平板DSA低剂量模式在冠状动脉造影术中的应用价值

目的 探讨平板探测器数字减影血管造影系统(DSA)低剂量模式在冠状动脉造影术中的应用价值.方法 选取住院拟行冠状动脉造影术患者60例,均为体重50 ～ 70 kg正常体型,随机分为低剂量模式组30例与常规对照组30例.术后由2位心内科介入治疗医师采用双盲法对所有图像进行评分.分别对两组患者的辐射剂量面积(DAP)、累积...     

Three-dimensional coronary angiography of the perfused rat heart

The purpose of this work was to visualize the whole three-dimensional coronary artery tree of the perfused beating rat heart using three-dimensional MRI. The spatial resolution amounts to 140 μm. Also, vessels having smaller diameters could be detected. Different strategies for the visualization of the three-dimensional coronary angiograms including maximum intensity projection, data thresholding, and segmentation, were shown. The coronary artery tree was best visualized by hysteresis threshold segmentation and subsequent surface reconstruction.     

Anomalous origin of the right coronary artery from the pulmonary artery

Anomalous origin of the right coronary artery from the pulmonary artery was diagnosed by selective left coronary artery angiography in an asymptomatic five-year-old boy with a continuous murmur. The anomalous coronary artery, along with a cuff of the pulmonary artery, was re-implanted into the aorta. The patient is asymptomatic five years postoperatively.     

Huge left coronary artery aneurysm associated with multiple arterial aneurysms

Natural history of an aneurysm at the bifurcation of the left coronary artery is reported. A gradual increase in its size occurred over an 18-year period until it was a huge and partially thrombosed sac. It was associated with ectasia of the right coronary artery, aneurysms of the left subclavian artery and thoracic aorta, and calcified dilatations of the branches of the celiac trunk.     

Postmortem angiographic and pathologic-anatomic findings in coronary heart disease: A comparative study using planimetry

Comparisons of the results of angiographic and pathologic-anatomic estimations of the degree of coronary artery stenosis are rare and the findings contradictory. In the present study, postmortem examinations were carried out on 26 hearts with coronary artery disease. Quantitative planimetric measurements of 203 coronary artery cross-sections were performed and compared with the results of postmortem coronary angiograms. Using a score rating scale, a highly significant difference (P<0.001) between the angiographic and morphologic findings was detected, with the degree of stenosis underestimated angiographically in 96 of the 203 sections (47%), overestimated in 18 (9%), and correctly estimated in 89 (44%). The tendency to underestimation was equal in all of the coronary arteries (left anterior descending, circumflex, and right coronary arteries); there were no statistically significant differences (P<0.20,P<0.30,P<0.10). The frequency of angiographic underestimation of the degree of morphologic stenosis—especially in critical stenoses of more than 60%—has important implications in the assessment of whether coronary artery surgery is warranted. Dedicated to Prof. Dr. Walter Sandritter on the occasion of his 60th birthday     

Coronary manifestations of Kawasaki Disease in computed tomography coronary angiography

Coronary arteritis in Kawasaki disease can lead to serious complications such myocardial infarction and sudden death. The identification of coronary manifestations with a method that is minimally invasive and of low radiation exposure is therefore important in paediatric patients with Kawasaki disease. Coronary CT angiography can be an attractive alternative to invasive coronary angiography. This paper describes imaging techniques for coronary CT angiography in pediatric patients and demonstrates the spectrum of cardiovascular manifestations in patients with Kawasaki disease.     

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.     

The radiographic appearance of coronary artery dissection: A decision-making dilemma

The appearance of acute iatrogenic dissection of the coronary arteries during coronary angiography is described in five patients. Specific signs of dissection include: 1) intimal flap, 2) delayed flow, 3) loss of side branches, 4) periostial contrast “puddling,” and 5) unusually small size coronary artery with atypical smooth walls. Recognition of the radiographic patterns of this complication should permit distinction from coronary spasm, thrombosis, and embolization. Recent advent of alternate forms of therapy (streptokinase infusion, angioplasty) makes it imperative to precisely diagnose the dissection to avoid possible catastrophic results.     

