磁共振冠状动脉成像技术临床应用分析

目的评价导航技术三维对比剂增强磁共振冠状动脉成像对冠心病患者诊断的临床应用价值。方法应用导航技术三维对比剂增强磁共振冠状动脉成像方法对45例受检者分别进行左、右冠状动脉成像后经处理获得左、右冠状动脉血管图像,根据图像进行冠状动脉主干评价与临床症状,ECG、DCG、UCG、DSA等检查结果相比较判断冠脉MR对冠心病诊断的价值。结果45例受检者冠脉MR图像中阳性18例、阴性27例;临床拟诊冠心病患者27例中ECG、DCC提示冠心病15例,冠脉MR图像中阳性18例;其中5例拟诊冠心病患者在冠脉MR2周内行常规冠状动脉造影(DSA)检查其结果2例阴性、3例阳性,与冠脉MR检查结果相符。结论冠脉MR可作为冠心病无创性检查的一种手段,由于图像显示右冠状主干、左主干、左前降支及左回旋支近中段图像清楚,而远段图像欠佳尚不能代替常规冠状动脉造影检查方法,可作为冠心病辅助检查。     

非屏气三维导航技术磁共振冠状动脉成像

目的评价非屏气三维导航技术磁共振冠状动脉成像的可行性.方法应用非屏气三维导航技术磁共振冠状动脉成像方法,对20名受检者分别进行左、右冠状动脉成像,经后处理获得左、右冠状动脉血管图像.应用信噪比评价冠状动脉图像,并测量冠状动脉主干及其主要分支的显示长度.结果所有受检者均显像成功,冠状动脉图像的信号强度为129.3±20.63,信噪比为37.35±6.32,冠周组织的信号强度为33.4±13.11,信噪比为9.65±4.02,两者比较有显著性差异(P＜0.01).左主干及左前降支、右冠及左回旋支冠状动脉的平均显示长度分别为(8.38±1.87) cm、(8.59±2.87) cm、(4.48±0.88) cm.结论非屏气三维导航技术磁共振冠状动脉成像有较高的信号强度和信噪比,应用于临床尚需进一步的对照研究.     

多层螺旋CT冠状动脉成像的初步临床应用

目的:初步探讨MSCT冠状动脉成像的临床应用价值。方法:45例临床诊断或可疑冠心病的患者做MSCT冠状动脉成像检查(回顾性心电门控、0.5s螺旋扫描、心脏分段重建算法和静脉注射对比剂)。在9个心电相位窗上对冠状动脉进行图像重建并分析影像学表现。结果:45例中,左前降支、左回旋支和右冠状动脉重建图像质量最佳的相位窗多数为70%,分别占84.4%,77.8%和66.7%。左冠状动脉主干、左前降支、左回旋支和右冠状动脉显示较好且能满足影像学评价分别占93.3%,80%,60%和42.2%。在心率<60次/分的16例中,左前降支、左回旋支和右冠状动脉显示较好且能满足影像学评价分别占93.8%,75%和62.5%。在心率为60~70次/分的21例中,左前降支、左回旋支和右冠状动脉图像质量较好且能满足影像学评价分别占85.7%,66.7%和42.9%。在心率>70次/分的8例中,左前降支、左回旋支和右冠状动脉图像质量较好且能满足影像学评价分别占37.5%,12.5%和0。在冠状动脉正常或狭窄程度<50%的12例中,二维曲面重建图像显示左前降支、左回旋支和右冠状动脉的长度分别为108±15mm,81±26mm和126±16mm。结论:MSCT在多数情况下能较好地显示冠状动脉,可以作为冠状动脉病变的筛选方法。     

呼吸导航3D B-TFE序列磁共振冠状动脉成像

目的 评价呼吸导航3D B-TFE序列在冠状动脉成像中的图像质量.方法 用三维(3D)B-TFE(balanced turbo fieldecho)序列,呼吸导航门控技术,心电向量(VCG)R波触发门控技术,对41例受检者进行磁共振冠状动脉造影(MRCA)检查.对图像质量进行评分,测量冠状动脉主干及其分支的显示长度,并计算成像信噪比(SNR)、对比噪声比(CNR).结果 评分≥2的病例共计38例.左主干(LM)、左前降支(LAD)、左回旋支(LCX)及右冠状动脉(RCA)的血管长度分别为15.34±6.60mm、52.50±16.37mm、50.92±21.14mm、97.38±29.16mm;SNR和CNR分别为108.86±86.11、67.77±53.14.RCA远段显示率为75%,其余节段的显示率为91.66%～100%.结论 呼吸导航3D BTFE序列具有较高的图像信噪比;可在自由呼吸的情况下得到冠状动脉的影像;对冠状动脉主干的显示率较高,RCA和LCX远段显示率相对较低.     

