双源CT冠状动脉血管成像时心肌桥的检出及其临床价值

目的:探讨患者在双源CT冠状动脉血管成像检查中心肌桥(MB)的发生率、特征,评价心肌桥与冠状动脉粥样硬化的关系。方法:临床确诊冠心病或疑似冠心病而行双源CT冠状动脉血管成像检查的患者182例,男128例,女54例。根据左前降支心肌桥的有无,将所有病例分为2组:心肌桥组和无心肌桥组。利用多平面重组(MPR)、最大密度投影(MIP)等技术进行图像后处理,显示心肌桥厚度及壁冠状动脉发生部位、长度及冠状动脉粥样硬化情况。结果:182例患者中,检出率为26.4%(48/182),其中左前降支中段最多见(61%)。心肌桥对左前降支动脉粥样硬化的发生无明显影响(P>0.05)。结论:利用双源CT可以无创、可靠、准确地检测心肌桥,心肌桥与冠状动脉粥样硬化无关联。     

无症状冠状动脉单纯心肌桥的CTA表现

目的 探讨无症状心肌桥的CT血管成像(CTA)表现.方法 回顾性分析69例无症状心肌桥的CTA资料,通过与60例有症状心肌桥的CTA表现进行对比分析.统计分析2组心肌桥的类型、发病年龄、心肌桥厚度、壁-冠状动脉长度和收缩末期直径的差异.结果 无症状浅表型心肌桥51例(74%),深埋型18例(26%);有症状对照组心肌桥浅表型和深埋型分别是13例(22%)和47例(78%);2组不同心肌桥类型发生率有统计学差异(P<0.05).2组平均发病年龄、心肌桥厚度及壁-冠状动脉的长度和直径分别是(53.01±11.17)岁,(1.25±1.16) mm,(21.33±7.32) mm,(2.86±0.45) mm和(51.36±9.31)岁,(1.45±1.87) mm,(20.07±6.60) mm,(1.37±0.41) mm.除心肌桥类型的发生率和壁-冠状动脉的直径相差显著(P<0.05)外,其他各项数据相差均不显著(P>0.05).结论 无症状单纯心肌桥多表现为浅表型,其位置和分布无特点,收缩末期壁-冠状动脉的直径是心肌桥是否出现症状的可能判断因素.     

64层螺旋CT冠状动脉成像在心肌桥和壁冠状动脉诊断中的价值

目的探讨64层螺旋CT冠状动脉成像对心肌桥(MB)的诊断及其临床价值。资料与方法1422例患者均行64层CT扫描,所有数据传至工作站进行重组和后处理,观察有无MB,测量MB的长度、厚度、壁冠状动脉狭窄程度等。所有MB病例均行冠状动脉造影(CAG)检查并与CT结果对比。结果共发现104例119段MB,平均长度及厚度分别为(5.0±2.7)mm、(2.0±1.6)mm,壁冠状动脉狭窄程度为(31±17)%。104例MB患者CAG发现42例44段MB,其长度、厚度与CT结果存在明显差异。结论64层CT对MB和壁冠状动脉清晰显示,有特殊的临床价值。     

CT冠状动脉成像诊断心肌桥的价值:与传统冠状动脉造影对照分析

目的 对比分析均行CT冠状动脉成像(CTCA)和传统冠状动脉造影(CAG)检查患者的影像学资料,探讨CTCA对心肌桥诊断的临床应用价值.方法 回顾性分析83例同时行CTCA及CAG检查患者的影像学资料.图像分析采用双盲法,由两名放射科诊断医师及两位介入科医师分别在不知道CTCA及CAG诊断结果的前提下协商作出心肌桥的诊断,计算CTCA及CAG对心肌桥的检出率并采用x2检验进行比较.结果 83例患者中CTCA显示41例共48处心肌桥,检出率为49.40％,CAG显示19例共19处冠状动脉“挤牛奶”效应,检出率为22.89％.与CTCA对照,CAG显示的19处心肌桥与其位置一致,其中15处为完全性心肌桥,4处为不完全心肌桥.CTCA对心肌桥的检出率高于CAG(x2=12.633,P＜0.001).结论 CTCA能多方位、直观显示冠状动脉与心肌的解剖关系,对心肌桥的显示优于CAG,且具有无创检查的优点.     

