冠状动脉CTA发现肥厚性心肌病29例分析  

Hypertrophic Cardiomyopathy discovered by Coronary CT Angiography 29 patients

作　　者：任宇婧[1] 陈顺强[1] 马丽佳[1] 郭濴[1] 张明[1] 谢瑞刚[1] 王艳[1] REN Yu-jing;CHEN Shun-qiang;MA Li-jia;GUO Ying;ZHANG Ming;XIE Rui-gang;WANG yan(Henan Provincial People＇ s Hospital,Zhengzhou 450003,Chin)

机构地区：[1]河南省人民医院放射科,郑州450003

出　　处：《医药论坛杂志》2018年第6期11-13,17,共4页Journal of Medical Forum

基　　金：河南省科技攻关计划项目(201503146)

摘　　要：目的探讨肥厚性心肌病(Hypertrophic Cardiomyopathy,HCM)患者的冠状动脉CTA可能影像学表现及其临床相关性。方法回顾性分析河南省人民医院放射科经冠状动脉CTA发现左室肥厚并经心脏MRI或超声心动图检测确诊的HCM患者,并对其冠状动脉CTA图像进行分析,计算肥厚心肌节段、测量最厚节段室壁厚度、中间段左室下壁厚度和左房最大截面,识别左室肥厚节段心肌内不均匀强化心肌、脂肪及粗大冠状动脉室间隔支。结果 17/29例患者经冠状动脉CTA检查首次意外发现HCM;所有HCM患者中,18/29例为非梗阻型室间隔型HCM,5/29例为心尖型HCM,4/29例为均匀型HCM,1/29例为肿块型HCM,1/29例为梗阻型HCM;7/29例有左房增大;16/29例发现粗大室间隔支,且与室间隔肥厚明显相关,R=0.80,P=0.03;4例发现肥厚节段心肌不均匀强化,4例发现肥厚心肌内脂肪,1例发现肥厚节段心肌内膜下钙化,2例伴发右室心尖肥厚。结论冠状动脉CTA在描述冠状动脉信息的同时,可部分反映心肌信息,对可能的HCM有重要提示作用。Objective This study proposes and discusses the probable imaging feature and its clinical interrelation of hypertrophic cardiomyopathy（ HCM） on coronary CTAngiography（ CTA）. Methods Retrospect the patients who were found left ventricular hypertrophy on coronary CTA and diagnosed HCM by subsequent cardiac MRI or echocardiographic,and then their coronary CTA images were analyzed. Count the hypertrophy myocardial segments,measure the thickness of the thickest wall and the thickness of the inferior wall of the left ventricle at the midventricular level and the largest cross-sectional area of the left atrium,record the uneven strengthened myocardium and the fat and the enlarged coronary interventricular septal branches in the thickened myocardium. Results 17/29 patients were diagnosed HCM accidently by the coronary CTA for the first time. 18/29 patients were Nonobstructive Septal HCM,5/29 patients were Apical HCM,4/29 patients were Symmetric HCM,1/29 patient was Masslike HCM,1/29 patient was Obstructive Septal HCM. 7/29 patients were found have larger left atrium. 16/29 patients were found have enlarged interventricular septal branches,and it has a good correlation with the thickened septal wall,R = 0. 80,P = 0. 03. 4 patients were found uneven strengthened myocardium in the thickened wall. 1 patient was found calcification under the endocardium of the hypertrophy segments. 2 patients were found hypertrophic right ventricular apex. Conclusion Coronary CTA can give the information of the coronary arteries and at the same time partly depict the information of myocardium,this may provide important clues for potential HCM.

关 键 词：肥厚性心肌病 体层摄影计算 CT计算机 血管造影 表型 

分 类 号：R816.2[医药卫生—放射医学]