核素心肌灌注显像在心肌桥中的应用价值  

Clinical Value of Myocardial Perfusion Imaging in Evaluation of Patients with Myocardial Bridge and Mural Coronary Artery

作　　者：刘海娜[1,2] 汪秀玲 李智勇 何苗[2] 王宇峰[2] 

机构地区：[1]徐州医科大学医学影像学院 [2]徐州市肿瘤医院核医学科 [3]徐州医科大学附属医院影像科 [4]徐州医科大学附属医院核医学科

出　　处：《中国医学计算机成像杂志》2017年第4期375-379,共5页Chinese Computed Medical Imaging

摘　　要：目的:探讨运动-静息心肌灌注显像在心肌桥-壁冠状动脉患者中的临床应用价值。方法:回顾性分析36例经冠状动脉CTA发现心肌桥-壁冠状动脉患者的心肌灌注图像,分析心肌灌注图像结果与临床症状、壁冠状动脉长度、心肌桥厚度及壁冠状动脉近远端形态之间的关系。利用χ2检验比较不同壁冠状动脉长度、不同心肌桥厚度及不同壁冠状动脉近远端形态所引起的心肌缺血情况是否有差异。结果:(1)36例患者中有临床症状者22例,出现心肌灌注缺血26例。(2)壁冠状动脉<10mm者7例,出现心肌灌注缺血2例(2/7,28.57%);10~20mm者17例,出现心肌灌注缺血13例(13/17,76.47%);>20mm者12例,出现心肌灌注缺血11例(11/12,91.66%)。(3)心肌桥厚度<1mm者5例,未出现心肌灌注缺血;1~2mm者14例,出现心肌灌注缺血10例(10/14,71.42%);>2mm者17例,出现心肌灌注缺血16例(16/17,94.11%)。(4)血管平滑者12例,出现心肌灌注缺血5例(5/12,41.66%);一侧成角组15例,出现心肌灌注缺血13例(13/15,86.66%);两侧成角组9例,出现心肌灌注缺血8例(8/9,88.88%)。结论:(1)仅依靠是否有临床症状对心肌桥-壁冠状动脉者是否进行进一步检查和治疗是不全面的,会遗漏一部分无症状的患者。(2)壁冠状动脉的长度、心肌桥的厚度及壁冠状动脉近远端血管形态均会对血流灌注造成影响,灌注结果与壁冠状动脉的长度、心肌桥的厚度及壁冠状动脉近远端血管形态呈正相关。Purpose： To explore the application value of stress-rest myocardial perfusion imaging （MPI） in evaluation of patients with myocardial bridge and mural coronary artery （MB-MCA） confirmed by coronary computed tomography angiography（CTA）. Methods： Retrospective analysis was done in 36 patients who had been diagnosed as MB-MCA by coronary CTA. The relationships between myocardial perfusion and the clinical symptoms, mural coronary artery length, thickness of the myocardial bridge, proximal and distal vascular morphology were analyzed. The differences of cardiac ischemia induced by mural coronary artery length, thickness and proximal and distal vascular morphology were analyzed by χ2 test. Results： （1） Among these 36 cases, there were 26 cases with cardiac ischemia and 22 cases with significant clinical symptoms. （2） When the MCA length was less than 10 mm, the incidence of myocardial ischemia was 28.57% （2/7）; when the MCA length was between 10-20 mm, the incidence was 76.47% （13/17）; when the MCA length was more than 20 mm, the incidence was 91.66% （11/12）. （3） The thickness of the myocardial bridge less than lmm was shown in 5 cases, and no confirmed cases of myocardial ischemia; the thickness of the myocardial bridge in 10 of 14 （71.42%） cases with myocardial ischemia was in the range of 1-2mm; and 16 of 17 （94.11%） cases were with thickness greater than 2 mm. （4） 5 of the 12 （41.66%） patients with smooth coronary artery were diagnosed as myocardial ischemia; 13 of the 15 （86.66%） patients with one lateral angulation were diagnosed as myocardial ischemia; 8 of the 9 （88.88%） patients with two lateral angulation were diagnosed as myocardial ischemia. Conclusion： （1） It was inappropriate to examine and treat the patients only rely on clinical symptoms in the diagnosis of MB-MCA,it would leave out the asymptomatic patients. （2） The length of the mural coronary artery, the thickness of the myocardial bridge and the morphology of mural coronar

关 键 词：心肌桥-壁冠状动脉 心肌灌注显像 单光子 体层摄影术 发射型计算机 

分 类 号：R543.3[医药卫生—心血管疾病] R816.2[医药卫生—内科学]