冠状动脉分叉病变斑块分布的CT研究  

Atherosclerotic plaque distribution in coronary bifurcation lesions: an computed tomography study

作　　者：李珊[1] 杨庭树[1] 盖鲁粤[2] 王禹[2] 刘宏斌[2] 

机构地区：[1]中国人民解放军总医院老年心血管一科,北京100853 [2]中国人民解放军总医院心内科,北京100853

出　　处：《医学影像学杂志》2010年第11期1609-1613,共5页Journal of Medical Imaging

基　　金：国家科技支撑计划课题资助项目(编号:2008SZBJ202)

摘　　要：目的:应用多层螺旋CT(MDCT)分析冠状动脉分叉病变的斑块分布特点。方法:利用MDCT对冠状动脉分叉病变分叉远端(分叉嵴平面)和分叉近端(分支入口平面)定性定量分析,比较不同位点的斑块分布厚度,研究MDCT下分叉病变的斑块分布特点,确定影响斑块分布位置的因素。结果:MDCT和冠状动脉造影(CAG)对主支血管定量分析无明显区别,二者测量分支血管最小管腔面积(5.22±2.85mm2vs 3.65±2.94mm2,P=0.027)、外弹力膜面积(7.69±1.69mm2vs 6.61±2.58mm2,P=0.041)、血管直径(2.98±0.50mm vs 2.72±0.41mm,P=0.023)有明显区别,CAG测量分支血管面积狭窄率高于MDCT(0.44±0.31 vs 0.20±0.14,P=0.041)。分叉近端斑块厚度在PT0,°PT90°,PT180°,PT270°四个位点无明显差别(0.95±0.65mm vs 1.00±0.61mm vs 0.99±0.62mm vs 0.96±0.65mm,P>0.05)。分叉远端斑块厚度PT180°(1.24±0.49mm)明显大于PT90°和PT270°,PT90°和PT270°斑块厚度明显大于PT0°(0.08±0.12mm)。分叉远端斑块最厚点与分支的角度和分叉角度正相关(r=0.93,r2=0.864)。结论:MDCT在大血管(>3.0mm)的定量分析上与CAG有很好的一致性,对小血管(<3.0mm)的定量分析结果与CAG有差别,且不能识别CAG显示的轻度病变;MDCT下分叉近端斑块呈360°向心性环周分布;分叉远端斑块呈偏心性分布,多占1/2～2/3管周,斑块主要分布在分叉嵴的对侧;MDCT下分叉远端斑块距离分支开口的位置与分叉角度相关,分叉角度接近直角时,斑块分布在分支开口的对侧壁(180°±),分叉角度为锐角时,斑块分布在分支开口的旁侧壁(90°或270°±)。Objective：To investigate atherosclerotic plaque distribution at coronary bifurcation by computed tomography angiography.Methods：Thirty-five coronary bifurcation lesions were enrolled in our study.We quartered main vessel lumen according to the site of side branch,measured plaque thickness and investigated characteristics of plaque distribution in coronary bifurcation lesions.We analyzed influential factors of plaque distribution by step regression.Results：There was no difference in quantitative analysis of main vessel between MDCT and CAG,but there was significant different in quantitative analysis of side branch.There was no difference with plaque thickness among each quadrant in proximal segment（0.95±0.65 mm vs 1.00±0.61 mm vs 0.99±0.62 mm vs 0.96±0.65 mm,P0.05）,but in distal segment,plaque thickness were larger in PT 180° than in PT 90° and PT 270°（1.24±0.49 mm vs 0.65±0.34 mm,P=0.000）,plaque thickness were larger in PT 90° and PT 270° than in PT 0°（0.65±0.34 mm vs 0.08±0.12 mm,P=0.000）.The plaque position was correlated with the side branch take-off angle positively（r=0.93,r2=0.864）.Conclusion：There was satisfactory concordance between MDCT and CAG in quantitative analysis of large vessel,but significant different in quantitative analysis of small vessel.The plaque distribution of proximal segment demonstrated concentric,but that of distal segment demonstrated eccentric,and plaque accumulated opposite to the flow divider.Plaque accumulated in the opposite wall when side branch took off by straight angle.Conversely,plaque accumulated in the lateral wall when side branch took off by acute angle.

关 键 词：冠状动脉 分叉病变 斑块分布 体层摄影术 X线计算机 

分 类 号：R541.4[医药卫生—心血管疾病] R814.42[医药卫生—内科学]