多层螺旋CT 对先天性右冠状动脉起始变异的评价

多层螺旋CT 对先天性右冠状动脉
起始变异的评价
史河水 韩萍 孔祥泉 冯敢生 Hans-Juergen Brambs Martin H. K. Hoffmann
【摘要】 目的 以常规X 线冠状动脉造影( CAG) 为标准, 评价16 层螺旋CT 在鉴别右冠状动脉
( RCA) 异常起源和异常行程中的价值。方法 回顾性分析8 例先天性RCA 变异患者的多层螺旋CT
造影( MSCTA) 表现, 其中7 例有CAG 资料。对比分析两者在显示RCA 异位开口和异常行程方面的
差异。仿真内镜技术用于评价异位开口及其与邻近正常冠状动脉开口的关系。采用多平面重组
( MPR) 、曲面多平面重组( CMPR) 、最大密度投影( MIP) 、容积成像( VR) 重组方法评价冠状动脉的异
常行径及其与邻近大血管的关系。CAG 所显示的RCA, 至少有2 个不同的视角用于评价其起源和行
程。结果 8 例患者变异的RCA 全部为MSCTA 所显示。其中6 例患者的RCA 起源于左冠状动脉
窦, 1 例起源于左主冠状动脉的末端, 另1 例则起源于扩大前移的后冠窦。所有异常开口均未见狭
窄。8 支异常冠状动脉均穿过主动脉根部和肺动脉或右室流出道的间隙。7 例CAG 则仅5 例显示异
常。结论 MSCTA 显示先天性变异的RCA 明显优于CAG, 凡疑为冠状动脉变异的患者, 可首选非创
伤性的16 层MSCTA 检查。
【关键词】 体层摄影术, X 线计算机; 冠状血管造影术; 冠状血管畸形
Evaluation of r ight cor onar y anomalous or igin with mulpi-slice spiral CT SHI He-shui* , HAN
Ping, KONG Xiang-quan, FENG Ga n-sheng, Ha ns-Juergen Brambs, Martin H. K. Hoffmann. * Department
of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430022, China
【Abstra ct 】 Obj ective To evaluate the role of 16-slice spiral computed tomography angiography
( MSCTA) to identify the anomalous origin and anatomic course of the right coronary artery ( RCA) with
conventional X-ray coronary angiography ( CAG) serving as standard of reference. Methods MSCTA data
in 8 patients with anomalous RCA were retrospectively analyzed for the study, 7 of them had also undergone
CAG examinations. MSCTA and CAG images were analyzed in blinded fashion for accuracy of anomalous
artery origin and path detection. Results were compared in a secondary consensus evaluation. Virtual
endoscopy ( VE) was used to evaluate the orifice of the anomalous arteries and its relationship with the
adjacent ostia of normal arteries. Multi-planar reconstruction ( MPR) , curved MPR, thin-slab maximum
intensity projection ( MIP) , volume rendering ( VR) or slab VR ( cut-plane VR) were used to assess the
aberrant path of the RCA and its relationship with the adjacent large vessels. At least two views of the RCA
were analyzed on CAG. Results The anomalous RCA for all 8 patients were correctly displayed on
MSCTA. RCA originated from the left sinus of Valsalva in 6 patients, one RCA from the end of left main
coronary artery, another RCA arose from the posterior sinus of Valsalva. The anomalous ostia showed no
stenosis. All of them passed between the aortic root and the pulmonary artery. For 7 patients with CAG alone
correct identification of the abnormality was achieved in only 71% . Conclusion MSCTA was superior to
show the anomalous orifice and path of the RCA, it should be considered as a prime non-invasive imaging
tool for suspected coronary anomalies.
【Key wor ds】 Tomography, X-ray Computed; Coronary angiography; Coronary vessel anomalies

多层螺旋CT 对先天性右冠状动脉--心血管.rar