无顶冠状静脉窦综合征的多层螺旋CT诊断价值

 目的 探讨多层螺旋CT (multi-slice spiral CT,MSCT)诊断无顶冠状静脉窦综合征(unroofed coronary sinus syndrome,UCSS)的应用价值。方法 回顾性分析13例经手术证实或综合临床症状及影像学资料确诊的UCSS患者的CT图像资料,通过横断位图像,联合多平面重组、容积再现、最大密度投影等后处理技术,观察病变冠状静脉窦的形态和血流的变化,测量冠状静脉窦的直径大小,与20例正常个体的冠状静脉窦的测量值进行比较。诊断结果与经胸超声心动图的诊断结果进行对照分析。结果 MSCT诊断UCSS的准确率明显高于经胸超声心动图,MSCT明确诊断13例,超声明确诊断5例(40%,5/13)。本组病例CT图像资料中,冠状静脉窦顶壁表现为完全缺如型7例,中上段局部缺如型3例,终末端局部缺如型3例。UCSS的MSCT主要表现为冠状静脉窦扩大,UCSS组的冠状静脉窦直径明显大于正常组［(18.7±10) mm vs.(8.7±1.6) mm,P<0.05］。多平面重组图像,尤其是冠状静脉窦轴位图像,可直观显示冠状静脉窦的形态以及顶壁缺损、左心房与冠状静脉窦之间血液异常分流情况。结论 冠状静脉窦位置结构特殊,MSCT能够良好地显示冠状静脉窦的走行,对UCSS具有较高的诊断价值。

Diagnostic value of multi-slice spiral CT on unroofed coronary sinus syndrome

Objective  To investigate the characteristic findings of multi-slice spiral CT (MSCT) and its clinical value for unroofed coronary sinus syndrome(UCSS). Methods  MSCT images of 13 patients with UCSS confirmed by surgery or images combined with clinical symptoms were analyzed retrospectively,including the defect size,location,coronary sinus diameter and associated cardiac malformation,which were all compared with transthoracic echocardiography.Transverse images combing with various reconstructions,such as multi planar reconstructions,volume rendering tedinique,maximum intensity projection,show the enlarged coronary sinus and the shunt flow.Another 20 normal subjects were included and the results of measurement were compared with UCSS patients.Results  The diagnostic accuracy of MSCT for UCSS was 100% (13/13),but the transthoracic echocardiography was 40%(5/13).Seven patients were diagnosed as completely unroofed coronary sinus.Three patients were diagnosed as partially unroofed coronary sinus in the mid-portion,the rest 3 patients were diagnosed as partially unroofed coronary sinus in the terminal portion.In the patients with UCSS,the mean diameter of the coronary sinus was (18.7±10.0) mm,which was significantly greater than the normal group［(8.7±1.6) mm,P<0.05］.The coronary sinus view in the plane of the atrioventricular groove is most suited for depiction of the anatomy of the coronary sinus defect and the shunt between left atrium and coronary sinus.Conclusions  Contrast-enhanced MSCT was  useful for the diagnosisof UCSS,which could demonstrate the special location and characteristic CT features of UCSS.