冠状动脉血管密度梯度参数对伴收缩期压迫的心肌桥的诊断价值  

The Diagnostical Value of Transluminal Attenuation Gradient Indices to Detect Myocardial Bridge with Systolic Compression on CCTA

作　　者：谢伟 谢元亮[1] 王翔[1] 张树桐 杨阳 XIE Wei;XIE Yuanliang;WANG Xiang(Department of Imaging,Wuhan Municipal Center Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan,Hubei Province 430014,P.R.China)

机构地区：[1]华中科技大学同济医学院附属武汉市中心医院影像科

出　　处：《临床放射学杂志》2018年第7期1107-1112,共6页Journal of Clinical Radiology

摘　　要：目的探讨基于CCTA数据建立的校正后冠状动脉血管密度梯度参数对有显著性收缩期压迫的心肌桥的预测价值。方法回顾性分析107例行CCTA和ICA检查的左前降支心肌桥病例,以ICA为金标准,测量冠状动脉腔内强化梯度（TAG）及其校正值（TAGstandardized）、壁冠状动脉血管密度差异（MCA-COD）、心肌桥长度,比较收缩期无压迫、轻度压迫、显著性压迫心肌桥组间差异,ROC分析TAG、TAGstandardized、MCA-COD对收缩期压迫的心肌桥的诊断价值。结果 （1）收缩期无压迫、轻度压迫、显著性压迫心肌桥组TAG（HU/10 mm）分别为（-14.0±4.8）HU、（-17.7±5.6）HU和（-22.8±8.3）HU;TAGstandardized（10^-2/10 mm）分别为-3.8±1.2、-4.4±1.4和-6.3±2.0;MCA-COD（10^-2/10mm）分别为9.5±10.2、12.6±10.0和29.1±10.6;TAGstandardized和MCA-COD显著压迫组与轻或无压迫组有显著性差异（P〈0.05）,无压迫组与轻度压迫组无显著性差异（P〉0.05）;（2）显著收缩压迫心肌桥,MCA-COD（AUC 0.89）比TAGstandardized（AUC 0.83）及心肌桥长度（AUC 0.76）具有更高的诊断价值;MCA-COD和TAGstandardized（AUC 0.94）联合显著高于单一指标（P〈0.01）。结论 MCA-COD和TAGstandardized联合作为一种无创性的冠状动脉检查CCTA指标,能够较准确地预测收缩期有显著压迫的心肌桥。Objective To evaluate the diagnostic performance of transluminal attenuation gradient（ TAG） indices for MB with significant systolic compression（ SC） with reference to ICA validation. Methods 107 patients diagnosed myocardial bridge on LAD who underwent coronary CTA and ICA were enrolled. In reference of ICA results as the gold standard,TAG、the standardized TAG and contrast opacification difference of mural artery（ MCA-COD） and MB length were calculated and compared among three subgroups： without SC（ 10%）,wild SC（ 10%-49%） and significant SC（ ≥50%）. Results TAG（ HU/10 mm） was（-14. 0 ± 4. 8） HU,（-17. 7 ± 5. 6） HU and（-22. 8 ± 8. 3） HU; TAG_（standardized）（ 10^-2/10 mm）-3. 8 ± 1. 2、-4. 4 ± 1. 4 and-6. 3 ± 2. 0; MCA-COD（ 10-2/10 mm） 9. 5 ± 10. 2,12. 6 ± 10. 0 and 29. 1 ± 10. 6 respectively. There was statistical difference in TAG standardized and MCA-COD between significant-SC MB and wild-SC MB,but no statistical difference between wild-SC and non-SC subgroup. For significant SC,MCA-COD showed higher diagnostic value（ AUC 0. 89） than TAGstandardized（ AUC 0. 83） and MB length（ AUC 0. 76）,combination MCA-COD with TAGstandardized（ AUC 0. 94） showed remarkable improvement. Conclusion MCACOD ＋ TAGstandardized with high diagnostic value,the noninvasive approach based on CCTA has a practical application to rule out significant SC of MB.

关 键 词：冠状动脉 心肌桥 体层摄影术 X线计算机 

分 类 号：R541.1[医药卫生—心血管疾病] R816.2[医药卫生—内科学]