冠心病的电影摄影诊断（附23例分析）

本文分析２３例冠心病患者的电影摄影所见，着重分析室壁瘤形成与冠状动脉狭窄的程度、部位、数目、侧支血管形成和临床病情等因素的关系。此外，对冠心病中继发二尖瓣返流的成因和机制进行了探讨。讨论中提出以下几点：（１）室壁瘤的发生与冠状动脉主要分支的严重狭窄关系最密切；（２）侧支循环能防止心肌梗塞范围扩大及室壁瘤形成；（３）二尖瓣返流与主要冠状动脉病变的狭窄程度及室壁瘤的存在有关。并对影响侧支循环显示的因素进行了探讨。     

冠心病的电影摄影诊断：附23例报告

本文分析２３例冠心病患者的电影摄影所见，着重分析室壁瘤形成与冠状动脉狭窄的程度，部位，数目，仙支血管形成和临床病性等因素的关系，此外，对冠心病中继发二尖瓣返流的成因和机理进行了探讨。讨论中提出以下三点：（１）室壁瘤的发生与冠状动脉主要分支的严重狭窄关系最密切；（２）侧支循环能防止心肌梗塞范围扩大及室壁瘤形成；（３）二尖瓣返流与主要冠状动脉病变的狭窄程序及室壁瘤的存在有关，并对影响侧支循环显示的因素     

Coronary arteries

Coronary angiography (CA) is presently considered the gold standard for the assessment of the coronary arteries. However, the presence of ionizing radiation, its invasiveness and the small associated risk of morbidity prompted long ago the development of more patient-friendly imaging modalities. A promising technique, magnetic resonance imaging (MRI), has been regarded as the major modality in the coming decade. Although still in its infancy qualitatively, its flexibility and non-invasiveness opens the door for a comprehensive evaluation of the heart and the coronary arteries in one single sitting with high anatomical definition and excellent soft tissue contrast capabilities, double-oblique tomographic sections and the possibility to quantify an innumerable number of cardiovascular physiological parameters. Numerous ideas have been assessed, comprising breath-hold and free-breathing two-dimensional and three-dimensional measurements. New ongoing trials with intravascular contrast agents may provide for all these techniques the long-awaited essential boost for reliable magnetic resonance coronary angiography (MRCA). Introduction of parallel MRI acquisition techniques, such as simultaneous acquisition of spatial harmonics (SMASH) and sensitivity encoding (SENSE) may provide the speed enhancement required to shorten imaging time for all techniques explored to date.     

Coronary arteries

Conventional coronary angiography (CA) is the standard of excellence for the evaluation of coronary artery disease. However, non-invasive imaging modalities have developed that can play an important clinical role in the diagnosis. Magnetic resonance imaging (MRI) can offer a comprehensive evaluation of the heart and the coronary arteries by virtue of its high soft tissue contrast capabilities, double-oblique tomographic sections and the possibility of quantifying physiological parameters without need of ionizing radiation. Magnetic resonance coronary arteriography (MRCA) using breath-hold and free-breathing techniques has been investigated but is still in the experimental phase; its precise role for the assessment of coronary stenosis must still be identified. Nonetheless, MRCA has proven clinically relevant in determining the course of anomalous coronary arteries and the patency of coronary artery bypass grafts. Novel intravascular contrast agents promise faster coverage of the cardiac anatomy and may provide a long-awaited boost for MRCA. Contrast-enhanced electron-beam computed tomography (EBT), another competing imaging modality, is now being subjected to widespread evaluation following initially encouraging results. Received 16 February 1998; Accepted 24 February 1998     

