64MSCTA对冠状动脉变异的诊断及临床评价

目的评价64层螺旋CT冠状动脉血管成像（CTCA）对冠状动脉变异的诊断价值及临床评价。方法回顾性分析3529例临床疑为心肌缺血患者及常规体查者冠状动脉CTA影像检查结果并对发现的变异冠状动脉进行分类。结果3529例冠状动脉CTA受检者中,共检出冠状动脉变异42例（1．19％,42／3529）,MIP、VRT、CPR重建图像均明确显示其开口及走行;其中右冠状动脉起自主动脉左冠状窦者9例,左冠状动脉起自主动脉右冠状窦者2例,左回旋支异位开口于右冠窦1例,冠状动脉高位开口于升主动脉壁者6例．并行左主干3例（前降支、旋支分别开口于左冠窦）,左主干开口于肺动脉伴右冠状动脉瘤1例,左旋支-冠状静脉瘘者2例,副冠状动脉9例,右冠状动脉-左心室瘘合并右冠状动脉瘤l例。冠状动脉发育不良8例。结论冠状动脉CTA能准确显示各种类型冠状动脉变异,可作为无创性诊断冠状动脉变异的首选方法。     

MDCT coronary angiography for diagnosis of anomalous origin right coronary artery: a case report

This is a case report of anomalous origin of the right coronary artery, which arises from the left sinus of Valsalva depicted with multi-detector row tomography (MDCT) coronary angiography performed in emergency. In symptomatic patient, this anomalous origin is considered a malignant anomaly and needs urgent surgical treatment. Some studies demonstrated that MDCT is a reliable non-invasive technique to identify and define anomalous coronary arteries (ACAs) and their course.     

64层螺旋CT诊断先天性冠状动脉起源异常的价值

目的：探讨64层螺旋CT冠状动脉造影诊断冠状动脉起源异常的临床价值。材料和方法：回顾性总结2005年12月至2006年12月间1800例64层螺旋CT冠脉造影的结果，统计冠状动脉起源异常的发生率。结果：1800例检查者中发现冠脉起源异常51例，发病率2．8％。包括右冠状动脉变异11例（21．6％）、左冠状动脉变异8例（15．7％）、左右冠均发生变异1例（2％）、单支冠状动脉1例（2％）、分支变异28例（54．9％）。结论：64层螺旋CT是诊断冠状动脉起源异常的安全有效方法，对临床治疗有重要的意义。     

Congenital anomalies of coronary arteries: Diagnosis with 64 slice multidetector CT

Objective

Congenital coronary artery anomalies are generally incidental, uncommon and asymptomatic. Some can cause severe potentially life threatening symptoms. The common mode of studying the coronary arteries is Conventional Coronary Angiogram. ECG-gated-multidetector CT is a non invasive modality. The objective of our study was to identify rare congenital coronary artery anomalies and discuss their clinical significance.

Material and methods

A total number of 900 MDCT coronary angiograms were carried out at our institution between the period of April 2006 and October 2010. Patients with coronary artery anomaly constituted the subject of study.

Results

The incidence of anomalous anatomical origin and course of the coronary arteries in our study was 1.55%. Hemodynamical significance was seen in five patients. 3 cases of single coronary artery originating from right coronary sinus were seen. 1 case of anomalous left coronary artery arising from main pulmonary artery was seen. 4 cases of anomalous RCA arising from left aortic cusp, 6 cases of absent LMCA with separate origin of LAD and LCX were seen.

Conclusion

Multidetector row CT is a noninvasive modality in cardiac imaging. It provides superior resolution of coronary tree and its variant. No projectional vascular overlap is seen. Various postprocessing techniques outclass catheter angiography imaging. Definition of ostia and proximal course of the coronary arteries by Multidetector CT is better than catheter angiography.     

