屏气法三维磁共振冠状动脉血管造影诊断先天性冠状动脉起源畸形

Diagnosis of coronary arterial anomalies with breath-holding three-dimensional coronary MR angiography

目的 探讨屏气法三维磁共振冠状动脉造影 (3DMRCA)显示畸形冠状动脉与主动脉根部、右心室流出道关系的可行性及价值。方法 5名临床拟诊患者、1例志愿者接受MRCA检查 ,以屏气法三维稳态进动快速成像 (3Dtrue FISP)梯度回波序列采集图像 ,获得左、右冠状动脉图像 ,分析畸形冠状动脉近段与冠状动脉窦 (Valsalva窦 )、右心室流出道的位置关系。结果 6例MRCA均明确诊断先天性冠状动脉起源畸形 ,畸形血管近段均走行于主动脉根部与右心室流出道之间。结论 屏气法 3DMRCA可明确诊断先天性冠状动脉起源畸形 ,显示畸形冠状动脉近段的走行路经 。

Objective To probe into the feasibility and value of breath-holding three-dimensional MR coronary angiography (MRCA) in diagnosing anomalous coronary arteries, particularly to demonstrate the relationship of the vessels to the aortic root and right ventricular outflow tract. Methods Five patients who were suspected coronary artery anomalies by X-ray coronary angiography (XCA) and one subject from health checkup were examined with breath-holding 3D MRCA using 3D true fast imaging with steady precession sequence. There were 4 males and 2 females in this group, ages ranging from 21 to 48,mean 43.5 years. The images of anomalous arteries were acquired and analyzed. The proximal anatomy of the coronary arteries was determined. Results All the 6 cases were diagnosed congenital coronary artery anomalies, among which 4 anomalous right coronary arteries originated from the left sinus of Valsalva, 1 left coronary artery arose from the right sinus of Valsalva, 1 left anterior descending artery arose from the right sinus of Valsalva were found. The proximal parts of the 6 anomalous arteries coursed between the aortic root and the right ventricular outflow tract, whereas conventional coronary angiography could not easily identify the proximal course. Conclusion Breath-holding 3D MRCA can be used to diagnose anomalous coronary arteries.