64排螺旋CT冠状动脉成像与冠状动脉造影对心肌桥诊断价值的探讨

Value of 64 multi-slice CT arteriography and coronary angiography in diagnosis of myocardial bridge-mural coronary artery

目的探讨64排螺旋CT血管造影(CTA)与冠状动脉造影(CAG)对心肌桥诊断的应用价值。方法 912例患者先后进行CTA检查和CAG检查,判断有无心肌桥-壁冠状动脉存在,将两者结果进行Kappa检验和配对t检验,判断两者间差异有无统计学意义。结果 CTA发现104例患者共121段存在心肌桥-壁冠状动脉,其中深在型心肌桥-壁冠状动脉42段,浅表型心肌桥-壁冠状动脉79段;而CAG发现97例患者共114段存在心肌桥-壁冠状动脉,其中深在型心肌桥-壁冠状动脉42段,浅表型心肌桥-壁冠状动脉72段。两者相比较,诊断深在型及浅表型心肌桥-壁冠状动脉两者Kappa一致性好(Kappa=1.000、0.877),42段深在型-壁冠状动脉心肌桥长度CTA(11.25±4.20)mm vs CAG(9.56±3.67)mm,壁冠状动脉狭窄程度CTA(50±12)%vs CAG(59±12)%(均P<0.01);72段浅表型-冠状动脉心肌桥长度CTA(7.39±3.02)mm vs CAG(5.54±2.18)mm,壁冠状动脉狭窄程度CTA(31±10)%vs CAG(38±11)%(均P<0.01)。结论 CTA能够诊断各型心肌桥-壁冠状动脉存在以及准确测量心肌桥长度,而测量壁冠状动脉狭窄程度则CAG优于CTA。

Objective To explore the value of 64 multi-slice CT arteriography and coronary angiography in the diagnosis of myocardial bridge-mural coronary artery.Methods 912 patients were collected and their coronary arteries were examined by 64 multi-slice CT and coronary angiography（CAG）.The result that whether the myocardial bridge-mural coronary arteries existed would be evaluated by CT and CAG diagnosticians,and Kappa test as well as paired t test would be adopted to judge the significant difference.Results The CT diagnosticians found 121 myocardial bridge-mural coronary arteries in 104 patients,in which there were 42 deep ones as well as 79 superficial ones.The CAG diagnosticians found that there were 114 myocardial bridge-mural coronary arteries in 97 patients,there were 42 deep ones as well as 72 superficial ones.The average length of the deep ones of CTA and CAG was（11.25±4.20） mm vs（9.56±3.67） mm.The stegnotic extent of mural coronary arteries of deep ones was CTA（50±12）% vs CAG（59±12）%（all P0.01）.The average length of superficial ones of CTA and CAG was（7.39±3.02） mm vs（5.54±2.18） mm.The stegnotic extent of mural coronary arteries of superrficial ones was CTA（31±10）% vs CAG（38±11）%.The concordance of Kappa was best in diagnosing deep ones and superficial ones by CTA or CAG（Kappa=1.000,0.877）.Conclusion CTA can diagnose exactly the existence of superficial myocardial bridge-mural coronary artery and measure the length of myocardial bridge,while CAG does better in measuring the stegnotic extent of mural coronary.