双源CT冠状动脉造影心肌桥—壁冠状动脉的诊断

目的 探讨双源CT冠状动脉造影对心肌桥-壁冠状动脉(MB-MCA)的显示方法及影像学特征.方法 回顾性分析654例患者双源CT冠状动脉造影资料,检出MB-MCA,观察其位置,测量MB深度及MCA长度,总结MB-MCA显示方法及影像表现.结果 MB-MCA检出率为28%(181/654).181例204段MB-MCA中发生于左前降支162段,占79%.MB深度0.6～12.7 mm,平均约2.0 mm.MCA长度7.6～64.6 mm,平均约23.6 mm.MB-MCA的CT表现包括:①冠状动脉主干或分支穿行于心壁肌层内;②迂曲成角;③圆锥状改变; ④ "挤奶效应".结论 DSCT可正确诊断MB-MCA,并可显示MB-MCA的形态特征.     

心肌桥以近节段冠状动脉粥样硬化与心肌桥-壁冠状动脉形态学特征相关性研究

目的 探讨深在型心肌桥-壁冠状动脉(MB-MCA)形态学特征与心肌桥近段冠状动脉粥样硬化的关系.方法 回顾性分析经128层螺旋CT冠状动脉血管成像证实190例单纯深在型心肌桥-壁冠状动脉患者和190例心肌桥近段冠状动脉合并粥样硬化患者的冠状动脉CTA检查原始数据,并进行图像处理,记录患者性别、年龄,统计MB-MCA形态特征,包括测量MB厚度、MCA长度和MB-MCA邻近两段血管形态变化,应用Logistic回归分析MB-MCA形态学特征与心肌桥近段冠状动脉粥样硬化病变的关系.结果 单纯深在型MB-MCA组:男/女=2.22/1(131/59),平均年龄(51.36±11.19)岁(12～83岁),MB厚度为(2.25±1.80)mm,MCA长度为(23.58±9.57)mm,MCA两端平滑者21.05％(40/190),近端成角者7.36％(14/190),远端成角者15.79％(30/190),两端成角者55.79％(106/190).心肌桥近段冠状动脉合并动脉粥样硬化组:男/女=5.55/1(161/29),平均年龄(57.19±11.29)岁(37～86岁),MB厚度为(2.19±1.67)mm,MCA长度为(21.45±8.38)mm,MCA两端平滑者26.32％(50/190),近端成角者5.79％(11/190),远端成角者21.05％(40/190),两端成角者46.84％(89/190).性别、年龄、MCA长度和邻近两端成角情况都与心肌桥近段冠状动脉粥样硬化有关(P＜0.05),而MB厚度与心肌桥近段冠状动脉粥样硬化无关(P=0.6825＞0.05).结论 MB-MCA这一复合体是心肌桥近段冠状动脉粥样硬化病变解剖学上的危险因素.     

螺旋CT血管造影检查技术在MB-MCA血管形态学诊断中的效果分析

目的 探讨螺旋CT血管造影检查技术在心肌桥一壁冠状动脉(MB-MCA)血管形态学诊断中的效果.方法 选取2019年5月-2020年5月就诊的疑似MB-MCA患者170例,所有患者均采取冠状动脉造影(CAG)与螺旋CT血管造影检查技术(CTA)检查,比较两种检查方式的检出率与MB-MCA狭窄程度与长度,并通过计算Kapp...     

