320排冠脉CTA对动脉间型右冠状动脉起自左冠窦的评价  

Evaluation of anomalous right coronary artery originating from the left sinus of valsalva with 320-row coronary CT angiography

作　　者：梁奕 凡娜 汪汉林[2] 杜柏林 

机构地区：[1]长江航运总医院武汉脑科医院影像科,湖北武汉430010 [2]贵州医科大学附属医院影像科,贵州贵阳550004

出　　处：《医学影像学杂志》2017年第8期1455-1457,1465,共4页Journal of Medical Imaging

摘　　要：目的探讨320排冠脉CTA评价动脉间型右冠状动脉起自左冠窦的价值。方法 320排冠脉CTA检查中发现右冠状动脉起自左冠窦且右冠状动脉近段走行于升主动脉与肺动脉之间(动脉间型)8例患者纳入本组,同时分析8例右冠状动脉起始正常的冠脉CTA资料作为对照组。运用MPR、MIP以及VR等技术显示右冠状动脉的起源、开口和走行。利用测量工具评价收缩期和舒张期右冠状动脉近段管径的变化以及升主动脉右前壁与右冠状动脉近段之间的夹角,计算收缩期狭窄率。采用独立样本t检验比较2组间患者年龄、射线剂量、右冠状动脉近段管径在收缩期和舒张期的变化以及升主动脉与右冠状动脉之间夹角的差异。结果 8例动脉间型右冠状动脉起自左冠窦通过VR和薄层MIP重组均可以确诊,VR重组显示该变异最为直观。两组患者年龄和射线剂量差异无统计学意义。患者组右冠状动脉近段收缩期管径为(2.1±0.3)mm,舒张期为(2.6±0.7)mm,升主动脉与右冠状动脉之间夹角为(18.4°±1.4°),较对照组[收缩期(4.7±0.7)mm,舒张期(4.9±0.6)mm,夹角(60.7°±9.4°)]均明显缩小,差异有统计学意义(P<0.05)。结论320排冠脉CTA能清楚显示右冠状动脉的异常起源和走行,动态评价近段血管在心动周期内的变化,为查明心肌缺血原因提供线索。Objective To evaluate the value of 320-row coronary CT angiography in the diagnosis of anomalous right coronary artery （ARCA） originating from the left sinus of valsalva. Methods Eight patients who underwent 320-row coronary CT angiography for an ARCA originating from the left sinus of valsalva were included in this study. The other eight patients with normal origin of RCA were included as the control group. All cases were used MPR, MIP and VR images to display the origin, opening orifice and course of RCA. The diameter of proximal segment of RCA during systole and diastole, and the angle between the right anterior wall of ascending aorta and proximal segment of RCA were measured. Systolic stenosis rate of the proximal RCA was calculated. In these two groups, ages, radiation dose, the diameter changes of the proximal RCA, and the angle between ascending aorta and RCA were compared with independent sample t test. Results 8 cases of ARCA originating from the left sinus of valsalva by VR and thin MIP were identified. VR display variation was the most intuitive. There was no significant difference of age and radiation dose between two groups （ P 〉 0.05）. The diameter of proximal segment of RCA during systole and diastole was （2.1 ± 0.3 ） mm, （2.6 ± 0.7） mm, angle between ascending aorta and RCA was （18.4°±1.4°）, compared with the control group [ systole （4.7 ± 0.7） mm, diastole （4.9± 0.6）mm, angle （60.7 ° ± 9.4° ） ] were reduced obviously （ P 〈 0.05 ）. Conclusion 320-row coronary CT angiography can visualize anomalous origin and course of the RCA, and dynamically evaluate diameter changes of proximal RCA in the cardiac cycle, providing useful clues to identify the cause of myocardial ischemia.

关 键 词：冠状血管畸形 体层摄影术 X线计算机 

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