完全性大动脉转位患者冠状动脉解剖分型的多层螺旋CT研究

Anatomic classification of coronary arteries in complete transposition of great arteries：diagnosis and analysis with multi-slice CT

目的：探讨MSCT在完全性大动脉转位（D-TGA）患者冠状动脉解剖分型的诊断价值及解剖类型的分布情况。方法回顾性分析2005年3月至2015年6月在我院进行MSCT检查的367例D-TGA患者的临床及CT检查资料，采用Marie Lannelongue分型对D-TGA患者的冠状动脉起源、走行进行解剖分型，将D-TGA患者的冠状动脉分为常态走行、成襻走行、壁内走行、壁内与成襻同时存在的混合走行4个类型（Ⅰ～Ⅳ型），进一步分为11种亚型。分析各种冠状动脉的解剖学类型，并采用分类变量资料中的构成比进行统计描述。结果 MSCT对367例D-TGA患者的冠状动脉起源、近段走行均能清晰显示。本组病例冠状动脉解剖类型包括方法中提到的全部4个类型11种亚型：Ⅰ型，常态走行209例（56.95%）；Ⅱ型，成襻走行共138例（37.60%），其中后襻走行63例（ⅡA型，17.17%）、前襻走行30例（ⅡB型，8.17%）、双襻走行45例（ⅡC型，12.26%）；Ⅲ型，壁内走行16例（4.36%）；Ⅳ型，壁内与成襻同时存在的混合走行4例（1.09%）。其中成襻走行的8种亚型的构成比为：ⅡA-1型44例（11.99%）、ⅡA-2型19例（5.18%）、ⅡB-1型12例（3.27%）、ⅡB-2型8例（2.18%）、ⅡB-3型10例（2.72%）、ⅡC-1型25例（6.81%）、ⅡC-2型17例（4.63%）、ⅡC-3型3例（0.82%）。结论 MSCT可显示D-TGA患者冠状动脉的起源及走行，对其进行准确解剖分型。

Objective To evaluate the diagnostic value of multi-slice spiral CT （MSCT） in classifying coronary arteries of complete transposition of great arteries （D-TGA）. Methods The clinical and imaging data of 367 patients with D-TGA who had undergone MSCT examination from March 2005 to June 2015 were retrospectively analyzed. The origin and course of the coronary arteries of the patients were classified according to the Marie Lannelongue classification. There were four patterns of courses： normal, looping, intramural and miscellaneous. And the four patterns were subdivided into eleven subgroups. The anatomic classification of coronary arteries in D？TGA were recorded, and the ratio of descriptive statistics was used according to categorical variable data. Results All the origin and course of the coronary arteries could be clearly displayed on MSCT. Of 367 patients with D-TGA, 209 cases （56.95%） were normal course （typeⅠ）, 138 cases （37.60%） were looping course （typeⅡ）, 16 cases （4.36%） were intramural course （typeⅢ）, and 4 cases （1.09%） were miscellaneous course （typeⅣ）. In looping course, the posterior looping （typeⅡA）, anterior looping （typeⅡB） and double looping （typeⅡC） were found in 63 cases （17.17%）, 30 cases （8.17%） and 45 cases （12.26%）, respectively. The ratios of the anatomic classification of looping courses wereⅡA-1 44（11.99%）,ⅡA-2 19（5.18%）,ⅡB-1 12（3.27%）,ⅡB-2 8（2.18%）,ⅡB-3 10（2.72%）,ⅡC-1 25 （6.81%）,ⅡC-2 17（4.63%）,ⅡC-3 3（0.82%）. Conclusions MSCT is an effective technique to visualize and classify the coronary arteries in patients with D-TGA. And it is helpful for successful transfer of the coronary arteries and reducing the rate of coronary events after operation.