高端CT冠状动脉成像对单冠状动脉畸形分型诊断价值

目的:通过对冠状动脉CTA对先天性单冠状动脉畸形的影像分析,探讨冠状动脉CTA对先天性单冠状动脉畸形分型诊断价值及其与临床症状相关性。方法:回顾性分析25例经冠状动脉CT血管造影(CTA)诊断为单冠状动脉畸形患者资料,使用CT多种后处理方法进行重建分析,观察冠状动脉的起始及走行情况。结果:25单冠状动脉畸形病例中,右冠状动脉缺如左冠状动脉供血整个心脏20例(其中回旋支供血右心系统15例,前降支供血右心系统3例;前降支及回旋支分别发出分支供血右心系统2例);左冠状动脉缺如单右冠状动脉畸形5例,所有病例均通过VR、MIP和MPR等重建显示冠状动脉的形态。结论:冠状动脉CTA能准确显示冠状动脉的走行分布,可以作为诊断先天性单冠状动脉畸形及其分型的首选检查方法,为临床症状诊断提供依据。     

CT冠脉血管成像诊断冠心病心绞痛与血管造影的一致性研究

目的:探究CT冠脉血管成像(CCTA)诊断冠心病心绞痛与血管造影的一致性.方法:回顾性分析101例血管造影确诊冠心病心绞痛患者临床资料,以血管造影检查为"金标准",评估CCTA对其病变血管的诊断效能.结果:CCTA诊断左前降支、冠状动脉主干、左回旋支、右冠状动脉的灵敏度分别为92.85％ (13/14)、93.75％ ...     

MSCT冠状动脉成像与冠状动脉造影的对比研究

目的 :研究MSCT在冠状动脉成像中的临床应用价值。方法 :4 0例疑冠状动脉狭窄者行MSCT扫描 ,利用最大密度投影 (MIP)重建 ,2D重建 ,仿真内窥镜技术 ,了解冠状动脉病变情况 ,并与冠状动脉造影对比。结果 :4 0例 16 0支血管经MSCT成像 ,134支 (84 % )可用于影像学评价 ,2 6支 (16 % )不能评价。冠状动脉造影发现狭窄 4 6支 ,其中左前降支 (LAD)病变 18支 ,回旋支 (LCA)病变 12支 ,左主干 (LMA) 3支 ,右冠 (RCA)病变 13支。MSCT发现狭窄 4 1支 ,其中左前降支病变 14支 ,回旋支病变 12支 ,左主干病变 3支 ,右冠病变 12支。敏感性为 82 .6 % (38/ 4 6 ) ,特异性 97.3% (111/ 114 )。结论 :在控制心率的情况下 ,MSCT可作为冠状动脉狭窄的一种无创筛选检查方法。     

右冠状动脉开口异常合并左回旋支发育异常1例

患者，男性，62岁，主因发作性胸痛1年，加重2天入院。患者既往体健。心电图示：V1～V4 ST段抬高0．2～0．4mV。入院诊断：急性前壁心肌梗死。于入院后第9天行冠状动脉造影示：右冠状动脉开口于左窦前部（图1），右冠状动脉分支丰富，其近端发出一较大分支近似左回旋支走行，左冠状动脉开口于左窦后部（图2），左主干短，前降支钙化明显，并弥漫斑块浸润，多处狭窄，以近端最重达（99％），左回旋支细而短小。处理：于前降支近端植入支架1枚。     

MDCT冠状动脉造影的临床应用价值分析及护理

目的 探讨MDCT冠状动脉造影检查技术的临床应用价值及护理体会.方法 55例冠心病的患者均同时行MDCT冠状动脉造影检查(CTCA)和DSA选择性冠状动脉造影检查(SCA),用GE Advantange Workstation A W4.3影像后处理工作站对采集的CTCA原始数据信息结果进行影像图像后处理,重建出冠状动脉影像,并以SCA为金标准分析CTCA的检查结果.结果 55例患者行CTCA检查显示冠状动脉左前降支、左回旋支及右冠状动脉的显示率分别为100%(55/55)、95.2%(51/55)和98.4%(54/55),CTCA诊断冠状动脉狭窄＞50%的敏感度93.5%、特异度95.3%、准确度94.6%.结论 MDCT冠状动脉CTA检查结果和SCA检查结果有较高的一致性,是临床上一种筛选冠状动脉病变的良好方法.     