CT诊断左冠状动脉异位起源于肺动脉1例

患儿男,14岁,主因“活动后心脏不适5年,基层医院检查怀疑先天性心脏病”人院.心脏听诊:左3、4肋间可闻及粗糙Ⅲ级收缩期杂音.血管成像CT增强扫描:左冠状动脉起自肺动脉根部左后方,主干、前降支及旋支明显增粗,其中主干直径约1.06 cm,前降支直径约0.30～0.75 cm,旋支直径约0.52 cm,左冠状动脉旋支、前降支终末支均进人心肌内.右冠状动脉起自右冠状动脉窦,全程明显纡曲扩张,右冠状动脉主干直径约0.80～1.10 cm,其分支明显增粗,终末支进人心肌内.     

3.0T磁共振全心方法冠状动脉造影的初步评价

目的初步评价三维(3D)全心方法冠状动脉造影在3.0T磁共振应用的可行性及价值。方法采用3D分段k空间快速梯度回波序列(turbofieldecho,TFE),实时呼吸导航门控技术,心电向量(VCG)R波触发门控技术,在3.0T磁共振对12例健康志愿者进行磁共振冠状动脉造影(MRCA)检查。结果左主干和左前降支(LM LAD)、左旋支(LCX)及右冠状动脉(RCA)的血管长度(mm)分别为98±16、56±9、108±29;血管直径(mm)分别为2.6±0.4、2.4±0.3、2.6±0.3;左、右冠状动脉的信噪比(SNR)和强化噪声比(CNR)分别为35±12、19±6和23±5、18±3。结论初步研究显示全心方法MRCA在3.0T磁共振是可行的,能够显示冠状动脉的远段和管径较小的分支血管,显示了增强的信噪比。全心方法使冠状动脉定位采集过程变得简单,易操作。     

双源CT在冠状动脉起源异常诊断中的应用2356例分析

目的探讨双源CT冠状动脉成像诊断冠状动脉起源异常的价值。方法对2 356例成人冠状动脉双源CT血管成像资料进行回顾性分析、总结。结果 2 356例冠状动脉CTA中,检查出冠状动脉起源异常31例,检出率为1.31%,其中冠状动脉开口水平变异9例,两支冠状动脉开口于左冠状窦5例,两支冠状动脉开口于右冠状窦8例,前降支起源于右窦1例,左回旋支起源于右窦2例,前降支及回旋支独立开口于左冠状窦2例,单一冠脉2例(均为单一右冠),左回旋支闭锁2例。结论双源CT冠状动脉成像可以清晰显示冠状动脉起源及走行,是一种良好的无创性的诊断冠状动脉起源异常的可靠方法。     

MSCT冠状动脉成像与冠状动脉造影的对比研究

目的 :研究MSCT在冠状动脉成像中的临床应用价值。方法 :4 0例疑冠状动脉狭窄者行MSCT扫描 ,利用最大密度投影 (MIP)重建 ,2D重建 ,仿真内窥镜技术 ,了解冠状动脉病变情况 ,并与冠状动脉造影对比。结果 :4 0例 16 0支血管经MSCT成像 ,134支 (84 % )可用于影像学评价 ,2 6支 (16 % )不能评价。冠状动脉造影发现狭窄 4 6支 ,其中左前降支 (LAD)病变 18支 ,回旋支 (LCA)病变 12支 ,左主干 (LMA) 3支 ,右冠 (RCA)病变 13支。MSCT发现狭窄 4 1支 ,其中左前降支病变 14支 ,回旋支病变 12支 ,左主干病变 3支 ,右冠病变 12支。敏感性为 82 .6 % (38/ 4 6 ) ,特异性 97.3% (111/ 114 )。结论 :在控制心率的情况下 ,MSCT可作为冠状动脉狭窄的一种无创筛选检查方法。     

