64MDCT冠状动脉血管成像的临床应用研究

Clinical Applicational Study of 64 Detector-rows CT Coronary Angiography

目的探讨64排探测器CT（64MDCT）冠状动脉造影的临床应用价值。方法对116例临床拟诊冠心痛者行64排冠状动脉成像（CTCA）检查，采用多种重建方法对原始数据进行重建，观察64MDCT对冠状动脉的显示能力、起源、冠脉内斑块性质及管腔狭窄程度，分析影响冠状动脉图像质量的因素，并对桥血管和支架通畅性进行观察。结果左冠状动脉主干及前降支重建的最佳时相为75％R-R时相，左回旋支及右冠状动脉为65％R—R时相。以75％的相位窗重建得到容积再现的图像为最佳。64排CTCA对冠状动脉1～3级分支和部分4级分支显示清晰，对变异血管及心肌显示较佳；对冠状动脉内斑块、冠脉狭窄显示较佳；对桥血管及支架通畅和有无再狭窄显示良好。结论64排探测器CTCA可作为冠心病、壁冠状动脉、血管变异及心肌病变的筛选手段及对冠状动脉血运重建术后复查有很高的临床应用价值。

Objective To study the clinical value of 64 detector rows CT coronary angiography （64DCTCA）. Methods One hundred and sixteen cases were examined with 64DCTCA, CT images were reconstructed by several reconstruction methods, the important influencing factors of the image quality, the displaying ability of coronary artery vessel by 64DCT,the character of plaques and the degree of calcification were analyzed. Coronal arterial stenosis, its degree, the patency of bypass graft and stents were also evaluated. And evaluated the bridge-vessel, unusual-vessel and stent were also evaluated. Results Left main artery and left anterior descending artery were all best visualized at 75% R-R phases. Right coronary artery and left circumflex artery were all best visualized at 65% R-R phases. CT images of volume rendering were all best visualized at 75% R-R phases. 64DCTCA could display 1 - 3, even 4 rank branches of coronary artery. The coronary soft or fibrous plaque, stenosis, stent and bypass graft were well showed. The bridge-vessel,unusual-vessel and cardiac muscle disease were also well showed. Conclusion 64DCTCA has important clinical value in filtering coronary heart disease, bridge-vessel, unusual-vessel, cardiac muscle disease and reexamination after revascularization.