冠状动脉造影与64排双源CT在冠心病的诊断中临床对比研究

选取我院2012年11月~2014年11月间收治的90例冠心病患者,分别进行冠状动脉造影与64排双源CT检查,检查结果以冠状动脉造影的结果为金标准,对两组检查结果进行对比分析。结果在可评价的1267支血管中,冠状动脉造影检查呈阳性的为564支,64排双源CT检查呈阳性的为572支者,检查结果无明显差异(P>0.05)。在各冠脉的检出结果如下:(1)左主干(LM):冠状动脉造影与64排双源CT分别检出32、36支;(2)左前降支(LAD):冠状动脉造影与64排双源CT分别检出245、258支;(3)左回旋支(LCX):冠状动脉造影与64排双源CT分别检出112、109支;(4)右冠状动脉(RCA):冠状动脉造影与64排双源CT分别检出85、77支;(5)其他:冠状动脉造影与64排双源CT分别检出90、92支。其中,64排双源CT在左主干(LM)、左前降支(LAD)较冠状动脉造影诊断价值高,而在左回旋支(LCX)、右冠状动脉(RCA)较冠状动脉造影诊断价值低,P<0.05,有统计学意义。冠状动脉造影(SCA)与64排双源CT在冠心病的诊断中临床应用价值显著,值得推广。     

定量组织速度成像技术对不同冠状动脉分支狭窄的诊断价值

目的：通过定量组织速度成像技术（quantitative tissue velocity imaging,QTVI）与冠状动脉造影术（se-lected coronary angiography,SCA）定位冠心病狭窄冠状动脉分支的对比研究,探讨定量组织速度成像技术诊断冠心病的临床价值。材料与方法：对122例拟行经皮冠状动脉介入术（Percutaneous coronary intervention,PCI）前常规行定量组织速度成像技术检查,节段性室壁运动异常（Regional wall motion abnor mality,RWMA）应用左室16节段分法定位并与冠状动脉造影进行比较。结果：①定量组织速度成像技术诊断室壁节段性运动异常准确性85.3%,敏感性85.7%,特异性80%。②检出冠状动脉狭窄敏感性左前降支74.4%,左回旋支51.7%,右冠状动75.0%,左前降支和右冠状动脉的敏感性高于左回旋支（P〈0.05）。③检出单支、双支、三支狭窄的敏感性分别为71.8%,76.3%,82.1%,QTVI与SCA检出冠脉单支、双支及多支病变无统计学意义（P〈0.05）。结论：定量组织速度成像技术检测节段性室壁运动异常可以准确诊断狭窄冠状动脉分支,是临床评价心肌缺血和（或）心肌梗死的可靠而敏感方法。     

冠状动脉造影结果及影响因素临床分析

目的 探讨冠状动脉造影结果与临床影响因素的关系，以提高冠状动脉造影的阳性率。方法 180例患者采用Judkins法，经股动脉穿刺，在多个投射角度作左、右冠状动脉造影。结果 阳性率47．77％（86／180），累及143支血管，其中，左前降支占41，95％（60／143），右冠状动脉占31．46％（45／143），左回旋支占20．97％（30／143），左主干占5．59％（8／143）。结论 男性，年龄〉50岁，有心肌梗塞、高血压病史、糖尿病、高脂血症、典型心绞痛病史、心电图典型缺血改变者，冠状动脉造影的阳性率明显增高。     

105例冠心病冠状动脉造影分析——附3例冠状动脉腔内成形术(PTCA)