冠状动脉病变自身因素对CTA评价冠状动脉狭窄准确性的影响

目的 探讨冠状动脉病变自身因素对CTA评估血管狭窄程度准确性的影响. 资料与方法 60例临床拟诊疑为冠状动脉狭窄的患者同期行冠状动脉CT血管造影(CTA)和冠状动脉血管造影检查(CAG).CTA扫描采用64层螺旋CT及回顾性心电门控技术,以CAG结果 为金标准,采用双盲法评价CTA诊断冠状动脉狭窄的准确性,并分析各种冠状动脉病变自身因素对评价狭窄准确性的影响. 结果 CTA诊断冠状动脉轻、中、重度狭窄的敏感性分别为76.47%、77.97%和85.71%,钙化斑块是导致64层螺旋CT评价冠状动脉狭窄假阳性最重要的自身因素(18/28,占64.29%),对于冠状动脉和其分支的狭窄程度的低估占假阴性结果 的66.67%(20/30),壁冠状动脉和心肌桥的漏诊占假阴性结果 的23.33%(7/30). 结论 64层螺旋CT诊断冠状动脉重度狭窄具有较高的准确性,钙化斑块、心肌桥和小血管的狭窄病变本身均影响CTA评价狭窄的准确性,而非钙化斑块和支架/冠状动脉旁路移植术(CABG)后狭窄的诊断准确性较高.     

256层螺旋CT冠状动脉造影在心肌桥检测中的应用

目的:利用256层螺旋CT冠状动脉成像探讨心肌桥的出现率、好发部位.方法:连续收集临床诊断为冠心病且行256层螺旋CT冠状动脉成像的病例251例,回顾性地在线分析冠脉CT血管造影上心肌桥的出现率及其部位.结果:52例患者检出了心肌桥(52/251,20.7%),其中男性20例,女性22例,年龄60.27±11.36岁,共66段心肌桥.其中38例为单一壁冠状动脉,14例为两段受累,分别发生在前降支中段和钝缘支、前降支中段和右侧冠状动脉中段.心肌桥最常见于左前降支中段(48段,72.7%).结论:心肌桥常见,最常出现于左前降支,特别是左前降支中段,256层螺旋CT有效、无创且清晰地显示了心肌桥.     

64层CTCA与CAG对心肌桥和壁冠状动脉诊断的对比分析

目的探讨64层CT冠状动脉成像(64 CTCA)对心肌桥(MB)和壁冠状动脉(MCA)的诊断价值。资料与方法回顾性分析行64 CTCA与冠状动脉造影(CAG)检查的527例患者资料,测量CTCA发现MB的长度、厚度和MCA狭窄程度,与CAG表现对比分析。结果 527例患者经64 CTCA检出MB 118例(22.4%),而该118例MB患者经CAG仅检出48例(9.1%),两者对比差异有统计学意义(P<0.05)。64 CTCA发现MB的平均长度及厚度分别为(6.1±2.5)mm、(2.5±1.6)mm,MCA狭窄程度为(47.3±11.3)%;与CAG检出的MB长度与MCA狭窄程度对比,差异均有统计学意义(P<0.05)。结论 64 CTCA对MB和MCA的诊断特异性较高,有重要的临床价值。     

64层螺旋CT冠状动脉成像临床应用评价

目的:评价64层螺旋CT冠状动脉成像(64SCTCA)的图像质量和在诊断冠状动脉疾病的临床价值。方法:搜集35例患者64SCTCA的完整资料,并以近期实施的选择性X线冠状动脉成像(SCA)结果为金标准进行对比,对64SCTCA显示的冠状动脉主支及主要分支情况进行分级评估。结果:35例病例可用于评估的冠状动脉共计368支,成功率达95.6%。其中SCA共显示74个节段冠脉有中、重度狭窄(≥50%)。MSCTCA诊断中重度狭窄的敏感性为86.5%,特异性为97.3%,阳性预测值88.9%,阴性预测值96.6%。经配对χ2检验,P>0.05,证明两种检查方法在发现冠状动脉病变方面差异无统计学意义。结论:64层螺旋CT冠状动脉成像是一种无创、快速的成像方法,对诊断冠状动脉≥50%狭窄有较高的敏感性和特异性,适合用于临床怀疑冠心病的患者SCA前的筛选检查。     