1879例成人非先天性心脏病患者双源CT检出的冠状动脉起源异常24例分析

目的：评价双源CT（DSCT）在成人非先天性心脏病患者冠状动脉起源异常检出中的价值。方法：回顾性分析2008年9月,2009年2月期间进行了DSCF冠状动脉检查的资料,总结成人非先天性心脏病患者冠状动脉起源异常的检出率。结果：1881例进行冠状动脉检查的患者中,共有1879例患者为非先天性心脏病患者,共检出了24例冠状动脉起源异常,检出率为1．3％。其中15例为右冠状动脉起源异常（12例起自左冠状窦,3例为高位起源）,8例为左冠状动脉起源异常（3例起自无冠状窦,回旋支起自左冠状窦、高位开口、回旋支起自右冠状动脉、左冠状动脉起自右冠状窦、单一冠状动脉各1例）,1例为左右冠状动脉均起源异常（均为高位开口）。结论：本组成人非先天性心脏病患者冠状动脉起源异常的检出率为1．3％。DSCT可很好地显示冠状动脉起源异常和走行,为临床决策提供重要信息。     

Coronary artery anomalies: Role of contrast enhanced MDCT coronary angiography

Objective

The purpose of this study is to evaluate the role of MDCT in the depiction of coronary artery anomalies.

Patients and methods

Sixteen patients were included in this study. Retrospectively gated coronary CT angiography was performed in 11 patients and prospectively gated CT coronary angiography was performed in 5 patients. Post-processing techniques as maximum-intensity projection, curved multiplanar reconstruction, and volume rendering were applied to assess the origin and course of the coronary vessels.

Results

Origin and course anomalies of the central coronary artery segments were seen in 11 patients (67%), anomalies of only coronary artery origin in 2 patients (13%), origin and course anomalies of the peripheral coronary segments in 2 patients (13%) and coronary arterio-venous fistula in one patient (7%). The origin and course anomalies of the central coronary artery segment were more common in the left coronary artery involving 8 patients (73%). Malignant inter-arterial course between aortic root and pulmonary artery or the right ventricle outflow tract was seen in 3 anomalous arteries.

Conclusion

MDCT coronary angiography can precisely depict the origin and course coronary artery anomalies and is recommended in young patients and before cardiac intervention or surgery to prevent possible complications.     

Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT

PURPOSE: To measure the effective radiation doses delivered at electron-beam computed tomography (CT) and multi-detector row spiral CT of coronary arteries and to compare these doses with those delivered at catheter coronary angiography. MATERIALS AND METHODS: An anthropomorphic phantom equipped with 66 thermoluminescent dosimeters was imaged at cardiac CT. Four protocols for unenhanced coronary artery calcium scoring were simulated: one with electron-beam CT and three with multi-detector row CT. Four similar protocols for coronary CT angiography were simulated. All multi-detector row spiral CT protocols were performed with retrospective electrocardiographic triggering. Biplane catheter coronary angiography also was simulated. Radiation doses to organs were measured, and effective doses were calculated according to guidelines published in International Commission on Radiological Protection Publication 60. RESULTS: Coronary artery calcium scoring with electron-beam CT yielded effective radiation doses of 1.0 and 1.3 mSv for male and female patients, respectively. The radiation doses at calcium scoring with multi-detector row CT were 1.5-5.2 mSv for male patients and 1.8-6.2 mSv for female patients. Electron-beam CT coronary angiography yielded effective doses of 1.5 and 2.0 mSv for male and female patients, respectively. The highest effective doses were delivered at multi-detector row CT angiography: 6.7-10.9 mSv for male patients and 8.1-13.0 mSv for female patients. Catheter coronary angiography yielded effective doses of 2.1 and 2.5 mSv for male and female patients, respectively. CONCLUSION: Higher radiation doses are delivered at multi-detector row cardiac CT compared with the doses delivered at electron-beam CT and catheter coronary angiography.     

64排容积CT对成人冠状动脉起源异常的诊断价值

 目的 探讨64排容积CT对成人冠状动脉起源异常的诊断价值.方法 回顾分析3 030例成人冠状动脉CTA检查资料. 结果 3 030例冠脉CTA中,检查出冠状动脉起源异常70例,检出率为2.3%,其中冠状动脉起源于对侧冠状窦及窦外27例(38.5%);冠状动脉高位开口23例(32.8%);前降支、回旋支均开口于左冠状窦17例(24.3%);单一冠脉2例(均为单一左冠,其中1例合并左主干高开口,2.8%),回旋支开口于对角支及窦房结支开口于右冠状窦各1例(1.4%).结论 64排容积CT诊断冠状动脉起源异常是一种无创、安全、准确、经济的检查方法 .     