冠状动脉CT血管造影对先天性右冠状动脉缺如的评价价值

目的总结先天性右冠状动脉缺如患者的临床和冠状动脉CT血管造影（CCTA）影像表现。方法回顾性分析2014年1月~2019年6月于本院行CCTA检查并经选择性冠状动脉造影（SCA）确诊的13例先天性右冠状动脉缺如患者的临床资料和CCTA影像表现。结果13例先天性右冠状动脉缺如患者的临床表现缺乏特异性,大多表现为心血管疾病的临床症状。CCTA平扫显示左主干、左前降支和（或）左回旋支走行区内数量不等、形态各异的高密度钙化斑块形成;增强扫描显示左主干、左前降支和（或）左回旋支不同程度变窄,升主动脉和右冠状窦区均未见右冠状动脉发出,左主干、左前降支和左回旋支均不同程度增粗,并左回旋支延伸至右心室背面,进而发出分支供应右心房和右心室。CCTA与SCA表现基本一致。结论先天性右冠状动脉缺如罕见,其临床表现缺乏特异性,仅凭临床表现往往难以诊断,CCTA联合SCA检查常可用于确诊。      

MR冠脉成像靶容积与全心扫描方法的优势探讨

目的探讨自由呼吸导航三维采样磁共振冠脉成像靶容积和全心扫描方法的特点与优势。方法对21例志愿者进行1.5T自由呼吸磁共振冠脉成像扫描,包括右冠状动脉和左旋支的靶容积及全心扫描,两种方法的基本扫描参数相同,扫描完成进行后处理,得到靶容积和全心扫描的右冠状动脉及左旋支图像,对右冠脉及左旋支各节段的图像质量进行评分,测量右冠脉及左旋支的长度,观察右冠脉后降支的显示情况,评价两种方法的特点和优势。结果全心扫描的时间明显长于单次冠脉靶容积扫描的时间,两种方法在显示右冠状动脉和左冠脉旋支的长度上无明显差别,对于右冠状动脉后降支的显示而言,全心扫描较靶容积扫描具有明显的优势,在图像质量方面,靶容积扫描优于全心扫描方法。结论自由呼吸导航三维采样磁共振冠脉成像靶容积和全心扫描方法具有各自的优势,在临床中可根据具体情况进行选择应用或联合应用。     

相位对比磁共振技术测量冠状动脉血流的方法有效性研究

目的评价相位对比磁共振技术测量冠状动脉主要分支血流的可行性.方法选择11例健康志愿者进行磁共振检查,对冠状动脉左前降支(LAD)和右冠状动脉(RCA)进行成像,利用相位对比、流速编码电影磁共振技术测量两支冠状动脉近段的血流,得到峰值流速、平均流速、平均流量等血流动力学参数.同时与经胸超声心动图(TTE)检查结果进行比较和相关性分析.结果 MR检查成功得到11支LAD及10支RCA近中段的峰值流速、平均流速及平均流量,测量值分别为(18.21±4.45)cm/s和(15.55±3.40)cm/s、(7.48±1.59)cm/s和(6.43±1.69)cm/s、(0.62±0.16)ml/s和(0.70±0.28)ml/s;所有参数与TTE检查结果比较具有良好的相关性,MR测量值与既往同类研究结果接近.结论 MR测量冠状动脉血流流速和流量是可行的.     

3.0T磁共振冠状动脉成像使用对比剂与不使用对比剂图像质量的定量对比分析

目的：采用定量的方法对比分析3．0T冠状动脉MRA（CMRA）使用和不使用对比剂采集对冠状动脉的显示能力和图像质量。方法：58例患者接受CMRA检查,在CMRA的成像过程中采用了使用（n=28）和不使用（n=30）对比剂采集两种方式。使用Soap-Bubble软件对两种方式采集的CMRA数据进行后处理重建并通过测量冠状动脉各主要分支的长度、直径及血管的锐利度,定量评价CMRA的图像质量。结果使用对比剂采集所获得的CMRA各主要分支的测量值为：长度RCA129mm、LM＋LAD112mm、LCX58mm;直径RCA2．9mm、LM＋LAD2．7mm、LCX2．8mm;血管锐利度RCA65％、LAD55％、LCX48％。不使用对比剂采集的CMRA测量值：长度RCA126mm、LM＋LAD109mm、LCX55mm;直径RCA3．0mm、LM＋LAD2．8mm、LCX3．0mm;血管锐利度RCA58％、LAD52％、LCX45％。统计结果显示二者间的血管锐利度和图像质量评分均存在显著性差异（P〈O．05）,但长度和直径的比较无明显差异（P〉0．05）。结论：CMRA采集过程中使用对比剂具有更好的血管锐利度和图像质量,在CMRA的采集过程中建议尽量使用对比剂采集的方式。     

Reproducibility of free-breathing cardiovascular magnetic resonance coronary angiography.

