64层螺旋CT评价心肌桥-壁冠状动脉及临床价值

Myocardial bridge-mural coronary artery as evaluated by 64 slices MDCT

目的探讨64层螺旋CT冠状动脉成像检查检出心肌桥的特征及临床意义。方法应用64层螺旋CT对526例对冠心病或疑似冠心病者,行冠状动脉血管成像。统计心肌桥的检出率、部位、长度、厚度、壁冠状动脉及其近段和远段血管的形态学变化。结果检出126(24%,126/526)例心肌桥-壁冠状动脉患者,共计154段,左前降支93(60.4%,93/154)段,对角支15(9.7%,15/154)段,中间段3(2%,3/154)段,旋支23(14.9%,23/154)段,钝缘支20(12.9%,20/154)段,其中72(46.8%,72/154)段位于前降支中段。69(44.8%,69/154)段心肌桥厚度可测量,为1.0mm～7.5mm(平均2.4mm),85(55.2%,85/154)段无法准确测量厚度。壁冠状动脉长度1.4cm～4.5cm(平均2.6cm)。25(16.2%25/154)段壁冠状动脉管腔狭窄<50%,101(83.8%,101/154)段管腔未见明确狭窄,19(12.3%,19/154)段壁冠状动脉近段管腔可见斑块并狭窄。结论64层螺旋CT冠状动脉成像可以显示壁冠状动脉管腔和管壁情况,心肌桥的部位、长度、厚度,是一种有效的诊断心肌桥-壁冠状动脉的检查方法。

Objective To explore the prevalence, appearance of myocardial bridge （MB）-mural artery（MCA） by 64 slices multidetector computed tomography（MDCT） cornory angiography（CTA） and its clinical significance. Methods A total of 526 consecutive patients diagnosed or suspected coronary artery disease underwent CTA performed by 64 slices MDCT. The prevalence, precise location, length, depth,and concomitant atheromatous changes were evaluated. Results 154 sites of MB were found in 126 （ 24%, 126/526 ） of 526 patients, 93 （ 60.4%, 93/154 ） on left anterior descending artery, 15（ 9.7%, 15/154 ）on diagnoal branch, 3（ 2%, 3/154 ）on intermediat ramus, 23（14.9%, 23/154）on left circumflex artery, 20（12.9%, 201154） on obtuse branch, 72（46.8%, 72/154） located on the middle segment of left anterior descending artery. The depth of 69（44.8%, 69/154）MB were measurable, varied between 1.0-7.5mm, （mean 2. 4ram）, the depth of 85（55.2%, 85/154）MBs were unmeasurable. The length of bridged segments varied between 1.4-4.5cm（mean 2.6cm）. The lumen of MCA stenosis 〈 50% in 25 （16.2% 251154） egments, 101（83.8%, 101/154） without stenosis, Atherosclerosis plaques and stenosis were found in 19（12.3%, 19/154） proximal segments to the MCA. Conclusion 64 slices MDCT coronary angiography is a non-invasive, sufficient method in the diagnosis of MB-MCA. MDCT coronary angiography allows direct visualization of the lumen and wall of MCA, also the site, depth, and length of MB.