Three-dimensional respiratory-gated coronary MR angiography with reference to X-ray coronary angiography

Purpose: To assess the clinical value of three-dimensional coronary MR angiography (CMRA) in the detection of significant coronary artery stenosis using conventional X-ray angiography as the standard reference.

Material and Methods: Sixty-nine patients underwent X-ray coronary angiography and CMRA because of suspected or previously diagnosed coronary artery disease. MRI was performed with a 1.5-T whole body imaging system using ECG-triggered 3D gradient echo sequence with retrospective navigator echo respiratory gating and fat suppression.

Results: A total of 276 coronary artery segments were analyzed. The X-ray coronary angiography was normal in 22 patients. Significant proximal stenoses (exceeding 50%) or occlusions were present in 102 coronary artery segments. In all, 120 stenoses or occlusions were identified in CMRA. Sixteen percent of the coronary artery segments had to be excluded because of poor image quality. The overall sensitivity and specificity for MRA for identification of significant stenosis were 75% and 62%, respectively. CMRA correctly detected 89% of patients with at least one vessel disease, but 6 patients with coronary artery disease would have been missed.

Conclusions: Because of the high data exclusion and false- negative case rate, CMRA with retrospective navigator echo triggering is at present not suitable as a clinical screening method in coronary artery disease.     

心肌桥和壁冠状动脉多层螺旋CT与冠状动脉造影诊断对照

目的 探讨多层螺旋CT（MSCT）和冠状动脉造影（CAG）诊断心肌桥-壁冠状动脉（MB—MCA）的能力。方法 对76例先后进行MSCT和CAG检查者，CT诊断和CAG诊断医师分别判断MB—MCA的有无，载MB—MCA血管形态特征。（1）采用双盲法MSCT和CAG分别独立阅片；（2）相互参照另1种检查结果后再次阅片。应用卡方统计分析方法，判断2种方法发现MB—MCA和判断血管迂曲有无差异。结果 双盲法MSCT发现MB—MCA27例29处，CAG发现2例2处（X^2=24．55，P〈0，05），MSCT发现22处（75．86％）载MB—MCA冠状动脉节段迂曲，CAG发现1处（X^2=28，82，P〈0．05），2种方法差异有统计学意义。相互对照后再次评价，MSCT发现MB—MCA数量同前，CAG新发现7例7处，位置与MSCT一致，2种方法差异仍有统计学意义（X^2=10．52，P〈0．05）。对22例MSCT诊断局部迂曲者，CAG也可证实，2种方法差异无统计学意义（X^2=0．33，P〉0．05）。结论 MSCT较CAG容易发现MB—MCA，CAG发现局部血管迂曲对MB—MCA有提示作用。     

磁共振冠状动脉成像定位方法

目的 摸索磁共振冠状动脉成像(MRCA)的扫描定位方法。方法 89例受检者，用快速平衡稳态成像(FIESTA)序列获得标准四腔心位、左室和右室长轴位的电影图像并确定舒张中期触发延迟时间，在此基础上用脂肪抑制的三维FIESTA序列在呼气末屏气定位扫描冠状动脉右支(RCA)、左主干(LM)、前降支(LAD)和回旋支(LCX)，以美国心脏协会(AHA)推荐的冠状动脉解剖分段法评价定位显示的可重复性。结果 86例受检者能够屏气配合完成检查，适用效率为96．63％；9个位置可以稳定地显示冠状动脉各主支，各位置综合对RCA近段和中段(AHA-18、19段)、LM全长(AHA-1、2)、LAD近段和中段(AHA-3、5、7段)，LCX近段(AHA-10段)的显示可重复性为100％；对LAD、LCX和RCA的远段(AHA-9、14、21段)的显示可重复性分别为94．19％、72．09％、96．51％。结论 MRCA定位方法简单实用，可以稳定显示冠状动脉主要分支的近段和中段，初步具备临床应用的价值。     

