64层螺旋CTA在冠状动脉搭桥术后桥血管评价中的临床应用

Clinical Application of 64-slices spiral CTA on the Evaluation of the by Pass Grafts Post-operative the Coronary Artery Bypass Grafts

目的:评价64层螺旋CTA在冠状动脉搭桥术后桥血管评价中的应用价值。方法:收集67例冠脉搭桥术后64层螺旋CTA资料,回顾性分析其成像条件、心电编辑软件对图像质量的影响;薄层容积图像及VR、CPP、MIP等后处理方法对桥血管的显示情况,并观察桥血管通畅状态。结果:67例CTA容积图像质量均满足诊断要求,其中15例经β受体阻滞剂控制心率;27例经过心电编辑软件后处理;检出正常桥血管107支,占74.31%(107/144);异常静脉桥血管32支,22.22%(32/144),包括近端吻合口尖角状闭塞13支,钙化斑块7支,软斑块8支,混合斑块1支;远端吻合口狭窄3支;正常动脉桥血管35支,24.31%(35/144);异常动脉桥血管5支,3.47%(5/144),包括闭塞内乳动脉桥血管4支,远端吻合口狭窄1支。上述多种后处理方法有助于多角度、多方位显示桥血管近、远端吻合口、桥血管行程及其与毗邻结构关系、有无斑块及管腔狭窄程度等。结论:64层螺旋CTA是冠脉搭桥术后评估桥血管状态准确、安全及简便的影像学检查方法。

Objective： The aim of this study was to evaluate the value of 64-slices spiral CT angiography on the patency of the by pass grafts after coronary artery bypass grafts（CABG） surgery. Methods： 67 patients with CABG received 64-slices spiral CT angiography using Aquilion 64-slice spiral CT-scanner in this study. We Retrospectively analyzed the affection of the scanning plans of CTA, and electrocardiography edit software to image quality. The displaying of arterial and venous bypass grafi on thinner slice volume image, some restructures methods ofVR, CPR, MIP and so on. Then we observed the main CTA signs of by pass grafts. Results： The quality of all CTA volume images were accordance with the diagnosis. There were 15 patients with an irregular or fast heart rate despite β-blocker administration which were not excluded from the study, and 27 patients＇ volume images were modified by electrocardiography edit soft ware. In all patients, we found the normal bypass grafts 107, occupied 74.31% （107/144）; abnormal venous grafts 32, occupied 22.22 % （32/144）, including 13 proximal anastomoses obstructed like cusp angle, soft plaque 8, mixing plaquel, calcified plaque 7 and distal anastomoses stenosis 3. normal arterial grafts 35, occupied 24.31% （35/144）; abnormal arterial grafts 5, occupied 3.47 % （5/144）, containing occluded internal mammary artery grafts 4 and proximal anastomoses stenosis 1. These post-processing methods as mentioned above were benefited to display the bypass grafts＇ proximal and distal anastomoses, course and the relationship with adjacent structure, plaque types and the lumens occlusion degree of by pass grafts. Conclusion： 64-slices spiral CTA can be used practically in the assessment of bypass grafts after CABG surgery. It is optimal modality for estimating the patency of bypass grafts and it is a fast, effective, reliable method at present.