Multi-detector row CT versus coronary angiography: preoperative evaluation before totally endoscopic coronary artery bypass grafting

PURPOSE: To assess multi-detector row spiral computed tomography (CT) for preoperative evaluation of patients undergoing totally endoscopic coronary artery bypass grafting and to correlate the data with coronary angiographic and intraoperative findings. MATERIALS AND METHODS: Thirty-six patients preoperatively underwent multi-detector row CT (4 x 1-mm collimation, pitch of 1.5, 500-msec rotation time, retrospective electrocardiographic gating, 1.25-mm effective section thickness) and coronary angiography. Assessment criteria for both techniques were visibility and cardiac course of coronary arteries, localization and degree of stenoses, composition of atherosclerotic plaques, and vascular diameter at anastomosis site. Site for distal bypass anastomosis was recommended. Results at multi-detector row CT were calculated relative to results at coronary angiography and surgery. RESULTS: Multi-detector row CT properly displayed 79.4% (154 of 194) of all surgical relevant coronary segments and 80.4% (434 of 540) of all coronary segments. For coronary angiography, ratios of 88.7% (172 of 194) and 94.6% (511 of 540), respectively, were observed. For detection of calcified plaques, multi-detector row CT results exceeded those at coronary angiography by a difference of 17% (18 of 18 [100%] compared with 15 of 18 [83%]). Hemodynamically relevant stenoses were identified with multi-detector row CT in 76% (42 of 55) of cases. Bridging of coronary segments through either myocardium (four of five) or epicardial fat (two of three) was better identified at multi-detector row CT than it was at coronary angiography (one of five compared with zero of three, respectively). At multi-detector row CT, 76% (28 of 37) of all distal bypass touchdown segments were identified, but at coronary angiography, only 70% (26 of 37) were identified. CONCLUSION: Multi-detector row CT provides extended information about coronary target site and therefore should be regarded as an ideal additive planning tool for complex minimally invasive procedures such as totally endoscopic coronary artery bypass grafting or minimally invasive direct coronary artery bypass grafting.     

Coronary artery stenosis: direct comparison of four-section multi-detector row CT and 3D navigator MR imaging for detection--initial results

PURPOSE: To prospectively compare the diagnostic accuracy of multi-detector row computed tomography (CT) and of three-dimensional (3D) navigator magnetic resonance (MR) imaging in patients referred for conventional coronary angiography for detection of coronary artery stenosis. MATERIALS AND METHODS: All patients gave written informed consent for the study, which was approved by the local ethics committee. Twenty-seven patients underwent multi-detector row CT and 3D navigator free-breathing MR imaging a mean of 5 days before undergoing invasive coronary angiography. The acquired multi-detector row CT and MR images were graded for the presence of greater than 50% stenosis in vessels larger than 1.5 mm in diameter. The diagnostic accuracies of the two examinations were compared with that of quantitative coronary angiography (QCA) by using the McNemar test. RESULTS: Owing to claustrophobia, MR images were not acquired in one patient; thus, 26 patients were included for analysis. According to QCA findings, 21 of the 26 patients had significant coronary artery disease and 58 (20%) of a total of 294 coronary artery segments larger than 1.5 mm in diameter had significant (>50%) stenosis. Multi-detector row CT had significantly higher sensitivity (46 [79%] of 58 segments) than MR imaging (36 [62%] segments, P < .05) for detection of segments with significant stenosis. Conversely, MR imaging had significantly higher specificity (198 [84%] of 236 segments) than did CT (168 [71%] segments, P < .001) for exclusion of segmental coronary artery stenosis. Both examinations had high negative predictive value for exclusion of segmental stenosis: 93% (168 of 180 segments) for CT and 90% (198 of 220 segments) for MR imaging. The overall diagnostic accuracy of MR imaging (80% [234 of 294 segments]) was significantly higher than that of CT (73% [214 segments], P < .05). CONCLUSION: MR imaging had significantly higher diagnostic accuracy than multi-detector row CT in the evaluation of coronary artery stenosis. Both techniques have high negative predictive value, making them particularly useful for ruling out coronary artery disease in symptomatic patients.     