OBJECTIVE: Contemporary free-breathing non contrast enhanced cardiovascular magnetic resonance angiography (CMRA) was qualitatively and quantitatively evaluated to ascertain the reproducibility of the method for coronary artery luminal dimension measurements. SUBJECTS AND METHODS: Twenty-two healthy volunteers (mean age 32 +/- 7 years, 12 males) without coronary artery disease were imaged at 2 centers (1 each in Europe and North America) using navigator-gated and corrected SSFP CMRA on a commercial whole body 1.5T System. Repeat images of right (RCA, n = 21), left anterior descending (LAD, n = 14) and left circumflex (LCX, n = 14) coronary arteries were obtained in separate sessions using identical scan protocol and imaging parameters. True visible vessel length, signal-to-noise (SNR), contrast-to-noise ratios (CNR) and the average luminal diameter over the first 4 cm of the vessel were measured. Intra-observer, inter-observer and inter-scan reproducibility of coronary artery luminal diameter were determined using Pearson's correlation, Bland-Altman analysis and intraclass correlation coefficients (ICC). RESULTS: CNR, SNR and the mean length of the RCA, LAD and LCX imaged for original and repeat scans were not significantly different (all p > 0.30). There was a high degree of intra-observer, inter-observer and inter-scan agreements for RCA, LAD and LCX luminal diameter respectively on Bland-Altman and ICC analysis (ICC's for RCA: 0.98. 0.98 and 0.86; LAD: 0.89, 0.89 and 0.63; LCX: 0.95, 0.94 and 0.79). CONCLUSION: In a 2-center study, we demonstrate that free-breathing 3D SSFP CMRA can visualize long continuous segments of coronary vessels with highly reproducible measurements of luminal diameter.     

Effect of infarct site on the clinical endpoints of thrombolytic-treated ST-elevation myocardial infarction

IntroductionSome studies suggest better outcomes after the use of thrombolytics in inferior ST-elevation myocardial infarction (STEMI) compared to other locations. The goal of this study is to compare the clinical endpoints of thrombolytic-treated STEMI based on coronary artery distribution.MethodsThe study population was extracted from the 2014 Nationwide Readmissions Data using the International Classification of Diseases, Ninth Revision, Clinical Modifications codes for STEMI, thrombolytic infusion, and complications of STEMI. Primary study endpoints included in-hospital all-cause mortality, length of hospital stay (LOS), cardiogenic shock, and mechanical complications of STEMI.ResultsA principal diagnosis of thrombolytic-treated STEMI was identified for in 1231 patients (mean age 61.5 years; 26.5% female). Four hundred and thirty-one STEMIs occurred in the left anterior descending (LAD) artery distribution, 124 in the left circumflex (LCX) artery distribution, and 676 in the right coronary artery (RCA) distribution. In comparison to the LAD and LCX distributions, thrombolytic-treated STEMIs in the RCA distribution were associated with lower mortality (6.5% with LAD, 5.7% with LCX, and 3.6% with RCA; p = 0.02), fewer cardiogenic shock (12.3% with LAD, 12.1% with LCX, and 7.7% with RCA; p = 0.01), and shorter LOS (4.5 days with LAD, 3.9 with LCX, and 3.6 days with RCA; p < 0.01). Mechanical complications showed no significant difference based on coronary distribution (2.3% with LAD, 3.2% with LCX, and 1.2% with RCA; p = 0.17).ConclusionsThrombolytic-treated STEMIs in the RCA distribution were associated with lower in-hospital all-cause mortality, cardiogenic shock, and shorter LOS. Mechanical complications were not different based on coronary distribution.     

