脈起始部壁內(nèi)冠狀動脈變異,右側(cè)副冠狀動脈15例；左冠狀動脈主干高位開口4例,左冠狀動脈主干缺如的5例,左冠狀動脈旋支開口于右冠狀竇2例；心肌橋42例,其中有7人存在不止1處的心肌橋,淺表型心肌橋37例,有5例為深埋型心肌橋；冠狀動脈瘺2例,一例為左冠狀動脈前降支肺動脈瘺,另一例為左冠前降支右心室瘺；冠狀動脈未發(fā)育及發(fā)育不良共9例,其中左旋支發(fā)育不良最多見,為4例。所有類型冠脈變異均在多期重建圖像上得到二位醫(yī)生的證實(shí)。結(jié)論：128層MSCT冠狀動脈成像可清晰顯示冠狀動脈變起源、行程、終止等各項(xiàng)變異表現(xiàn),可為臨床醫(yī)生提供具有很高診斷價(jià)值的影像圖片,使臨床醫(yī)生可以直觀、清晰、準(zhǔn)確、方便的對患者冠狀動脈變異的情況進(jìn)行判定,引導(dǎo)臨床進(jìn)行合理診療。
[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 鹵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.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R543.3;R816.2

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