双源CT冠状动脉成像在飞行人员冠心病诊断中的价值

目的 探讨双源CT冠状动脉成像在飞行人员冠心病诊断中的临床应用价值.方法对10名临床怀疑冠心病的飞行人员患者行双源CT冠状动脉成像（computed tomography coronary angiography,CTCA）检查和常规X线冠状动脉血管造影（conventional coronary angiography,CCA）检查,以CCA为金标准比较分析CTCA诊断冠状动脉狭窄的敏感性、特异性及准确性.结果 10例飞行人员患者均成功完成了双源CTCA与CCA 检查,双源CTCA图像优良率为96.3%.CTCA发现不同程度冠状动脉狭窄和斑块形成7例,其中2例同时存在前降支心肌桥;冠状动脉-肺动脉瘘1例;冠状动脉正常2例.7例患者的CTCA图像上15个冠状动脉节段有不同程度狭窄,以CCA为金标准,双源CTCA诊断冠状动脉有狭窄的敏感性、特异性及准确率分别为100.0%、98.2%、98.4%;诊断冠状动脉中度及中度以上狭窄的敏感性、特异性及准确率分别为80.0%、99.2%、98.4%.双源CTCA与CCA显示冠状动脉节段病变的能力无统计学差异（χ2=0.50,P=0.4795）.结论 双源CTCA作为一种无创检查方法,能够准确地评估飞行人员冠状动脉狭窄程度和冠状动脉管壁斑块情况,并能显示冠状动脉先天变异等,对于安全可靠地诊断飞行人员冠心病具有较高的应用价值.     

Prevalence and morphology of coronary artery ectasia with dual-source CT coronary angiography

To assess the prevalence and morphological characteristics of coronary artery ectasia (CAE) with CT coronary angiography (CTCA) in comparison to conventional catheterangiography (CCA). Dual-source CTCA examinations from 677 consecutive patients (223 women; median age 57 years) were retrospectively evaluated by two blinded observers for the presence of CAE defined as a diameter enlargement ≥1.5 times the diameter of adjacent normal coronary segments. Vessel diameters and contrast attenuation within and proximal to ectatic segments were measured. CCA was used to compare measurements obtained from CTCA with the coronary flow velocity by using the thrombolysis in myocardial infarction (TIMI) frame count. CTCA identified CAE in 20 of 677 (3%) patients. CCA was performed in ten of these patients. CAE diameter measurements with CTCA (10.0 ± 5.4 mm) correlated significantly (r = 0.92, p < 0.001) with the CCA measurements (8.8 ± 4.9 mm), but had higher diameters (levels of agreement: −1.0 to 3.4 mm). Contrast attenuation was significantly lower in the ectatic (343 ± 63 HU) than in the proximal (394 ± 60 HU) segments (p < 0.01). The attenuation difference significantly correlated with the CAE ratio (r = 0.67, p < 0.01) and the TIMI frame count (r = 0.58, p < 0.05). The prevalence of CAE in a population examined by CTCA is around 3%. Contrast attenuation measurements with CTCA correlate well with the flow alterations assessed with CCA.     

Plaque imaging with CT coronary angiography: Effect of intra-vascular attenuation on plaque type classification

AIM:To assess the attenuation of non-calcified atherosclerotic coronary artery plaques with computed tomography coronary angiography(CTCA).METHODS:Four hundred consecutive patients underwent CTCA(Group 1:200 patients,Sensation 64 Cardiac,Siemens;Group 2:200 patients,VCT GE Healthcare,with either Iomeprol 400 or Iodixanol 320,respectively) for suspected coronary artery disease(CAD).CTCA was performed using standard protocols.Image quality(score 0-3),plaque(within the accessible non-calcified component of each non-calcified/mixed plaque) and coronary lumen attenuation were measured.Data were compared on a per-segment/perplaque basis.Plaques were classified as fibrous vs lipid rich based on different attenuation thresholds.A P < 0.05 was considered significant.RESULTS:In 468 atherosclerotic plaques in Group 1 and 644 in Group 2,average image quality was 2.96 ± 0.19 in Group 1 and 2.93 ± 0.25 in Group 2(P ≥ 0.05).Coronary lumen attenuation was 367 ± 85 Hounsfield units(HU) in Group 1 and 327 ± 73 HU in Group 2(P < 0.05);non-calcified plaque attenuation was 48 ± 23 HU in Group 1 and 39 ± 21 HU in Group 2(P < 0.05).Overall signal to noise ratio was 15.6 ± 4.7 in Group 1 and 21.2 ± 7.7 in Group 2(P < 0.01).CONCLUSION:Higher intra-vascular attenuation modifies significantly the attenuation of non-calcified coronary plaques.This results in a more difficult characterization between lipid rich vs fibrous type.     

