128排螺旋CT检测心肌桥-壁冠状动脉与冠状动脉粥样硬化相关性

Correlation between MB-MCA evaluated by 128-slice spiral CT and coronary atherosclerosis

目的探讨128排螺旋CT评价心肌桥-壁冠状动脉(MB-MCA)的形态学特征,并分析其与冠状动脉粥样硬化的关系。方法回顾性分析2014至2018年82例具有MB-MCA患者的影像资料,用冠状动脉重建结合多平面重建(MPR)、容积再现(VR)、最大密度(MIP)投影技术测量MB-MCA相关参数,对比分析其结果以及测量各项冠状动脉检测指标(心肌桥厚度、壁冠状动脉长度、壁冠状动脉狭窄程度),并通过多因素Logistic回归分析MB-MCA与冠状动脉粥样硬化病变的关系。结果 82例MB-MCA患者共96段病变中,发生于左前降支63例,占65.6%(近段10例,占10.4%;中段41例,占42.7%;远段12例,占12.5%),回旋支4例,占4.2%,对角支11例,占11.5%,钝缘支5例,占5.2%,右冠状动脉13例,占13.5%,病变以前降支近段、中段及对角支多见。测得MB厚度0.50~6.50(2.27±1.20)mm,长度为4.00~40.00(15.34±7.67)mm。选择MCA狭窄显示最清楚时相共63段(其中33段未见狭窄或无法测量),狭窄程度7%~65%(33.44±13.88)%。心肌桥和壁冠状动脉患者的形态学表现,冠状动脉主干和分支穿行在心肌内,局部有圆锥样改变、挤奶现象等。Logistic回归分析表明,年龄、壁冠状动脉长度、壁冠状动脉厚度可作为影响动脉硬化的独立因素(P<0.05,P<0.01)。结论 128排CT重建技术对MB-MCA检出率高。MB-MCA患者的年龄、壁冠状动脉长度、厚度与冠状动脉粥样硬化的发生有一定的相关性。采用128排螺旋CT冠状动脉成像技术可有效评价MB-MCA形态学特征以及和冠状动脉粥样硬化的相关性。

Objective To explore the morphological characteristics of myocardial bridge-mural coronary artery(MB-MCA) evaluated by 128-slice spiral computed tomography(CT) and the relationship between MB-MCA and coronary atherosclerosis.Methods The imaging data of 82 patients with MB-MCA from 2014 to 2018 were retrospectively reviewed.MB-MCA parameters were measured by coronary artery reconstruction combined with multiplanar reconstruction(MPR),volume rendering(VR) and maximum intensity projection(MIP) techniques and were compared with the indexes of coronary artery(myocardial bridge thickness,length of mural coronary artery,degree of coronary artery stenosis).The relationship between MB-MCA and coronary atherosclerosis was analyzed by multivariate logistic regression analysis.Results In 82 patients with 96 segments involved,63 segments(65.6%) located at left anterior descending(LAD),including 10 segments(10.4%) in proximal artery,41 segments(42.7%) in middle artery,12 segments(12.5%) in distal artery,4 segments(4.2%)in circumflex branches,11 segments(11.5%) in diagonal branches,5 segments(5.2%) in blunt marginal branches and 13 segments(13.5%) in right coronary artery.The segments involved mostly occurred in proximal and middle anterior descending branch and the diagonal branch.The depth of MB ranged from 0.50-6.50(2.27±1.20)mm,and its length ranged from 4.00-40.00(15.34±7.67)mm.In 63 segments with distinct imaging of MCA,33 segments had no stenosis or could not be measured,and the degree of stenosis was 7%-65%(33.44±13.88)%.Morphological manifestations of MB-MCA showed that the coronary arteries were embedded in myocardium with cone-shaped change and milking effect.Logistic regression analysis showed that age,length and thickness of MCA were the independent influencing factors of atherosclerosis(P<0.05,P<0.01).Conclusion The 128-slice CT reconstruction technology has a high detection rate of MB-MCA.Age,length and thickness of MCA in patients with MB-MCA are certainly correlated with the occurrence of coronary atherosclerosis.128-slice spiral CT coronary angiography can effectively evaluate the morphological characteristics of MB-MCA and its correlation with coronary atherosclerosis.