64层螺旋CT在冠状动脉疾病诊断中的价值

目的 评价64层螺旋CT冠状动脉成像（64SCTCA）在诊断冠状动脉疾病的临床价值。方法 搜集100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（CCA）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 所有病例可用于评估的920支冠状动脉中，共显示病变370支，其中348支得到CCA证实；22支64SCTCA诊断狭窄而CCA显示正常，另外有10例CCA确诊存在的病变而在64SCTCA上未能显示，得出64SCTCA诊断冠状动脉病变的敏感性为97．2％，特异性为96．0％，阳性预测值为94．0％，阴性预测值为98．1％。经配对χ^2检验，P=0．052，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。在显示病变程度上，64SCTCA评估与CCA完全一致者311支，准确性86．8％。在64SCTCA结果中，共有59支病变在程度上的评价与CCA结果不符合。结论 64SCTCA在显示冠状动脉病变时，具有较高的敏感性和特异性，并且对于病变程度的评估也比较准确，适合用于临床怀疑冠心病的患者CCA前的筛选检查。     

Fatal atheromatous embolization during coronary angiography

Multiple fatal embolism following left heart catheterization is described in two patients. Postmortem examination showed friable atheromatous aortic plaques as the likely source of emboli that clinically involved the heart, peripheral blood vessels, brain, gastrointestinal system and solid organs. Histologic examination showed widespread arterial embolism by atheromatous material.     

16层螺旋CT冠状动脉成像的临床应用

目的:探讨16层螺旋CT冠状动脉(简称冠脉)成像在冠心病诊断中的临床价值。方法:选取50例临床诊断或可疑冠心病患者行16层螺旋CT冠状动脉造影检查(MSCTCA),先行冠脉钙化积分平扫,然后行冠脉增强扫描,选取一组质量最佳的薄层图像行冠脉三维重建,分析MSCTCA对冠状动脉狭窄性病变的显示能力,并对冠脉支架显示及通畅性进行评价。结果:冠脉钙化积分与其狭窄程度呈正相关,中度以上狭窄的冠脉钙化积分值明显高于轻度狭窄,其间有统计学显著性差异(P<0.001)。MSCTCA对诊断有临床意义的冠脉中度以上狭窄的敏感度、特异度、诊断准确率、阳性预测值、阴性预测值分别约89.6%、93.9%、92.6%、86.7%、95.4%。MSCTCA对冠脉支架显示良好,检出5例9根支架,其中2根支架不通畅,出现支架内再狭窄。结论:16层螺旋CT冠脉成像安全、无创,对评价冠状动脉狭窄、支架开放及通畅性等方面有着较高的临床应用价值,可作为冠心病筛查的有效手段以及介入和手术治疗后的随访手段。     

Primary dissecting aneurysms of the coronary arteries: Case report and literature review

We describe a case of dissecting aneurysm that occurred in a 33-year-old woman suffering from acute myocardial infarction, which was discovered by coronary angiography. Angiographic diagnosis of dissections is rare with only six such cases previously reported. Sixty cases in the literature are reviewed to ascertain the main characteristics of this rare entity. The distinct predominance of this disease among women, particularly post partum, suggests an hormonal influence on its pathogenesis.     

