心肌桥的双源CT冠状动脉血管成像诊断及临床意义

Myocardial Bridge:Diagnosis with Dual-Source CT Coronary Angiography and its Clinical Significance

目的探讨心肌桥(myocardial bridge,MB)在双源CT冠状动脉血管成像(dual-source CT coronary angiogra-phy,DSCTCA)中的检出率及其形态学特征,明确MB与邻近冠状动脉硬化的关系。方法对108例拟诊冠心病患者行DSCTCA,观察MB的检出率、位置、长度、厚度及壁冠状动脉(mural coronary artery,MCA)收缩期受压缩程度;观察记录MCA近、远端2 cm以内血管及MCA本身有无动脉硬化(atherosclerotic,AS)。结果 (1)MB检出率为27.8%(30/108),以左前降支中段最多见(53.3%,16/30),MB平均长度为(19.17±6.43)mm,MB的平均厚度为(2.02±0.80)mm。MCA收缩期平均受压缩程度为(38.41±17.09)%;MCA收缩期受压缩程度与MB厚度呈正相关(r=0.910,P<0.01),与MB的长度无相关性(r=0.176,P=0.362>0.05)。(2)所有MCA未发现明显AS斑块,相邻2 cm以内冠状动脉段发现AS斑块14例,其中近端12例,远端2例。近端AS斑块发生率明显高于远端及MCA(χ2=9.32,P<0.05;χ2=15.00,P<0.05)。结论 DSCTCA对MB的检出率高,并可判断MB的形态特征,是检测MB安全、有效、可靠的诊断手段。

Objective To investigate the morphological features of myocardial bridge（MB）with dual-source CT coronary angiography（DSCTCA）,and to assess the relationship between MB and coronary atherosclerosis.Methods Totally One hundred and eight patients with suspected coronary artery disease underwent DSCTCA examination.The location,length and thickness of MB as well as the degree of systolic compression of MCA were observed and measured.The presence or absence of atherosclerosis of the MCA and in the coronary artery 2 cm distance to MB were recorded.Results（1）30 cases of MB among 108 patients（27.8%） were detected on DSCT images.The mid segment of LAD was the most common location of MB.Mean MB length and depth on DSCT were（19.17±6.43） mm and（2.02±0.8） mm,respectively.The mean degree of systolic compression was（38.41±17.09）%.A significant correlation was found between systolic compression and depth（r=0.910,P0.05）.（2）No evidence of atherosclerotic was found in MCA.In a 2 cm distance proximal or distal to the MB,atherosclerotic plaques were found in 14（46.7%）,including 12 proximal segments and 2 distal segments.The incidence of atherosclerotic of the proximal segments was significant higher than the MCA and the distal segments（χ2=9.32,P〈0.05;χ2=15.00,P〈0.05）.Conclusion DSCTCA can diagnose MB with a high detection rate and clearly show the morphological features of MB.It was an effective,safe,reliable diagnosis method of MB.