CT冠状动脉成像在冠心病诊断中的应用

目的:研究CT冠状动脉成像在冠心病早期诊断冠状动脉狭窄定性定量判读的作用。方法:对34例临床未发生急性冠脉综合征的冠心病患者,先后进行冠状动脉造影、128排双源CT冠状动脉成像。以冠状动脉造影为"金标准",计算CT冠状动脉成像敏感性、特异性、阳性预测值、阴性预测值。结果:①与冠状动脉造影相比,CT冠状动脉成像的敏感性为68%,特异性为97%,阳性预测值为89%,阴性预测值为90%。②CT冠状动脉成像有65个血管段图像质量差,约占12%,造成图像质量差的原因主要为钙化,心跳、呼吸伪影,少部分为管腔显示不良。结论:冠心病早期诊断中,CT冠状动脉成像可用作冠状动脉造影前筛选,CT冠状动脉成像阴性的患者不必行冠状动脉造影检查;CT冠状动脉成像阳性的患者,可行冠状动脉造影进一步确认病变。     

自适应前瞻性心电门控双源CT冠状动脉成像的初步研究

目的 探讨双源CT自适应前瞻性心电门控技术冠状动脉成像的可行性.方法 对31例患者行双源CT前瞻性心电门控技术冠状动脉成像.将患者分为2组:A组心率≤75次/min,选择R-R间期的70%扫描;B组心率＞75次/min,选择R-R间期的40%扫描.2名有经验的放射医师,利用双盲法、以4分法评定系统对冠状动脉15支分支血管成像质量进行评分,统计方法采用独立样本t检验.计算2组总CT剂量指数(CTDIvol)及有效剂量(ED)均值.结果 31例患者,共纳入分析的血管节段为437段,共有408支(93.4%)冠状动脉节段可满足影像学评价,29支(6.6%)冠状动脉节段不能满足影像学评价,其中A组共226个节段,12个节段(5.3%)不能评价,B组共211个节段,17个节段(8.1%)不能评价;31例患者冠状动脉均分3.57±0.64;其中A组冠状动脉均分(3.65±0.39)与B组冠状动脉均分(3.41±0.43)之间差异无统计学意义(t=1.62,P=0.12);在A、B 2组各段冠状动脉图像质量对照时,只有第10段2组图像质量差异有统计学意义(t=3.8,P＜0.05).CTDIvol均值为(18.88±5.04) mGy,有效剂量为(4.31±1.05) mSv.结论 双源CT自适应前瞻性心电门控冠状动脉成像技术在无需控制心率情况下可得到满足临床诊断的冠状动脉图像,加之低的辐射剂量有望成为冠状动脉CT成像常规的检查方法.     

320层容积CT冠状动脉血管造影的护理

目的:探讨320层容积CT冠状动脉造影检查中相关的护理因素。方法:对620例(男380例,女240例,平均年龄58.4±9.2岁)临床怀疑冠心病行320层CT冠状动脉造影检查的患者在检查前、检查过程中及检查后采用有效的护理流程进行严格的护理,并对相关图像资料进行回顾性分析。结果:620例患者中605例(97.5%)的图像能满足影像学评价。在2480支冠状动脉分支中1级血管分支共1709支(68.9%),满足诊断要求的血管分支共2390支(96.4%)。结论:严格和有效的护理流程是320层容积CT冠脉造影检查成功和提高图像质量的重要保证。     

16-MDCT coronary angiography versus invasive coronary angiography in acute chest pain syndrome: a blinded prospective study