本文分析105例冠心病的冠状动脉造影。其中78例同时作左心室造影。X线表现为冠状动脉粥样硬化82例,累及157支血管,以前降支最多占50.3％,右冠状动脉30.9％,左回旋支17.2％,左主干1.9％。动脉管腔以中,重度狭窄为多,完全梗阻较少。37例左室功能异常,7例室壁瘤。二尘瓣关闭不全13例,二尖瓣脱垂4例,3例行PTCA治疗,2例前降支效果好,1例右冠状动脉术中急性闭塞。     

多层螺旋CT冠状动脉成像的初步临床应用

目的:初步探讨MSCT冠状动脉成像的临床应用价值。方法:45例临床诊断或可疑冠心病的患者做MSCT冠状动脉成像检查(回顾性心电门控、0.5s螺旋扫描、心脏分段重建算法和静脉注射对比剂)。在9个心电相位窗上对冠状动脉进行图像重建并分析影像学表现。结果:45例中,左前降支、左回旋支和右冠状动脉重建图像质量最佳的相位窗多数为70%,分别占84.4%,77.8%和66.7%。左冠状动脉主干、左前降支、左回旋支和右冠状动脉显示较好且能满足影像学评价分别占93.3%,80%,60%和42.2%。在心率<60次/分的16例中,左前降支、左回旋支和右冠状动脉显示较好且能满足影像学评价分别占93.8%,75%和62.5%。在心率为60~70次/分的21例中,左前降支、左回旋支和右冠状动脉图像质量较好且能满足影像学评价分别占85.7%,66.7%和42.9%。在心率>70次/分的8例中,左前降支、左回旋支和右冠状动脉图像质量较好且能满足影像学评价分别占37.5%,12.5%和0。在冠状动脉正常或狭窄程度<50%的12例中,二维曲面重建图像显示左前降支、左回旋支和右冠状动脉的长度分别为108±15mm,81±26mm和126±16mm。结论:MSCT在多数情况下能较好地显示冠状动脉,可以作为冠状动脉病变的筛选方法。     

64层螺旋CT对先天性冠状动脉异常起源的显示

目的总结冠状动脉异常起源的螺旋CT影像表现。方法回顾性分析2005年5月1日-2006年5月1日行冠状动脉检查的患者的CTA结果,共2274人,其中冠状动脉异常起源者共24例,发生率为1.06%。其中男22例,女2例,年龄36~79岁,平均52.8岁。对患者图像分别行多平面重建(MPR)、最大密度投影(MIP)和容积重现(VR)法重建图像。结果右冠状动脉开口于左冠窦6例,开口高位5例;左主干开口高位4例,开口于左冠窦后缘2例;左前降支与左回旋支分别开口于左冠窦5例;左回旋支开口于右冠窦1例;左右冠状动脉共干1例。所有图像通过不同的重建方法可以清晰直观地显示异常血管的起始和行程。结论64层螺旋CT可清晰显示冠状动脉异常起源及行程异常,可为心血管医生提供有价值的影像。     

舌下含服硝酸甘油对螺旋CT冠状动脉造影中检测冠脉内径狭窄程度准确性影响的评价

目的评价64层螺旋CT(64-MSCT)冠状动脉造影中舌下含服硝酸甘油对检测冠脉内径狭窄程度准确性的影响。方法 2010年6月至2013年6月疑为冠心病的患者共72例行64-MSCT冠状动脉造影,分为给硝酸甘油及不给硝酸甘油两组,每组各36例,分别对两组患者右冠状动脉(RCA),左前降支(LAD),回旋支(LCA),左主干(LMA)近端内径进行测量,同时计算两组图像冠状动脉的13个节段显影的差异。结果硝酸甘油组的RCA、LM、LAD、LCX各支冠脉近端平均内径比非硝酸甘油组大,差异具有统计学意义(P0.05)。两组冠状动脉13个节段中,右冠状动脉、左主干、左前降支、左旋支可评价血管例数相同,后降支和左室后支、左前降支远段、第l对角支、钝圆支显示例数硝酸甘油组较多,但两者差异无统计学意义(P0.05);第2对角支及左旋支远段两组显示的例数有显著性差异(P0.05)。结论硝酸甘油对冠状动脉近端内径有显著的扩张作用,显示的节段数增多,可以提高64层螺旋CT冠状动脉造影成像质量,在一定程度上能提高冠状动脉内径狭窄程度的诊断的准确性。     

