多层螺旋CT血管成像诊断“恶性”冠状动脉畸形  

"Malignant" coronary artery anomalies detected by MDCT angiography

作　　者：戴沁怡[1,2] 吕飙[1,2] 张兆琪[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管病研究所医学影像科,北京100029

出　　处：《心肺血管病杂志》2012年第1期50-53,67,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨"恶性"冠状动脉畸形(coronary artery anomalies,CAA)的MDCTA影像特点及诊断价值。方法:2005年至2009年,我院完成冠状动脉多层螺旋CT血管成像(MDCTA)检查38 573例,检出"恶性"CAA 54例[1.40‰,女性29例,平均年龄(51±15)岁]。结果:左冠状动脉起源于肺动脉4例(0.10‰);冠状动脉起自对侧冠状窦或单支冠状动脉畸形,且近段走行于主、肺动脉间38例(0.99‰);多发或较大冠状动脉瘘12例(0.31‰)。结论:MDCTA可无创而可靠的显示"恶性"CAA开口部位、走行路径、毗邻关系、有无瘘口及并存异常。Objective：To retrospectively determine the imaging features of ＂malignant＂ or ＂major＂ congenital coronary artery anomalies（CAA） depicted at multi-detector row computed tomographic（MDCT） angiography.Methods：Between August 2005 and December 2009,38 573 patients（excluding congenital heart disease） underwent imaging with MDCT（64-slice and dual-source CT） by using retrospective electrocardiographic（ECG） gating.Volume rendering,maximum intensity projections and curved multiple planar reformation images were obtained,each study was assessed for the origin,course and terminal point of the anomalous coronary artery,and combined manifestations by 1 experienced radiologist.Results： Total 54 patients（1.40‰,29 female,9～78 years,mean age（51 ± 15） years） of ＂malignant＂ CAA were detected.Four cases（0.10‰） were anomalous left coronary artery originating from the pulmonary artery,adult type.Thirty-eight cases（0.99‰） were anomalous coronary artery originates from the opposite sinus（interarterial course）,in which 35 cases were right coronary artery arising from the left sinus of Valsalva,2 cases were left coronary artery arising from the right sinus of Valsalva,and 1 case was single coronary artery.Twelve cases（0.31‰） were multi or larger coronary artery fistula,in which 9 cases were unilateral fistulas（66.67% from the left coronary artery）,3 cases from both.The most common site of drainage is the pulmonary artery（n=9）,followed by the left ventricle（n=2） and the right atrium（n=1）.Two cases were displayed as gigantic aneurysm.Three cases combined with pericardial effusion,2 cases with left ventricular aneurysm.Twelve patients were false-negative diagnosed by echocardiogram during 21 cases.Fifteen cases were verified with coronary angiography,and 11 cases were operated,1 patient died due to coronary aneurysm rupture.Conclusion： MDCTA is an ideal noninvasive technique to evaluate the origin,course,terminal point of ＂malignant＂ CAA and the com

关 键 词：先天性冠状动脉畸形 断层 X线计算机 

分 类 号：R543.3[医药卫生—心血管疾病]