Coronary MRA: use in assessing anomalies of coronary artery origin

PURPOSE: The purpose of this work was to describe the use of coronary MR angiography (MRA) in the clinical evaluation of a series of patients with anomalous origin of the coronary arteries suspected on coronary angiography. METHOD: Eight patients underwent coronary MRA to further define variant coronary anatomy that was found on coronary angiography. A 2D segmented k-space gradient echo sequence was used with breath-holding. MRA images were assessed for traversal of an anomalous artery between the aorta and pulmonary artery trunks, which carries the greatest clinical significance. RESULTS: Of six patients with anomalous origin of the right coronary artery on angiography, two were shown by MRA to have an interarterial course of the anomalous vessel. Neither of two left coronary arteries with ectopic origin coursed between the great arteries, although one passed through the septum. CONCLUSION: Coronary MRA is a useful adjunctive technique to angiography in the evaluation of the relationship of anomalous coronary arteries to the great arteries.     

国人窦房结动脉解剖特点的初步探讨—156例CTA结果分析

目的 探讨256层CT评价国人窦房结动脉形态学特征的应用价值.方法 回顾性分析256层冠状动脉CTA患者156例,对窦房结动脉的起源部位、数目、走行、分支、终止部位进行系统分析观察.结果 98例窦房结动脉单支起源于右冠状动脉近端,37例单支起源于左旋支近端,20例观察到有两条窦房结动脉,分别来自右冠状动脉及左旋支,距右冠状动脉开口45mm、左旋支开口32mm范围内.1例没有观察到窦房结动脉.窦房结动脉发出后至上腔静脉口周围,沿途发出分支供应邻近心房、心耳及房间隔.结论 256层CT冠状动脉成像能够有效显示窦房结动脉,正确评价窦房结动脉的解剖起源、数目、走行及沿途分支.     

Infrarenal aortic and lower-extremity arterial disease: diagnostic performance of multi-detector row CT angiography

PURPOSE: To compare multi-detector row spiral computed tomographic (CT) angiography with digital subtraction angiography (DSA) in evaluation of the infrarenal aorta and lower-extremity arterial system. MATERIALS AND METHODS: Fifty patients with peripheral arterial occlusive disease were evaluated with multi-detector row CT angiography and DSA. Arteries depicted at CT angiography and DSA were graded separately for degree of stenosis as 23 anatomic segments (infrarenal aorta, right and left common iliac artery, internal iliac artery, external iliac artery, common femoral artery, superficial femoral artery, deep femoral artery, popliteal artery, anterior tibial artery, tibioperoneal trunk, posterior tibial artery, and peroneal artery). Grades included the following: 1, normal patency; 2, moderate (< or =50%) stenosis; 3, focal severe (>50%) stenosis; 4, multiple severe stenoses; and 5, occlusion. Three readers independently interpreted the images, and statistical analysis was performed. The results of image interpretation were evaluated for strength of agreement by using Cohen kappa statistics. On the basis of consensus readings, sensitivity, specificity, and accuracy for detection of stenotic lesions were calculated, with findings at DSA used as the reference standard. RESULTS: Substantial to almost perfect interobserver agreement was achieved in all cases. At DSA, 349 diseased segments were found among the 1,137 segments evaluated. Sensitivity, specificity, and accuracy, based on a consensus reading of multi-detector row CT angiograms, were 96%, 93%, and 94%, respectively. A statistically significant difference (P <.05) between DSA and multi-detector row CT angiography was present only in arteries graded 1 or 2. Interobserver agreement was almost perfect among the three readers for treatment recommendations based on findings at CT angiography and DSA. CONCLUSION: Multi-detector row CT angiography appears consistent and accurate in the assessment of patients with peripheral arterial occlusive disease.     

