64排CTA对冠状动脉埋藏式走行的诊断价值

64-detector row CT angiography in the diagnosis of buried traveling coronary artery

目的:探讨64排128层螺旋CT对先天性冠状动脉起源异常及埋藏式走行的诊断价值。方法:回顾性分析25例冠脉起源异常患者的64排128层CT冠脉血管成像及冠脉血管造影(CAG)资料。CT检查资料采用容积再现(VR)、曲面重组(MPR)及最大密度投影(MIP)等方法进行图像后处理,观察冠状动脉的起源及走行,并与CAG的结果进行对照。结果:MSCTA显示25例患者均为冠状动脉起源于相反主动脉窦开口,16例(16/25)为右冠状动脉起自左冠状窦,其中6例为右冠状动脉走行于主动脉与肺动脉-右室流出道之间,呈埋藏式走行;9例为左冠状动脉起源于右冠状窦,其中2例为左冠状动脉走行于主动脉与肺动脉-右室流出道之间,呈埋藏式走行。8例埋藏式走行的冠状动脉中7例冠脉与主动脉间夹角<45°,7例管腔狭窄>50%。25例患者中CAG仅正确诊断冠脉起源异常22例,漏诊2例、误诊1例,8例冠脉埋藏式走行均未能提示。结论:64排128层CTA对冠脉起源异常及冠脉埋藏式走行的诊断准确性高,优于冠状动脉造影检查。

Objective：To evaluate the clinical value of 128-slice of 64-detector row CT angiography in the diagnosis of congenital coronary artery（CA） origin anomalies and buried traveling CA.Methods：The 128-slice CTA and DSA data of 25 cases with coronary origin anomalies（COA） were retrospectively reviewed.Post-processing techniques including volume rendering（VR）,curved planar reformation（CPR） and maximum intensity projection（MIP） were used to observe the origin and course of coronary artery,and the data were compared with those of coronary angiography.Results：It was shown by MSCTA that in all 25 patients the left and right CA originated from the contralateral coronary sinus.In 16 cases（16/25） the right CA originated from left coronary sinus,including 6 cases with buried traveling CA which were located between aorta and pulmonary artery（PA）-right ventricular outflow tract（RVOT）.In 9 cases（9/25） the left CA originated from right coronary sinus,including 2 cases with buried traveling CA which were located between aorta and PA-RVOT.Of the 8 buried traveling CA,the angle with aorta 45° and the lumen area reduction 50% were found in 7 CA.In all 25 COA patients only 22 cases were correctly diagnosed by CAG,and the 8 buried traveling CA were not detected by CAG.Conclusion：128-slice CTA is a valuable technique for detecting coronary artery origin anomalies,being superior to CAG,especially in the diagnosis of buried traveling CA.