Bachmann束及其血供的双源CT冠状动脉成像表现

目的 探讨健康志愿者(对照组)和冠状动脉病变(CAL)患者Bachmann束(BB)及其血供的双源CT冠状动脉成像(DSCTCA)形态学特征.方法 分析206名受检者(对照组100例,CAL组106例)的临床病史、ECG和DSCTCA影像,CAL组患者均行冠状动脉造影(CCA),采用Gensini评分系统评价CCA结果,按照Gensini积分的三分位间距将CAL患者分为3组(35例:0.00～9.33分;36例:9.34～33.34分;35例:33.35～258.00分).对BB的长度、宽度、上下径、CT值和血供进行研究.连续变量用秩和检验,类别变量采用联列表的x2检验.结果 (1)对照组BB显示率(86.0%,86/100)高于CAL组(51.9%,55/106;x2=27.726,P＜0.01);CAL各亚组中Gensini评分越高组其BB的显示率越低80.0%(28/35)、55.6%(20/36)、20.0%(7/35);x2=25.530,P＜0.01].(2)对照组和CAL组BB各径线测量值(长度、宽度、上下径的中位数分别为:13.0和13.8、5.0和5.2、5.9和6.2 mm;P值均＞0.05).(3)对照组BB区域CT值(中位数42.6 HU)高于CAL组(中位数13.0 HU;Z=-7.061,P＜0.01),CAL组BB未显示患者BB区域CT值(中位数-16.0 HU)低于BB显示者(中位数32.5 HU;Z=-6.530,P＜0.01)CAL组BB区域CT值与Gensini积分(中位数19.0)呈负相关(r=-0.553,P＜0.01).(4)BB及BB区域的血供主要来自右窦房结动脉(SNA,58.7%,121/206),其次是左SNA(35.9%,74/206)和双侧SNA(5.3%,11/206).结论 DSCTCA可以了解BB及其血供的解剖特点.CAL程度越严重,BB的显示率越低,ECG异常的发生率越高,提示BB病变的发生可能与局部缺血有关.

Abstract：

Objective To investigate the morphologic features of Bachmann bundle (BB) and its vascular supply on dual-source CT coronary angiography(DSCTCA) in healthy volunteers and patients with coronary artery lesion (CAL). Methods Clinical histories, electrocardiograms (ECGs), and images of DSCTCA of 106 patients ( CAL group) and 100 healthy volunteers ( Control group) were reviewed. All 106 patients underwent conventional coronary angiography ( CCA ). The Gensini scoring system was used to assess the results of CCA. The patients were divided into three groups according to their Gensini scores. The length, width and superoinferior diameter, CT value, and vascular supply of BB were studied. Rank sum test for continuous variables and Chi-square test for categorical variables were used in statistical analysis.Results ( 1 ) BB visualization rate of control group was higher than CAL group 86.0% (86/100) vs 51.9%(55/106), x2 = 27.726, P ＜ 0.01]. The higher the Gensini score of CAL subgroup, the lower the visualization rate of its BB 80.0% ( 28/35 ), 55.6% ( 20/36 ), 20.0% ( 7/35 ), x2 = 25.530, P ＜ 0.01].(2)The median of measurements of length,width and superoinferior diameter of control and CAL group were 13.0 vs 13.8,5.0 vs 5.2 and 5.9 vs 6.2 mm, respectively ( P ＞ 0.05 ). (3) The CT value of the BB region in control group( median :42.6 HU ) was higher than that of CAL group( median: 13.0 HU) ( Z = - 7.061, P ＜0.01). The CT values of BB regions in patients with nonvisualized BB (median: -16.0 HU) were lower. The CT values of the BB regions in CAL group were negatively-correlated with Gensini scores( median:19.0) (r = -0.553, P ＜0.01 ). (4)The blood supply of BB and BB region was provided by right sinuatrial node artery ( SNA, 58.7%, 121/206 ), left SNA ( 35.9%, 74/206 ) or both SNAs ( 5.3%, 11/206 ).Conclusions DSCTCA could can show the anatomical characteristics of BB and its arterial supply. The serious the degree of CAL , the lower the BB display rate, and the higher the abnormal ECG incidence,which indicate that the occurrence of BB lesions is probably related to ischemia.

Imaging findings of Bachmann bundle and its arterial supply on dual-source CT coronary angiography

Objective To investigate the morphologic features of Bachmann bundle (BB) and its vascular supply on dual-source CT coronary angiography(DSCTCA) in healthy volunteers and patients with coronary artery lesion (CAL). Methods Clinical histories, electrocardiograms (ECGs), and images of DSCTCA of 106 patients ( CAL group) and 100 healthy volunteers ( Control group) were reviewed. All 106 patients underwent conventional coronary angiography ( CCA ). The Gensini scoring system was used to assess the results of CCA. The patients were divided into three groups according to their Gensini scores. The length, width and superoinferior diameter, CT value, and vascular supply of BB were studied. Rank sum test for continuous variables and Chi-square test for categorical variables were used in statistical analysis.Results ( 1 ) BB visualization rate of control group was higher than CAL group 86.0% (86/100) vs 51.9%(55/106), x2 = 27.726, P ＜ 0.01]. The higher the Gensini score of CAL subgroup, the lower the visualization rate of its BB 80.0% ( 28/35 ), 55.6% ( 20/36 ), 20.0% ( 7/35 ), x2 = 25.530, P ＜ 0.01].(2)The median of measurements of length,width and superoinferior diameter of control and CAL group were 13.0 vs 13.8,5.0 vs 5.2 and 5.9 vs 6.2 mm, respectively ( P ＞ 0.05 ). (3) The CT value of the BB region in control group( median :42.6 HU ) was higher than that of CAL group( median: 13.0 HU) ( Z = - 7.061, P ＜0.01). The CT values of BB regions in patients with nonvisualized BB (median: -16.0 HU) were lower. The CT values of the BB regions in CAL group were negatively-correlated with Gensini scores( median:19.0) (r = -0.553, P ＜0.01 ). (4)The blood supply of BB and BB region was provided by right sinuatrial node artery ( SNA, 58.7%, 121/206 ), left SNA ( 35.9%, 74/206 ) or both SNAs ( 5.3%, 11/206 ).Conclusions DSCTCA could can show the anatomical characteristics of BB and its arterial supply. The serious the degree of CAL , the lower the BB display rate, and the higher the abnormal ECG incidence,which indicate that the occurrence of BB lesions is probably related to ischemia.