64排螺旋CT在评价冠状动脉桥血管中的价值  

The value of 64 multislice CT in the evaluation of coronary bypass grafts

作　　者：李忠信[1] 于淑靖[1] 马国军[1] 

机构地区：[1]河北医科大学沧州临床医学院CT室,河北沧州061001

出　　处：《中国临床医学影像杂志》2007年第9期643-645,共3页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨64排螺旋CT对冠状动脉桥血管病变评估的临床应用价值。方法:对21例冠状动脉搭桥术后患者,共77条桥血管(其中内乳动脉桥20条,桡动脉桥1条,大隐静脉桥56条)行64排CT造影(CTA)。扫描时患者平均心率(60±5)次/min。扫描范围从内乳动脉起始部到膈下2cm。冠状动脉桥血管的通畅和狭窄程度由两位有经验的医师来评估。其中9例桥血管或吻合口远端冠状动脉狭窄(≥50%)或闭塞的患者同时接受了传统冠脉造影检查。结果:21例患者CTA均获得了成功。冠状动脉主干及主要分支,均可见不同程度的狭窄或闭塞。显示冠状动脉桥血管通畅62条。闭塞10条(其中内乳动脉桥2条,静脉桥8条),显示桥血管近端吻合处狭窄(≥50%)3条,远端吻合处狭窄(≥50%)2条。吻合口远侧冠状动脉再狭窄或闭塞6例。9例CAG结果与CTA完全吻合。CTA显示冠状动脉桥血管狭窄(≥50%)或闭塞的准确性达100%。结论:CTA可准确评价冠状动脉桥血管以及吻合口再狭窄的程度。CTA可直观显示桥血管近端吻合口的位置,可指导冠状动脉搭桥术后CAG入路。是评估冠状动脉桥血管病变的首选方法。Objective： To study the clinical application value of 64 multislice spiral CT （MSCT） in evaluating the bridge vessel of coronary artery. Method： Twenty-one patients after bypass operation of coronary artery（77 bridge vessel, including 20 internal mammary artery bridge, 1 radial artery bridge and 56 great saphenous vein bridge） received 64 multislice spiral CT angiography（CTA）. The average heart rate of patients is （60=l：5）/min scanning. The range of scanning is from internal mammary artery to 2cm below diaphragm. Two experienced doctors evaluate the degree of opening and stenosis of bridge vessel of coronary artery. 9 patients who had been found bridge vessel or distal stoma of coronary artery stenosis （≥50%） by MSCT accepted traditional coronary artery angiography at the same time. Result： CTA was performed successfully in all of the 21 patients. Differemt degree of stenosis or obstruction of the main coronary artery and main branch in all of the 21 patients were showed by CTA. Sixty-two bridge vessels of coronary artery are open and smooth. 10 were obstructed （including 2 internal mammary and 8 vein bridge）. 3 were stenotic （≥50%） in proximal end anastomotic stoma of bridge vessel. 2 were stenotic in distal anastomotic stoma. 6 vessels had restenosis or obstruction in distal coronary artery of anastomotic stoma. The results of CAG and CTA are the same in 9 patients. The accuracy of CTA in evaluating the stenosis （~〉50%） or obstruction was 100%. Conclusion： CTA can evaluate the bridge vessel of coronary artery and the degree of restenosis of stoma accurately. CTA can discover the location of proximal end stoma directly and guide the approach of CAG after bypass operation of coronary artery. CTA is the method of choice to evaluate the abnormalities of the bridge vessel of coronary artery.

关 键 词：冠状动脉狭窄 体层摄影术 螺旋计算机 

分 类 号：R543.3[医药卫生—心血管疾病] R814.42[医药卫生—内科学]