64排VCT冠状动脉成像与冠脉造影对冠心病诊断的对比研究

目的 探讨64排VCT冠状动脉造影检查对冠状动脉疾病的诊断价值.方法 连续性收集173例临床怀疑及确诊冠心病的患者,先后行64排VCT冠状动脉成像(CTA)及冠脉造影(CAG),对所有病例使用GE AW4.3独立工作站提供的冠状动脉分析软件进行分析,主要进行了最大密度投影重建(MIP)、多平面重建(MPR)、容积重建(VR),将获得图像与冠脉造影图像进行对比分析.结果 173例中CTA显示的冠状动脉直径>1.5 mm的节段有746个,发现冠状动脉狭窄的敏感性为94.15%(193/204),特异性为95.90%(514/536),阳性预测值为89.77%(193/215),阴性预测值为97.90%(514/525).配对χ~2检验结果说明CTA和CAG 2种检查方法在诊断冠状动脉狭窄病变上无统计学差异(χ~2=1.58,P＞0.05),CTA与CAG在显示冠状动脉狭窄分级方面的一致性检验(Kappa值=0.890,P<0.001),提示CTA与CAG在显示与诊断冠状动脉狭窄分级方面具有良好的一致性.结论 64排VCT作为冠状动脉疾患的筛选、内支架术后及血管搭桥术后疗效随访有很大的临床应用价值.     

Coronary artery anomalies

Coronary artery anomalies are uncommon findings but can be of significant clinical importance in a small number of individuals. Clinical presentation depends on the specific anomaly. Most coronary artery anomalies are benign and clinically insignificant, however, some anomalies are potentially significant and can lead to heart failure and even death. Noninvasive imaging has emerged as the preferred way to image coronary anomalies. Both electron beam computed tomography (EBCT) and magnetic resonance angiography (MRA) are useful for the diagnosis of anomalous coronary arteries. Recently, MDCT has also proven to be very useful in the detection and characterization of anomalous coronary arteries. This chapter will review the appearance of the most commonly encountered coronary anomalies on MDCT.     

引起冠状动脉功能学缺血性的斑块特征分析

目的 以有创分数血流储备(FFR)为标准,鉴别引起冠状动脉功能性缺血斑块的影像学特征,进一步提高冠状动脉CT血管造影(CCTA)的诊断效能。方法 回顾性纳入2012年9月至2020年1月在本院30天内接受CCTA、有创性冠状动脉造影(ICA)以及导丝FFR检查患者,在CCTA上记录血管狭窄度以及斑块参数,包括非钙化斑块、病变长度、钙化的形态、正性重构、“餐巾环征”、狭窄程度。FFR<0.80的病变被认为功能性缺血性病变。将单因素逻辑回归中有统计学意义的斑块参数纳入多因素模型,受试者工作特征曲线(ROC)分析模型的曲线下面积(AUC),并与单独血管狭窄率模型比较。结果 共纳入173例患者[男112例(61.73±8.34岁]的204枚斑块。将3个单因素有意义的参数(即“餐巾环征”、正性重构、点状钙化)与血管狭窄率共同建立的模型,AUC达到0.837,显著高于单独以血管狭窄率建立的模型(AUC为0.679,P<0.001)。结论 研究表明部分高危斑块特征与血管狭窄率组合建模后对于预测有血流动力学意义的狭窄有着更高的准确率。     

Coronary Vasospastic Angina: Assessment by Multidetector CT Coronary Angiography

Objective

We aimed to describe the imaging findings of multidetector CT coronary angiography (MDCTA) in cases of vasospastic angina (VA) and to determine the accuracy of MDCTA in the identification of VA as compared with invasive coronary angiography with an ergonovine provocation test (CAG with an EG test).

Materials and Methods

Fifty-three patients with clinically suspected VA were enrolled in this study. Two radiologists analyzed the stenosis degree, presence or absence of plaque, plaque composition, and a remodeling index of the related-segment in CAG with an EG test, which were used as a gold standard. We evaluated the diagnostic performances of MDCTA by comparing the MDCTA findings with those of CAG with an EG test.

