64层螺旋CT在评价冠状动脉桥血管中的价值

Value of 64-slice spiral CT in diagnosis of coronary artery bypass graft

目的探讨64层螺旋CT在诊断冠状动脉桥血管的临床价值。方法对21例冠状动脉搭桥术的患者行64层螺旋CT心、胸部血管造影检查。对所有扫描原始数据行冠状、矢状MPR、曲面重建(CPR)以及VR、MIP重建。由两位有经验的放射科医生对所有图像进行观察,对桥血管狭窄进行诊断,并评价其狭窄程度。8例CT诊断桥血管重度狭窄(管腔狭窄>75%)或闭塞的患者同时行选择性血管造影检查。结果21例患者均可清晰地显示冠状动脉各主要分支,并能清晰地显示其斑块和管腔的狭窄。21例患者经螺旋CT心、胸部血管造影检查,可清晰显示52条桥血管,其中13条桥血管出现再狭窄(10条为大隐静脉桥血管,3条为乳内动脉桥血管),狭窄部位均位于桥血管吻合口处;重度狭窄7条,闭塞1条,此8条桥血管均与选择性血管的结果相吻合,CT评价冠状动脉桥血管重度狭窄的准确性为100%。结论64层螺旋CT心、胸血管造影检查不但能显示冠状动脉桥血管,而且能清晰地显示原始的冠状动脉及冠状动脉与桥血管的吻合口,是评价冠状动脉桥血管的一种有效的可靠的检查方法。

Objective To explore the clinical value of 64-slice spiral CT in the diagnosis of coronary artery bypass graft. Methods CT coronary and chest angiography were performed in 21 patients who were operated coronary artery bypass grafts. Two- and three-dimensional reconstruction were performed in all cases by means of MPR （coronal, sgittal oblique）, CPR, MIP, VR and clipped VR. The obtained images were evaluated by two experienced radiologists. Selective coronary angiography were performed in 8 patients whose stenosis〉75 % diagnosed by CT. Results All coronary artery branches and part sub-branches of 21 patients were clearly displayed by CT. Twenty-one patients showed 52 coronary artery bypass grafts, and 13 coronary artery bypass grafts were restenosis （great saphenons vein, 10; internal mammary artery, 3）, 7 were high-grade stenosis, 1 was occlusion. Eight patients with severe stenosis/occlusion dectected by CT were consistent with that by selective coronary angiography, and the coincidence rate was 100%. Conclusion 64-slice spiral CT coronary and chest angiography is useful and noninvasive to evaluate coronary artery bypass graft.