冠状动脉异常起源合并升主动脉壁内走行的CT诊断

CT angiography of intramural segments in anomalous origin coronary arteries

目的探讨冠状动脉异常起源合并升主动脉壁内走行的CTA特征及其诊断价值。方法回顾性分析14例冠状动脉异常起源并经外科手术证实为冠状动脉在升主动脉壁内走行(壁内走行组)的患者和50例冠状动脉起源异常无壁内走行(无壁内走行组)的患者资料,观察两组术前CTA图像特点,并与手术结果相对照。结果壁内走行组CTA正确诊断13例(13/14,92.86%)。CTA后处理的MIP血管轴位像显示冠状动脉横截面呈椭圆形,血管高度/宽度均>1.6,平均2.06±0.29;无壁内走行组异常走行血管的高度/宽度均<1.4,平均1.26±0.14,两组高度/宽度差异有统计学意义(t=8.547,P=0.005)。壁内走行组右冠状动脉发生率为64.29%(9/14);MIP血管轴位像见冠状动脉与升主动脉共用血管壁5例(5/14,35.71%)。结论血管横断面呈椭圆形是冠状动脉在升主动脉壁内走行的特征。CT可在术前识别壁内走行冠状动脉。

Objective To evaluate CTA characteristics and diagnostic value of anomalous coronary arteries with an intramural segment（intramural coronary artery）.Methods There were 14 patients diagnosed by surgery as having an intramural coronary artery and 50 patients diagnosed as without having an intramural coronary artery.CTA images were retrospectively analyzed for the presence of high-risk features by a radiologist blinded to the surgical findings.Results Pre-operative CTA diagnosed 13 patients of intramural coronary artery（13/14,92.86%）.CTA MIP showed an elliptical shaped crosssection throughout the intramural segment of the anomalous vessel.The average vessel height/width ratio for anomalous coronary vessels with an intramural segment was more than 1.6（mean[2.06±0.29]）,and the ratio was less than 1.4for anomalous vessels without an intramural segment（mean[1.26±0.14]）.There were statistical differences was found between the two groups（t=8.547,P=0.005）.The intramural segments was the right coronary artery in 9patients（9/14,64.29%）.MPI anomalous vessel showed coronary artery wall shared with the ascending aorta in 5cases（5/14,35.71%）.There were statistical differences between two roup（t=8.547,P=0.005）.Conclusion CTA can identify intramural segment of anomalous interarterial coronary artery by its elliptical shape.