3.0 T非增强全心冠状动脉MR成像评价冠状动脉狭窄的初步研究

目的 评价3.0T非增强全心冠状动脉MR血管成像(CMRA)诊断冠状动脉狭窄的临床价值.方法 对33例冠状动脉CT血管成像(CCTA)诊断冠状动脉有意义狭窄(＞50％)且拟行冠状动脉造影(CAG)的患者行冠状动脉MR血管成像(CMRA)检查.应用3.0T扫描仪及32通道成像线圈,采用非对比增强、心电门控触发、呼吸导航、T2预置脉冲以及脂肪抑制的三维梯度回波序列.利用美托洛尔降低心率至＜ 80次/min.采用配对样本Wilcoxon秩检验分析CMRA及CCTA在冠状动脉近中段及远段评分的差异性.以CAG结果为金标准,评价CMRA诊断冠状动脉近中段＞50％狭窄的准确性以及与CCTA的一致性.结果 33例患者中30例成功完成CMRA扫描,CMRA及CCTA 在冠状动脉近中段的评分相近[CMRA:(3.49±0.61)分,CCTA:(3.56±0.55)分,Z=-1.715,P＞0.05],CCTA评价冠状动脉远段明显优于CMRA[CMRA:(2.44±0.76)分,CCTA:(3.23±0.60)分,Z=-6.159,P＜0.05].CMRA及CCTA在以段为基础诊断冠状动脉近中段＞50％狭窄的一致性良好(Kappa=0.779,P＜0.05).CMRA诊断的敏感度、特异度、阳性预测值及阴性预测值分别为84.1％ (37/44)、85.8％ (115/134)、66.1％(37/56)、94.3％ (115/122),CCTA分别为88.6％ (39/44)、89.6％ (120/134)、73.6％ (39/53)、96.0％ (120/125).结论 3.0T非增强全心CMRA及CCTA诊断冠状动脉近中段狭窄的准确性相似,但CMRA诊断冠状动脉远段的狭窄需进一步深入研究.     

Multidetector-row cardiac CT: diagnostic value of calcium scoring and CT coronary angiography in patients with symptomatic,but atypical,chest pain

The aim of this study was to investigate the accuracy of multidetector-row cardiac CT (MDCT), calcium scoring (Ca-Sc), and MDCT coronary angiography (MD CTA) in the assessment of coronary atherosclerosis. Thirty-eight patients underwent invasive coronary angiography (CA) and MDCT (collimation 4×1 mm, pitch 1.5 mm, TI 500 ms, 120 kV, 300 mAs, and retrospective ECG-gating). Calcium scoring was calculated for the total coronary artery territory and for RCA, LCA, and LCX separately. The MD CTA served to assess the degree and the localization of stenoses. All findings were compared to invasive coronary angiography. Approximately 68.4% (390 of 570) of all coronary segments could be visualized by MDCT. Correlation coefficient for MD CTA and CA amounted to r=0.58, showing distinct differences for the individual segments. Proximal segments generally showed better correlation (range 0.81–0.77) than medial segments (range 0.91–0.20), distal segments (range 0.55–0.04), or side branches (range 0.76–0.00). Patients with hemodynamically relevant (>75%) stenoses were detected by MD CTA with 72.2% sensitivity (13 of 18) and 100% specificity (20 of 20). For Ca-Sc sensitivity ranged between 94.7% (17 of 18) and 66.7% (12 of 18), specificity between 20% (4 of 20) and 80% (16 of 20) respectively, depending on the prevailing cutoff value. Combination of both methods led to 83.3% sensitivity (15 of 18) and 100% specificity (20 of 20), reaching no level of significance as compared with Ca-Sc (p=0.73) or MD CTA (p=0.23) alone. Calcium scoring as a single method showed highest sensitivity in the detection of coronary atherosclerosis but at the expense of low specificity. In patients with no or moderate calcifications, combination with MD CTA helped to distinctly increase specificity and NPVM. Britten and C. Herzog contributed equally to this study     

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.     

Prospective adaptive navigator correction for breath-hold MR coronary angiography

Current MR coronary angiography (MRCA) methods use breath-holding to minimize respiratory motion. A major limitation to this technique is misregistration between imaging slices due to breath-hold variability. Prospective adaptive correction of image location using real-time navigator measurement of diaphragm position is a potential method for improving slice registration in breath-hold MRCA. Ten subjects underwent MRCA using an ECG-gated, fat-suppressed, segmented k-space, gradient-echo sequence. Transverse and coronal images were acquired using standard breath-holding with and without prospective navigator correction. Breath-hold MRCA with prospective navigator correction resulted in a 47% reduction in craniocaudal slice registration error compared to standard breath-holding (0.9 ± 0.2 mm versus 1.7 2 0.4 mm, P = 0.04). Prospective adaptive navigator correction of image location significantly improves slice registration for breath-hold MRCA and is a promising motion correction technique for cardiac MR.