Results

Among the 25 patients with positive CAG with an EG test, all 12 patients with significant stenosis showed no definite plaque with the negative arterial remodeling. Of the six patients with insignificant stenosis, three (50%) had non-calcified plaque (NCP), two (33%) had mixed plaque, and one (17%) had calcified plaque. When the criteria for significant stenosis with negative remodeling but no definite evidence of plaque as a characteristic finding of MDCTA were used, results showed sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) of 48%, 100%, 100%, and 68%, respectively.

Conclusion

Significant stenosis with negative remodeling, but no definite evidence of plaque, is the characteristic finding on MDCTA of VA. Cardiac MDCTA shows good diagnostic performance with high specificity and PPV as compared with CAG with an EG test.     

Coronary MR angiography

MR angiography of the coronary arteries became possible in 1991 with the development of a new group of fast MR imaging sequences. Although the role of coronary MR angiography in screening for coronary artery lesions has not yet been established, coronary MR angiography already has been very successful in the detection of coronary artery variants and the imaging of coronary stents and bypass grafts. Variants of these new MR imaging techniques also can quantitate velocity in native coronary arteries. Several generations of coronary MR angiographic techniques exist; all techniques use EKG-triggering. The use of MR contrast agents appears to further improve all techniques. Technical progress and changes in this subfield of cardiac MR imaging have been so fast that large-scale preclinical trials have not been conducted with the majority of the first and second generation coronary MR angiographic pulse sequences as known today. This article reviews the development of these new cardiac MR imaging techniques and the initial successes with clinical application using commercial MR scanners.     

Coronary CT angiography

Owing to ongoing technical refinements and intense scientific and clinical evaluations, computed tomography (CT) of the heart has left the research realm and matured into a clinical application that is about to fulfill its promise to replace invasive cardiac catheterization in selected patient populations. CT coronary angiography is technically more challenging than other CT applications owing to the nature of its target, the continuously moving heart. Rapid technical developments in this field require constant adaptation of acquisition protocols. These challenges, however, are in no way insurmountable for users with knowledge of the general CT technique. The intent of this communication is to provide those interested in and involved with coronary CT angiography with a step-by-step "manual" describing the authors' approach to performing coronary CT angiography. Included are considerations regarding appropriate patient selection, patient medication, radiation protection, contrast enhancement, acquisition and reconstruction parameters, image display and analysis techniques, and the radiology report. The recommendations are based on the authors' experience, which spans the evolution of multi-detector row CT for cardiac applications, from its beginning to the advent of the most current generations of 64-section and dual-source CT technologies, which they believe herald the entrance of this examination into routine clinical practice.     

冠状动脉瘘

研究分析冠状动脉瘘的临床和影像诊断。材料和方法：收集３９例冠状动脉瘘,年龄５岁～６４岁（平均２５．２岁）;均有主动脉根部或（和）冠状动脉造影（ＤＳＡ １９例,电影造影１２例,大片快速换片８例）。结果：听诊有连续性或双期性杂音２８例,ＥＫＧ正常或大致正常心电图１８例,单支形成瘘３７例,双支形成瘘２例,瘘口在右心室１５例（ＲＣＡ８例,ＬＣＡ７例）,右心房７例（ＲＣＡ４例,ＬＣＡ３例）,肺动脉８例（ＲＣ     

64层CT冠状动脉成像检测冠状动脉畸形价值初探

目的:探讨64层CT冠状动脉成像检测冠状动脉畸形的方法和诊断价值.方法:采用容积再现(VR)、最大密度投影(MIP)以及多平面重组(MPR)等方法分析2672例64层CT冠状动脉成像资料,总结冠状动脉畸形的发生率和CT表现.结果:2672例中发现冠状动脉起源异常18例(0.67%),其中发生于右冠11例(61.11%),左冠7例(38.89%);发现冠状动脉瘘7例(0.26%).结论:64层CT冠状动脉成像能够准确全面地显示冠状动脉的异常起源、走行和终止.