高分辨力计算机断层摄影术冠状动脉成像时在心尖肥厚型心肌病检出中的补充价值  

The Supplemental Value of High-Resolution Computed Tomography Coronary Artery Angiography for Unexpectedly Detecting Apical Hypertrophic Cardiomyopathy

作　　者：刘兴众[1] 杨志强[1] 王照谦[1] 贾崇富[1] 孙喜霞[1] 陈爱军[1] 邹玉洁[1] 

机构地区：[1]大连医科大学附属第一医院心脏CT检查科,辽宁省大连市116011

出　　处：《中国循环杂志》2013年第6期417-421,共5页Chinese Circulation Journal

摘　　要：目的 :探讨在计算机断层摄影术(CT)冠状动脉成像检查时心尖肥厚型心肌病(AHCM)检出率,并分析其特征,以提高临床对该病的认识。方法 :2011-09至2013-03筛查冠心病而接受高分辨力CT冠状动脉成像检查的11 241例患者中,意外检出25例AHCM(组)。分析其CT图像特征,并与磁共振成像检查结果对照。测量左心室收缩末期和舒张末期心尖部最大厚度及舒张末期左心室后壁厚度。计算左心室心尖部舒张末期最大厚度与后壁比值、心尖部室壁增厚率、左心室舒张末期容积和左心室射血分数。另取正常人30例为正常对照组进行对比分析。结果 :意外检出AHCM 25例,检出率约为0.2%。25例AHCM患者在CT横轴面、两腔心面或四腔心面图像上均存在左心室心尖部室壁节段性或弥漫性肥厚,均伴有不同程度左心室腔变形等征象,其中17例患者在舒张末期两腔心面上左心室腔呈"黑桃A"形状,在收缩末期左心室心尖心室腔闭塞。7例行磁共振成像患者检查结果与冠状动脉CT成像结果一致。AHCM组与正常对照组比较,AHCM组的左心室舒张末期容积、左心室心尖部室壁增厚率降低,左心室心尖部舒张末期最大室壁厚度、左心室心尖部舒张末期最大室壁厚度/左心室后壁舒张末期室壁厚度增加,差异均有统计学意义(P均<0.05)。两组左心室舒张末期室壁厚度和左心室射血分数等CT指标比较差异无统计学意义(P均>0.05)。25例AHCM患者中,9例伴冠状动脉狭窄(中度狭窄2例,轻度狭窄7例);10例伴心肌桥。结论 :高分辨力CT冠状动脉成像意外检出的AHCM具有典型CT特征,可作为磁共振成像诊断AHCM的辅助检查手段。每一位临床影像医师都应利用冠状动脉CT图像评价是否存在AHCM,尤其是可疑冠心病合并AHCM者应引起重视。Objective：To explore the supplemental value of the high-resolution computed tomography coronary artery angiography （CT-CAG） for unexpectedly detecting the patients with apical hypertrophic cardiomyopathy （AHCM） and to analyze the preliminary features of AHCM in clinical practice.Methods：We summarized a total of 11241 patients who received high-resolution CT-CAG for coronary artery disease （CAD） screening in our hospital from September 2011 to March 2013,and found 25 of them suffered from AHCM.Based on AHCM group,we set up a Control group with 30 healthy volunteers.We analyzed CT and MR imaging features and calculated left ventricular apex thickening rate,the ratio of maximum wall thickness of left ventricular apex to left ventricular posterior wall thickness in end-diastole phase,and evaluated left ventricular end-diastolic volume （LVEDV） and left ventricular ejection fraction （LVEF） in both groups.Results：The unexpected AHCM detection rate was 0.2％ （25/11241）.In four-chamber or two-chamber view of CT images,diffuse or segmental thickening of left ventricle apical myocardium were found in all 25 patients,which leaded to deformation of left ventricular chamber.Spade like changes in left ventricle were found in 17 patients,and their cardiac apex ventricular cavities were occlusive at the end systolic period.There 7 patients had consistent CT-CAG and MR imaging.Compared with Control group,AHCM group showed decreased LVEDV and left ventricular apex thickening rate; increased maximum left ventricular apex end-diastolic wall thickness,the ratio of maximum wall thickness of left ventricular apex to left ventricular posterior wall end-diastolic thickness,all P＜0.05.While left ventricular posterior wall thickness and LVEF were similar between 2 groups,P＞0.05.There were 9/25 patients with coronary artery stenosis （moderate stenosis in 2 and mild stenosis in 7）,and 10/25 with myocardial bridge.Conclusion：High-resolution CT-CAG could unexpectedly detect AHCM with the typical CT manif

关 键 词：心肌病 体层摄影 X线计算机 

分 类 号：R541[医药卫生—心血管疾病]