电子束CT血管造影及三维重建在冠状动脉搭桥术后的临床应用

Clinical application of EBCT angiography and three dimensional reconstruction for evaluation of CABG

目的探讨电子束ＣＴ（ＥＢＣＴ）扫描及其三维重建方法对冠状动脉搭桥术（ＣＡＢＧ）后血管显示情况的临床应用价值。材料与方法８０例ＣＡＢＧ术后患者，平均术后１７个月（７天～１２０个月）接受了ＥＢＣＴ检查；８０例中，男７２例，女８例，年龄３２～７６岁，平均５６±８岁。搭桥血管共２０４支，其中乳内动脉桥（ＩＭＡ）４６支，大隐静脉桥（ＳＶＧ）１５８支。扫描方法均采用单层增强扫描（ＳＳＭ）和血流扫描；三维重建采用表面阴影显示法（ＳＳＤ），三维图像均与手术结果做了对照，其中６例有术后造影检查结果。结果８０例ＥＢＣＴ扫描及三维重建均获得成功；根据搭桥血管三维图像及其血流曲线，２０４支搭桥血管中有１６３支显示通畅，通畅率为７９．９％；其中，４６支乳内动脉桥中４２支通畅（占９１．３％），１５８支大隐静脉桥中１２１支通畅（占７６．６％）。６例有术后冠状动脉造影，显示１１支桥有５支发生了阻塞，与其ＥＢＣＴ结果一致。结论（１）ＥＢＣＴ血管造影及三维重建，可以显示冠状动脉搭桥血管解剖结构，是评价搭桥血管通畅的有效的无创方法；（２）ＥＢＣＴ血流扫描，可以提供搭桥血管血流的定量数据，是评价血管三维重建定量诊断的补充；（３）作为评价冠状动脉搭?

Purpose To probe into the method of EBCT angiography and 3 D reconstruction ofcoronary artery bypass grafts (CABG) and to evaluateits clinical application. Materials and methods EBCT angiography with 3 D reconstruction was achieved in eighty patients (72 male and 8 female, mean age,56±8 years) with 204 grafts including 46 internal mammary artery(IMG) and 158 saphenous vein grafts(SVG) respectively. The duration from bypass surgery to EBCT scanning was 7 days 120 months with mean duration of 17±28 months. Both enhanced single slice mode (SSM) and flow study were performed in all cases. The results of 3 D reconstruction of CABG were correlated with bypass opration records and in 6 cases with coronary arteriograms. Results For all 80 patients, the EBCT angiography and 3 D reconstruction of CABG were carried out satisfactorily. The technical successful rate was 100%. According to 3 D reconstruction of the coronary bypass grafts with flow studies, 163 of 204 coronary bypass grafts were patent including IMG patency in 91.3%(42/46) and SVG in 76.6% (121/158). Overall patent rate was 79.9%. In 6 cases with 11 coronary bypass grafts, EBCT studies showed graft patent in 6 and occluded in 5, which was confirmed by conventional graft angiography. Conclusion (1) EBCT angiography with 3 D reconstruction is easy to perform and is an effective technique for providing the entire anatomic structure of coronary bypass grafts and evaluating coronary bypass graft patency. (2) EBCT flow study can provide quantitative data for evaluating coronary bypass graft patency to provide supplemental diagnosis of CABG 3 D reconstruction. (3) EBCT angiography is a noninvasive technique that could supplant conventional coronary arteriography for follow up survey of coronary bypass surgery in future. (4) The limitation of EBCT in diagnosis of CABG was discussed.