OBJECTIVE: The purpose of our study was to prospectively evaluate the usefulness of CT coronary angiography versus invasive coronary angiography for the detection of clinically significant coronary artery disease in patients hospitalized for acute chest pain syndrome. SUBJECTS AND METHODS: Sixty-six consecutive patients (52 men and 14 women; average age, 57 +/- 11 [SD] years) who were hospitalized for acute chest pain syndrome underwent CT coronary angiography and invasive coronary angiography within an average time interval of 4 days. ECG-gated CT coronary angiography was performed with a 16-MDCT scanner (0.42-sec rotation time, 16 x 0.75 mm detector collimation). Beta-blockers were not administered routinely, and thus the average heart rate was 71 +/- 11 beats per minute. CT coronary angiographic images were evaluated concurrently by two radiologists, who were blinded to invasive coronary angiography results, for stenoses having a diameter of 50% or more, using a 15-segment classification, including all segments 2 mm or more in diameter. The consensus interpretation was compared with results of invasive coronary angiography. RESULTS: CT coronary angiography was technically successful in 59 patients (89%). After exclusion of 20 (3.1%) of 649 coronary segments, which were classified as nonevaluable by CT coronary angiography, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT coronary angiography for identifying significant coronary artery disease in the remaining 629 coronary segments were 80% (68/85), 89% (482/544), 52% (68/130), 97% (482/499), and 87% (550/629), respectively. The overall accuracy for the main vessels (left main, left anterior descending, left circumflex, and right coronary arteries) was 93%, 88%, 86%, and 86%, respectively. CONCLUSION: CT coronary angiography using a 16-MDCT scanner enables accurate noninvasive detection of significant coronary artery disease in patients hospitalized for acute chest pain syndrome. Furthermore, relative high sensitivity and specificity of CT coronary angiography can be achieved without pharmacologic manipulation of patient heart rates.     

64层螺旋CT CA对冠状动脉狭窄的误诊原因（附76例分析）

目的分析64层螺旋CTCA评价冠状动脉狭窄的误诊原因,以期提高其诊断的准确性。方法收集76例疑诊冠心病患者64层螺旋CT冠状动脉成像（64SCTCA）的完整资料,并与常规冠状动脉造影（CCA）结果为金标准对比,分析误诊原因。结果76例64-SCTCA共评价852个冠状动脉节段,其中53个节段与CCA结果不一致,误诊率为6．2％。冠脉主干与分支的误诊率存在显著差异（P〈0．05）;左前降支中段、回旋支远段和右冠中段的误诊率显著高于其他节段（P〈0．05）。血管闭塞、钙化和呼吸伪影是导致误诊最常见的原因。结论了解64-SCTCA对冠脉狭窄误诊的原因,可以针对性地完善检查前准备和提高对狭窄的认识能力,并最终提高放射医师的诊断能力。     

Intraindividual comparison of 3D coronary MR angiography and coronary CT angiography

RATIONALE AND OBJECTIVES: To compare the diagnostic value of magnetic resonance (MR) and computed tomography (CT) for the detection of coronary artery disease (CAD) with special regard to calcifications. MATERIALS AND METHODS: Twenty-seven patients with known CAD were examined with a targeted, navigator-gated, free-breathing, steady-state free precession MR angiography sequence (repetition time = 5.6 milliseconds, echo time = 2.8 milliseconds, flip angle 110 degrees ) and 16-slice coronary CT angiography. Segment-based sensitivity, specificity, and accuracy for the detection of stenoses larger than 50% were determined as defined by the gold standard catheter coronary angiography along with the subjective image quality (Grade 1-4). The degree of calcifications in each segment was quantified using a standard calcium scoring tool. RESULTS: Of 115 possible segments, 7% had to be excluded in MR imaging because of poor image quality. In CT, 3% were nondiagnostic because of image quality and 15% were not evaluable because of calcifications. Values for the detection of relevant coronary artery stenoses in the evaluated segments were: sensitivity: MR imaging 85% versus CT 96%; specificity: 88% versus 96%; accuracy: 87% versus. 96%. Average subjective image quality was 1.8 for MR imaging and 1.6 for CT. Of the 15% of segments that had to be excluded from CT evaluation because of calcifications, MR imaging provided the correct diagnosis segments in 67%. CONCLUSIONS: CT provided a better image quality with superior accuracy for the detection of CAD. Despite its overall inferiority, MR imaging proved to be helpful method in interpreting coronary stenosis in severely calcified segments.