Volume coronary angiography using targeted scans (VCATS): a new strategy in MR coronary angiography

The aim of this study was to explore the clinical possibilities of a new strategy for magnetic resonance imaging of the coronary arteries. Thirteen patients were studied by volume coronary angiography using targeted scans (VCATS) to visualize the major coronary arteries in a series of breath-holds. The proximal coronary arteries were clearly seen in 92% and the mid segments in 50–70% of the patients. VCATS was able to visualize a total vessel length of the left main (LM) (mean: 9.4 ± 3.4 mm), of the left anterior descending (LAD) 69 ± 20 mm, of the right coronary artery (RCA) 90 ± 33 mm and of the left circumflex (LCX) 41 ± 18 mm. There was a reasonable correlation between the VCATS and conventional coronary angiography (CAG) for vessel diameter (r = 0.71), with a slight overestimation of 0.7 mm by VCATS. There were nine significant stenoses present of which six were correctly detected, three were missed and one false positive was present. VCATS is fast strategy for visualizing the major coronary artery branches and has the potential to detect significant stenoses in these branches.     

统一体位在16排螺旋CT评价冠状动脉狭窄中的应用

目的通过建立统一的重组图像体位,研究16层螺旋CT(MSCT)诊断冠状动脉狭窄的准确性。方法对55例临床可疑冠心病患者16层MSCT心电门控增强扫描。用舒张期增强扫描图像行统一体位的最大密度投影(MIP)及容积显示(VR)重组,分析应用CT血管成像(CTA)7个MIP重组体位和9个VR重组体位评价冠状动脉狭窄≥50%的情况,将结果与常规X线冠状动脉造影作对照。结果共分析55例患者的220个血管分支,常规冠状动脉造影发现62个血管分支狭窄≥50%,综合7个MIP重组体位和9个VR重组体位,CTA发现58个血管分支狭窄≥50%(左主干5个,前降支21个,回旋支14个,右冠状动脉18个)。CTA诊断冠状动脉狭窄≥50%的敏感性为94%(58/62),特异性为92%(146/158)。结论 16层MSCT诊断冠状动脉狭窄有较高的敏感性和特异性;建立统一的成像体位有利于CTA与常规X线冠状动脉造影结果对照。     

肥厚性心肌病的冠状动脉造影分析

目的：了解肥厚性心肌病患者冠状动脉及其特征。方法：25例肥厚性心肌病患者行冠状动脉造影,观察其冠状动脉分布及特点,测量其各分支中段内径,并与同期行冠状动脉造影的正常人相比。结果：肥厚性心肌病患者冠状动脉供血呈左优势者占20％,各亚型间无明显判别：5例发现合并冠心病,其中1例行PTCA及冠脉内支架术,另1例植入永久性DDD起搏器治疗,1例左前降支中段发现冠脉肌桥;无冠状协脉病变的19例患者左主干,回旋支及右冠脉中段内径较正常者明显粗大（P＜005）,结论：肥厚性心肌病患者冠脉供血呈左优势者比较较高,其冠状动脉内径较正常者粗大,疑有合并冠心病者须行冠状动脉造影,对指导治疗有一定意义。     

An analysis of the myocardial contractile function of the left ventricle in patients with ischemic heart disease and isolated involvement of the anterior descending artery based on data from x-ray contrast ventriculography

Coronaroventriculography was performed in 36 patients with an isolated injury to the anterior, descending artery (ADA) and in 32 patients with concomitant injury to the ADA and the right coronary artery (RCA) or to the circumflex artery. Associated injury to the ADA and RCA resulted in greater disorders of left ventricular function than an isolated injury to the ADA. Dysfunction of the left ventricle was less pronounced in patients with an isolated injury to the ADA in the presence of postinfarction angina pectoris whereas in ADA occlusion, in proper collateral filling of the vessel.     

