多层螺旋CT评价先天性单冠状动脉畸形

Evaluation of Congenital Single Coronary Artery with 16-slice Spiral Computed Tomography

目的探讨16层螺旋CT(MSCT)冠状动脉造影诊断先天性单冠状动脉畸形的价值。资料与方法回顾性分析4例先天性单冠状动脉患者的MSCT和常规X线冠状动脉造影(CCA)资料,对比两者在显示和诊断此病中的差异。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,多平面重建、曲面多平面重建、最大密度投影、容积成像等重建方法则用于评价变异冠状动脉的行径及其与邻近大血管的关系。结果4例患者变异的冠状动脉全部为MSCT造影所显示并明确诊断。MSCT显示3例患者的左主干起源于右冠状动脉的近段,其中1例在CCA中左主干仅近段局部显影,未能明确诊断,另2例左冠状动脉虽显影,但较淡。1例右冠状动脉起源于左主干的末端,CCA则误为起源于回旋支。MSCT显示2例异常开口冠状动脉的近段狭窄,3支异常冠状动脉穿过主动脉根部和肺动脉或右室流出道的间隙,1支绕主动脉根部后方走行,而CCA均不能明确诊断。结论MSCT显示先天性单冠状动脉明显优于CCA,凡疑及冠状动脉变异的患者,可首选非创伤性的MSCT冠状动脉造影检查。

Objective To evaluate the role of 16-slice spiral computed tomography （MSCT） to identify the anomalous origin and anatomic course of congenital single coronary artery. Materials and Methods Coronary MSCT angingrams （MSCTA） and conventional coronary angingraphy （CCA） in 4 patients with congenital single coronary artery were retrospectively analyzed. MSCTA and CCA images were analyzed in blinded fashion for accuracy of anomalous artery origin and path detection. Results were compared in a secondary consensus evaluation. Virtual endoscope （VE） was used to evaluate the orifice of the anomalous arteries and its relationship with the adjacent nstiole 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 anomalous artery and its relationship with the adjacent large arteries. Results The anomalous coronary arteries in 4 patients were clearly displayed on MSCTA. The left main coronary artery originated from proximal fight coronary artery in 3 patients, 2 of them demonstrated faint and 1 was not demonstrated on CCA. RCA arose from the end left main coronary artery in I patient, which was incorrectly thought to arise from left circumflex. The proximal segment of anomalous artery was found stenosis in 2 patients ; 3 aberrant arteries passed between the aortic root and the pulmonary artery and 1 behind the aortic root, the stennsis and anomalous path of them could not be evaluated on CCA. Conclusion MSCT could clearly show the anomalous orifice and path of the aberrant coronary artery in congenital single coronary, it is superior to CCA and should be considered as a first imaging tool for suspected coronary anomalies.