冠状动脉闭塞支的双源CT评价  

Imagings of Coronary Total Occlusion Using Dual-source Computed Tomography

作　　者：郑敏文[1] 赵宏亮[1] 李剑[1] 魏梦琦[1] 袁远[1] 石明国[1] 宦怡[1] 

机构地区：[1]第四军医大学西京医院放射科,西安710032

出　　处：《中国医学科学院学报》2010年第6期677-682,共6页Acta Academiae Medicinae Sinicae

摘　　要：目的总结冠状动脉完全闭塞病变的影像学特点,以期为介入手术提供指导性信息,提高闭塞支的手术成功率。方法回顾性分析2008年3月至2010年3月诊断冠心病并经冠脉造影证实有完全闭塞病变患者的双源CT和冠脉造影资料。结果 140例患者共152支冠状动脉发生闭塞:右冠状动脉68支,前降支48支,回旋支20支,左主干1支,分支血管闭塞15支。其中两支冠状动脉闭塞共13例。闭塞段长度5～58mm,平均(16.8±3.9)mm,其中长度大于1cm的闭塞病变占91.4%。闭塞残端形态:68支为齐头状闭塞,64支为锥状闭塞,20支为鼠尾状闭塞。多数闭塞病变(73%)为软斑块或以软斑块为主合并少量钙化;其次为混合性斑块及钙化斑块。10支闭塞病变呈膨大改变,为血栓形成。共25支冠状动脉闭塞段成角或弯曲,多见于右冠的长段闭塞。闭塞一端有分支血管发出的62支;两端均有分支血管发出的36支。152例闭塞支中仅3例双源CT可显示明确的侧支血供,无1例可明确显示闭塞两端桥侧支血管。结论双源CT可很好地显示冠状动脉闭塞支的绝大多数信息,对闭塞病变的手术有指导意义,有助于提高手术成功率。Objective To analyze the imaging characteristics of coronary arteries with total occlusion （TO） lesions shown by dual-source computed tomography CT （DSCT） coronary angiography.Method The clinical data of patients who were diagnosed as coronary heart disease together with total occlusion lesions between March 2008 and March 2010 were retrospectively analyzed.Results In a cohort of 140 patients with 152 TO lesions,TO vessels in right coronary artery,left anterior descending artery,left circumflex coronary artery,or left main coronary artery were 68,48,20,and 1,respectively.Side branch TO were found in 15 vessels,in which 13 cases were found to be with TO in two coronary arteries.The length of TO was 5-58 mm,mean （16.8±3.9） mm.TO lesions with a length ≥ 1 cm accounted for 91.4%.The appearance of stump in TO were abrupt occlusion （n=68）,blunt occlusion （n=64）,and mouse-tail occlusion （n=20）.Among all the TO lesions,73% were soft plaque or mainly soft plaque together with minimal calcification.Mixed plaque and calcified plaque were less seen.Ten TO segments presented with dilated lumens were thrombogenesis.There were 25 TO segments angulated or tortuosity,which were most frequently shown in right coronary artery.DSCT only presented 3 TO with clear collateral vessels and no TO with bridge collateral vessels was shown.Conclusions DSCT can provide most necessary information of coronary TO lesions.Therefore,it can be used to guide surgeries on TO lesions and improve the success rates of surgeries.

关 键 词：冠状动脉 闭塞 CT 

分 类 号：R445.3[医药卫生—影像医学与核医学]