冠周脂肪影像组学鉴别冠状动脉狭窄程度初探

目的 初步探讨基于冠脉CTA(CCTA)图像上冠状动脉周围脂肪(PCAT)的影像组学模型对冠状动脉狭窄程度的鉴别诊断.方法 回顾性分析319例接受CCTA检查者的临床、影像资料,分为三组,包括正常组(101例202支经CCTA评估为正常者),轻中度组[74例74支经数字减影血管造影(DSA)评估为轻中度狭窄者],重度组...     

Anomalous origin of the three coronary arteries from the right aortic sinus Valsalva: Role of MDCT coronary angiography

Background Monocuspal origin of all three coronary arteries through separate ostia from the right aortic sinus (RCS) is a rare occurrence. To date, the use of multidetector computed tomography (MDCT) for imaging of congenitally abnormal coronary arteries has been discussed only in few individual case reports.Objective To describe the role of MDCT coronary angiography in the evaluation of two rare cases of monocuspal origin of all three coronary from RCS.Patients and methods We had a retrospective review of clinical information and imaging studies for two patients presented with chest pain. Both patients underwent conventional coronary angiography followed by noninvasive imaging with MDCT.Results Both patients had anomalous origin of the all three coronary arteries from the RCS. In one case the LAD took an intramural course in between the aorta and the right ventricular outflow tract (RVOT) while it passed anterior to the RVOT in the other patient. In the first patient, there was also associated coronary fistula to the right ventricle along with right coronary artery (RCA) and left anterior descending coronary artery (LAD) narrowing. Both the stenosed segments were successfully stented and were demonstrated to be patent in the subsequent MDCT.Conclusion Monocuspal origin of all three coronary artery from the RCS is a rare anomaly, can be reliably diagnosed by MDCT. CT angiogram is a convenient complementary tool for the coronary arteriography     

Use of the internal mammary artery for myocardial revascularization in a patient with radiation-induced coronary artery disease.

A 9-year-old boy with clinical stage IIA Hodgkin's disease underwent radiotherapy to the neck and mediastinum. Twenty-two years later, he sought medical attention because of angina pectoris. Cardiac catheterization revealed proximally located high-grade stenoses of the left main, left anterior descending, circumflex, and right coronary arteries. He underwent coronary artery bypass grafting with use of the left internal mammary artery to the left anterior descending coronary artery and reversed saphenous vein grafts to the circumflex and right coronary arteries. The postoperative course was uncomplicated. Previous radiotherapy to the mediastinum should be considered a risk factor for the development of premature coronary artery disease. Surgical revascularization is the preferred method of management. A combination of an internal mammary artery graft and a saphenous vein graft should be used in young patients.     

Anomalous origin of the left circumflex coronary artery from the pulmonary artery. A very rare congenital anomaly in an adult patient diagnosed by cardiovascular magnetic resonance

Here we report for the first time on the diagnostic potential of cardiovascular magnetic resonance (CMR) to delineate the proximal course of an anomalous left circumflex coronary artery (LCX) originating from the right pulmonary artery in an adult patient with no other form of congenital heart disease. The patient was referred to our institution due to exertional chest discomfort. X-Ray coronary angiography showed a normal left anterior descending coronary artery (LAD) and right coronary artery (RCA), while the LCX was filled retrograde by collateral flow through the LAD and the RCA. The origin of the LCX was postulated to be the pulmonary artery, but the exact origin of the anomalous artery could not be depicted on conventional angiograms. CMR provided the unambiguous depiction of the origin of the anomalous LCX from the right pulmonary artery and the delineation of its proximal course in this case of a very rare coronary anomaly in adults.