冠状动脉起源异常多层螺旋CT诊断及临床意义

Diagnosis of abnormal coronary artery origin with multislice spiral CT and its clinical significance

目的总结冠状动脉先天性起源异常的多层CT表现和临床意义。方法回顾性分析4581例冠状动脉CT血管造影(CT angiography,CTA)检查的影像和临床资料,冠状动脉起源异常者41例,男性34例,女性7例,年龄3～81(54.3±15.6)岁。观察CTA横轴位薄层重建图像,再进行多平面重组(multi-planar reconstruction,MPR)、最大密度投影(maximum intensity project,MIP)和容积再现(volume rendering,VR)后处理观察。结果冠状动脉起源异常41例,发生率为0.9%。41例中,右冠状动脉起源于左冠窦9例,高位开口6例;左冠状动脉高位开口4例,左冠状动脉起源于右冠窦3例;左前降支与左旋支分别起源于左冠窦8例,左前降支起源于右冠状动脉2例,左旋支起源于右冠状动脉5例;左右冠状动脉共干起源4例。41例中23例有发作性胸闷、心悸,4例有心绞痛,其中2例有心源性休克。结论多层螺旋CTA可无创性显示冠状动脉起源及走行异常,应作为疑诊冠状动脉起源异常的首选影像学检查方法 。

Objective To summarize the multislice spiral CT findings in congenital abnormal coronary artery origin and its clinical significance. Methods Imaging and clinical data about coronary artery angiography for 4 581 patients were collected. Abnormal coronary artery origin was found in 41 patients （ 34 males,7 females） at the age of 3 -81 （ 54. 3 ± 15. 6）. Their axial thin reconstruction images were observed followed by multi-planar reconstruction （ MPR） ,maximum intensity project （ MIP） and volume rendering （ VR） to demonstrate the origin and course of coronary arteries. Results Abnormal coronary artery origin was found in 41 patients with an incidence of 0. 9%. Among the 41 patients,the right coronary artery （ RCA） was originated from the left coronary sinus in 9,high orifice in right coronary sinus was found in 6,the left coronary artery was originated from the right coronary sinus in 3,high orifice in left coronary artery （ LCA） was observed in 4,the left anterior descending artery （ LAD） and left circumflex （ LCX） were originated from the left coronary sinus in 8,the LAD was originated from the RCA in 2,the LCX was originated from the RCA in 5,the RCA and LCA were originated from a common trunk in 4,respectively. Of the 41 patients,23 had seizures of dyspnea and palpitation,4 had angina including 2 who had cardiogenic shock. Conclusion Abnormal coronary artery origins and courses can be demonstrated at multislice spiral CT angiography which should therefore be considered a prime non-invasive imaging tool for suspected abnormal coronary artery origins.