640层螺旋CT冠脉成像对心肌桥-壁冠状动脉的形态学量化评价及粥样硬化相关性分析

目的 利用640层螺旋CT冠状动脉成像对心肌桥-壁冠状动脉（MB-MCA）的形态学特征行定量分析，并探讨其与粥样硬化的关系。 方法 收集行冠状动脉成像的186例疑似冠心病患者的影像资料进行分析，若MB-MCA的诊断成立，描述MB-MCA的分布和分型，并在心脏收缩期和舒张期分别记录位于左前降支2段（LAD2）的MB-MCA的厚度以及血管直径，计算其在收缩期及舒张期的变化情况；同时分析MB-MCA粥样斑块情况。 结果 186例患者中56例（70段）存在MB-MCA，其中48段（68.6%）位于LAD2；70段MB-MCA中浅表型有44段（62.9%），深厚型有26段（37.1%）。位于LAD2的MB-MCA厚度和直径在心脏收缩期和舒张期差异均有明显变化，差异具有统计学意义（t=2.84、3.38，P均 < 0.05）；43段位于LAD2的纳入分析的MB-MCA中有28段（65.1%）为Ⅱ级狭窄。70段MB-MCA中共48段（68.6%）存在粥样斑块，其中近侧者42段（87.5%），明显高于远侧者6段（12.5%），两者之间的差异有统计学意义（t=3.12，P < 0.05）。 结论 640层螺旋CT不仅能直接显示MB-MCA的存在，同时能对其形态特点、伴随心动周期动态变化情况行量化分析，具有较高的临床价值。

Quantitative evaluation of morphological characteristics and their correlation with atherosclerosis of the myocardial bridge-mural coronary artery by 640 multi-detector spiral CT

Objective To evaluate the morphological characteristics of myocardial bridge and mural coronary artery (MB-MCA) and to discuss the correlation between atherosclerosis and MB-MCA.Methods The coronary artery imaging data of 186 with suspected coronary heart disease patients undergoing 640-slice computed tomography angiograms (CTA) were included.After the MB-MCA diagnosis was confirmed,the location and distribution of MB-MCA were recorded.The diameter and thickness of MB in the middle segment of LAD (LAD2) during the diastole and systole phases were also recorded,and changes in the MB-MCAs were calculated.In addition,the correlation between atherosclerosis and MB-MCA was discussed.Results Among the 186 patients,70 MB-MCAs were found in 56 patients(30.1％),whereas 48 MB-MCAs(68.6％) were located in LAD2.According to the MB thickness,70 patients had MB-MCAs.Among which,44 patients (62.9％) have the superficial type of MB-MCA,whereas 26 (37.1％)have the deep type.The change in the average diameter of MCA in LAD2 from the systole phase to the diastole phase was obvious and statistically significant differences(t=2.84,3.38,both P＜0.05) were observed.Notably,28 (65.1％) of the patients have MCA diameters indicative of Grade Ⅱ stenosis.Among the 70 diagnosed MB-MCA,48 segments have atherosclerosis.Atherosclerosis occurred in approximately 42 (87.5％) of the MB-MCA patients,which was higher than the occurrence of distal segments in 6 MB-MCA patients(t=3.12,P＜0.05).Conclusion A 640-slice coronary CTA directly displays MB-MCA and can be used for the quantitative analysis of morphological characteristics and changes in the cardiac cycle of MB-MCA patients to provide reliable imaging data for clinical settings.