Contrast material injection protocol with the flow rate adjusted to the heart rate for dual source CT coronary angiography

To investigate the effect on coronary arterial attenuations of contrast material flow rate adjusted to a patient’s heart rate during dual source CT coronary angiography (DSCT-CCTA). A total of 296 consecutive patients (mean age: 58.7 years) undergoing DSCT-CCTA without previous coronary stent placement, bypass surgery, congenital or valvular heart disease were included. The image acquisition protocol was standardized (120 kV, 380 mAs) and retrospective electrocardiograph (ECG) gating was used. Patients were randomly assigned to one of three groups [flow rate: G1: dosage/16, G2: dosage/(scan time +8), G3: fixed flow rate]. The groups were compared with respect to the attenuations of the ascending aorta (AA) above coronary ostia, the left main coronary artery (LM), the proximal right coronary artery (RCA), the left anterior descending artery (LAD), the left circumflex artery (LCX), and the contrast to noise ratio of the LM (LM_CNR) and the proximal RCA (RCA_CNR). Correlations between heart rate and attenuation of the coronary arteries were evaluated in three groups with linear regression. There was no significant difference in the three groups among the mean attenuations of AA (P = 0.141), LM (P = 0.068), RCA (P = 0.284), LM_CNR (P = 0.598) and RCA_CNR (P = 0.546). The attenuations of the LAD and the LCX in group 1 were slightly higher than those in group 2 and 3 (P < 0.05). In group 1, the attenuations of the AA (P < 0.01), LM (P < 0.01), RCA (P < 0.01), LAD (P = 0.02) and LCX (P < 0.01) decreased, respectively, with an increasing heart rate. A similar finding was detected in group 3 (AA: P < 0.01, LM: P < 0.01, RCA: P < 0.01, LAD: P < 0.01and LCX: P < 0.01). In contrast, the attenuations of the AA (P = 0.55), LM (P = 0.27), RCA (P = 0.77), LAD (P = 0.22) and LCX (P = 0.74) had no significant correlation with heart rate in group 2. In all three groups, LM_CNR (P = 0.77, 0.69 and 0.73 respectively) and RCA_CNR (P = 0.75, 0.39 and 0.61 respectively) had no significant correlation with heart rate. Contrast material flow rate adjusted to heart rate can diminish the influence of heart rate on attenuations of the coronary arteries in DSCT-CCTA.     

Epicardial adipose tissue parameters for predicting coronary atherosclerotic heart disease and the degree of coronary artery stenosis in HIV infected patients北大核心CSCD

目的观察以心外膜脂肪组织(EAT)各参数预测HIV感染者冠状动脉粥样硬化性心脏病(CHD)及冠状动脉狭窄程度的价值。方法将149例HIV感染者根据存在CHD与否分为CHD组(n=97)与非CHD组(n=52),再根据冠状动脉狭窄程度将CHD组分为轻度(n=60)、中度(n=23)及重度狭窄亚组(n=14);选取52名非HIV、非CHD志愿者作为对照组。计算各组及亚组冠状动脉左前降支(LAD)、左回旋支(LCX)及右冠状动脉(RCA)周围脂肪衰减指数(FAI)、EAT体积和EAT密度;观察上述各参数预测HIV感染者CHD及冠状动脉狭窄程度的效能。结果CHD组中,各亚组RCA、LAD和LCX周围FAI差异均有统计学意义(P均<0.05),重度狭窄亚组FAI明显高于轻度狭窄亚组(P<0.05)。非CHD组RCA、LAD和LCX周围FAI均明显高于对照组(P均<0.05)。以-87.74 HU为RCA周围FAI的截断值,其预测冠状动脉重度狭窄的敏感度为83.30%,特异度为63.00%,曲线下面积(AUC)为0.75;以-72.29 HU为LAD周围FAI的截断值,其预测冠状动脉重度狭窄的敏感度为75.00%,特异度为80.20%,AUC为0.95;二者AUC差异有统计学意义(Z=2.86,P<0.01)。结论冠状动脉周围FAI可用于评估冠状动脉狭窄程度,尤以LAD周围FAI的价值最高。     