64层螺旋CT诊断成人冠状动脉起源异常

目的 探讨64层螺旋CT诊断成人冠状动脉起源异常的价值。方法 对978例成人冠状动脉CT血管成像（CTA）资料进行回顾性分析、总结，并与国内外文献比较。结果 978例完整冠状动脉CTA结果中，共检出成人冠状动脉起源异常30例，检出率为3．07％，包括右冠状动脉起源异常9例（30．00％），左冠状动脉起源异常7例（23.33％），左、右冠状动脉均起源异常2例（6.67％），回旋支缺如1例（3.33％）和冠状动脉其他分支起源异常11例（36．67％）。结论 64层螺旋CT诊断成人冠状动脉起源异常是一种无创、安全和有效的方法。     

Malignant right coronary artery anomaly simulated by motion artifacts on MDCT

OBJECTIVE: The aim of our study was to determine the prevalence of anomalous right coronary artery imitation due to motion artifacts in MDCT. Routine chest MDCT for reasons other than cardiac or vascular imaging is usually performed using breath-hold technique but without retrospective ECG gating and consequently yields pulsating motion artifacts. A possible artifact in front of the aortic root imitates an anomalous right coronary artery originating from the left posterior sinus. This course of the right coronary artery is considered a malignant variant and raises the question of far-reaching consequences such as a bypass operation. SUBJECTS AND METHODS: We performed a prospective study involving 355 patients undergoing routine chest CT examinations. To determine the prevalence of anomalous right coronary artery imitation caused by this motion artifact, all images were evaluated prospectively by an experienced radiologist. RESULTS: Twenty-one patients (5.9%) were suspected of having a malignant variant of the right coronary artery. However, in all patients prior chest CT or additional coronary MR angiography showed a normal origin of the right coronary artery. CONCLUSION: Routine chest MDCT without retrospective ECG gating may produce artifacts around the aorta simulating a malignant variant of the right coronary artery. Considering the low incidence of this malignant interarterial variant, the need for routine chest CT examinations combined with ECG gating and further workup can be disputed from an economic point of view. This artifact should be known to avoid unnecessary further examinations.     

多层螺旋CT对先天性右冠状动脉起始变异的评价

目的 以常规X线冠状动脉造影（CAG）为标准，评价16层螺旋CT在鉴别右冠状动脉（RCA）异常起源和异常行程中的价值。方法 回顾性分析8例先天性RCA变异患者的多层螺旋CT造影（MSCTA）表现，其中7例有CAG资料。对比分析两者在显示RCA异位开口和异常行程方面的差异。仿真内镜技术用于评价异位开口及其与邻近正常冠状动脉开口的关系。采用多平面重组（MPR）、曲面多平面重组（CMPR）、最大密度投影（MIP）、容积成像（VR）重组方法评价冠状动脉的异常行径及其与邻近大血管的关系。CAG所显示的RCA，至少有2个不同的视角用于评价其起源和行程。结果 8例患者变异的RCA全部为MSCTA所显示。其中6例患者的RCA起源于左冠状动脉窦，1例起源于左主冠状动脉的末端，另1例则起源于扩大前移的后冠窦。所有异常开口均未见狭窄。8支异常冠状动脉均穿过主动脉根部和肺动脉或右室流出道的司隙。7例CAG则仅5例显示异常。结论 MSCTA显示先天性变异的RCA明显优于CAG，凡疑为冠状动脉变异的患者，可首选非创伤性的16层MSCTA检查。     

致猝死的冠状动脉起源异常及其临床意义

目的 了解起自对侧冠状动脉窦并可能引发青少年运动员猝死的冠状动脉畸形在国人中的发病率,结合文献资料比较其影像学特点和临床意义.方法 应用PACS系统顺序回顾14 343例不伴有其他心脏大血管畸形的国人CT冠状动脉成像所见,选取左、右冠状动脉起自对侧冠状动脉窦及左、右单冠状动脉的病例,对冠状动脉开口位置、走行路径、非粥样硬化狭窄截面形态、径线、狭窄程度及冠状动脉近段与主动脉壁夹角进行分析统计.结果 检出冠状动脉发自对侧冠状动脉窦(包括单冠状动脉)74例,其近段走行于主、肺动脉之间者59例.右冠状动脉起自左冠状动脉窦且走行于主、肺动脉之间55例,左冠状动脉起自右冠状动脉窦且走行于主、肺动脉间2例,左、右单冠状动脉且走行于大动脉间者各1例.国人此类冠状动脉近段走行于两大动脉之间的起源异常发病率为4.1‰(59/14 343).右冠状动脉起自左冠状动脉窦,起始段常伴非粥样硬化性狭窄,狭窄面积≥50%者29例(52.7%),≥70%者3例(5.4%).近段走行于主、肺动脉之间的右冠状动脉起自左窦是左冠状动脉起自右窦的18.7倍(56/3).结论 CT冠状动脉成像是诊断冠状动脉起源异常的最佳影像学手段.国人中该畸形的解剖类型分布有其特点,这一特点对引发我国青少年运动性猝死的影响值得探讨.     