2742例不同年龄段冠脉造影患者冠脉病变特点分析

目的总结分析各年龄段患者冠状动脉造影检查（CAG）各支冠脉血管病变的特征及差异，为临床诊治提供决策。 方法回顾性分析2013年1月至2016年12月昆明医科大学第五附属医院/红河州滇南中心医院心内科住院且行CAG的患者2742例，按年龄分为青年组（18~40岁）126例，平均年龄（35.10±4.91）岁；中年组（41~65）岁1774例，平均年龄（55.00±6.60）岁；老年组（≥66岁）842例，平均年龄（71.68±4.49岁）。运用自编的"CAG检查Epidata数据库"，收集个人基本信息和冠脉数据，包括：左主干（LM）、右冠状动脉（RCA）、左前降支（LAD）、左回旋支（LCX）及各支血管的病变特征、TIMI血流情况、放置支架及手术情况，并依据美国心脏协会所制定的冠脉狭窄程度评价标准计算Gensini积分。 结果青年组、中年组和老年组患者行CAG检查的构成比分别为4.6%、64.7%、30.7%，其中以中老年人群占比最高为95.4%；3组患者男性比例（84.1%、65.8%、58.7%）、年龄[（35.10±4.91）岁、（55.00±6.60）岁、（71.68±4.49）岁]、LM病变（0.8%、5.4%、12.4%）、RCA病变（38.9%、62.5%、77.7%）、LAD病变（55.6%、81.0%、92.2%）、LCX病变（23.0%、52.5%、71.1%）比较，差异均具有统计学意义（P<0.05）；3组患者血管弥漫性病变（4.0%、5.2%、9.3%）、钙化病变（1.6%、8.2%、11.2%）、侧支循环的建立（6.3%、3.0%、15.8%）、急诊手术比例（18.3%、24.5%、20.0%）、需择期PCI术比例（6.3%、13.7%、18.9%）、手术时间[12.0（7.0，28.5）min、15.0（9.0，38.0）min、16.0（10.0，45.5）min]比较，差异均具有统计学意义（P<0.05），而3组RCA、LM/LAD、LCX是否放支架、是否有血栓形成及是否有瘤样扩张比较，差异无统计学意义（P>0.05）。3组患者3支血管（RCA、LAD、LCX）TIMI血流为3级（RCA：61.1%、86.0%、84.9%，LAD：54.8%、75.2%、82.5%，LCX：75.4%、47.9%、62.6%）、LAD病变TIMI血流为0级（15.1%、7.7%、7.6%）、LCX病变TIMI血流为1级（1.6%、0.3%、1.7%）及2级（15.9%、1.5%、2.0%）比例比较，差异均具有统计学意义（P<0.05）。3组患者冠脉病变程度Gensini评分[5.0（0，39.8）分、13.0（4.0，35.6）分、22.0（10.0，50.0）分]比较，差异具有统计学意义（P<0.05）。而RCA病变TIMI血流0级、1级与2级，LAD病变TIMI血流1级与2级，LCX病变TIMI血流0级差异无统计学意义（P>0.05）。 结论不同年龄段患者冠脉病变有差异，随着年龄的增长，冠脉病变率增加；不同年龄段LM、RCA、LAD、LCX冠脉病变比例、弥漫病变、钙化病变、侧支循环的建立及冠脉严重程度Gensini积分随着年龄的增长而增加；3支血管以LAD病变比例最高；LCX血管病变以TIMI血流1级、TIMI血流2级的血流缓慢现象差异显著。     

Volume coronary angiography using targeted scans (VCATS): a new strategy in MR coronary angiography

The aim of this study was to explore the clinical possibilities of a new strategy for magnetic resonance imaging of the coronary arteries. Thirteen patients were studied by volume coronary angiography using targeted scans (VCATS) to visualize the major coronary arteries in a series of breath-holds. The proximal coronary arteries were clearly seen in 92% and the mid segments in 50–70% of the patients. VCATS was able to visualize a total vessel length of the left main (LM) (mean: 9.4 ± 3.4 mm), of the left anterior descending (LAD) 69 ± 20 mm, of the right coronary artery (RCA) 90 ± 33 mm and of the left circumflex (LCX) 41 ± 18 mm. There was a reasonable correlation between the VCATS and conventional coronary angiography (CAG) for vessel diameter (r = 0.71), with a slight overestimation of 0.7 mm by VCATS. There were nine significant stenoses present of which six were correctly detected, three were missed and one false positive was present. VCATS is fast strategy for visualizing the major coronary artery branches and has the potential to detect significant stenoses in these branches.