Visualization of anomalous coronary arteries on dual-source computed tomography

The purpose of this study is to assess the capability of dual-source computed tomography (DSCT) in evaluating coronary artery anomalies. Early detection and evaluation of coronary artery anomalies is essential because of their potential association with myocardial ischemia and sudden death. In 16 patients (12 men, mean age 50 ± 14 years), anomalous coronary arteries were detected on contrast-enhanced DSCT in a patient cohort of 230 individuals (incidence of 7%). Six different types of anomalies were diagnosed (three fistula, four anomalies of the circumflex artery, four anomalous right coronary arteries, three anomalies of the left coronary artery, one absent left main coronary artery, and one left coronary artery arising from the pulmonary trunk). Of the 16 patients, 10 also underwent conventional coronary angiography (CAG). Retrospective evaluation of the CAGs by an experienced interventional cardiologist resulted in a precise diagnosis in 50% of patients. With DSCT, sufficient image quality and exact visualization of the aberrant anatomy were achieved in all patients. Therefore, DSCT seems to be an accurate diagnostic tool for examining the precise origin, course, and shape of aberrant coronary arteries.     

成人先天性冠状动脉畸形的分类及其发生率

目的 探讨成人冠状动脉(冠脉)造影人群先天性冠脉畸形(CCA)的类型及其发生率.方法 2000年10月～2006年10月共1 520例成人患者行冠脉造影检查,对检出有CCA患者的影像资料进行回顾性分析,并根据CCA解剖学特征进行分类.结果 1 520例成人患者共检出各类CCA 58例,发生率3.82%.冠脉起源和分布异常26例,发生率1.71%;其中前降支和回旋支分别开口于左冠窦14例,左主干或回旋支起源于右冠窦各1例,右冠脉分别起源于升主动脉4例、左冠窦3例和无冠窦1例,单支左冠脉2例.冠脉终止异常11例,均为冠脉瘘,发生率0.72%.冠脉结构异常21例,发生率1.38%,其中心肌桥18例,回旋支发育不良2例,窦房结动脉起源于左室后支1例.本组病例未发现有冠脉间异常交通者.结论 冠脉造影是诊断成人CCA的主要方法之一,按解剖学特征进行分类有助于阐明CCA类型及其发生率.     

多层螺旋CT评价先天性单冠状动脉畸形

目的 探讨16层螺旋CT（MSCT）冠状动脉造影诊断先天性单冠状动脉畸形的价值。资料与方法 回顾性分析4例先天性单冠状动脉患者的MSCT和常规X线冠状动脉造影（CCA）资料。对比两者在显示和诊断此病中的差异。仿真内镜技术用于评价异位开口及其与邻近正常冠状动脉开口的关系,多平面重建、曲面多平面重建、最大密度投影、容积成像等重建方法则用于评价变异冠状动脉的行径及其与邻近大血管的关系。结果 4例患者变异的冠状动脉全部为MSCT造影所显示并明确诊断。MSCT显示3例患者的左主干起源于右冠状动脉的近段,其中1例在CCA中左主干仅近段局部显影,未能明确诊断,另2例左冠状动脉虽显影,但较淡。1例右冠状动脉起源于左主干的末端,CCA则误为起源于回旋支。MSCT显示2例异常开口冠状动脉的近段狭窄,3支异常冠状动脉穿过主动脉根部和肺动脉或右室流出道的间隙,1支绕主动脉根部后方走行,而CCA均不能明确诊断。结论 MSCT显示先天性单冠状动脉明显优于CCA,凡疑及冠状动脉变异的患者,可首选非创伤性的MSCT冠状动脉造影检查。