冠状动脉慢性完全闭塞病变计算机断层扫描血管成像的形态学特征

目的分析冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)在双源计算机断层扫描(computed tomography,CT)血管成像上的形态学特点,并评估具有指导经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗价值的形态学特征。方法回顾性分析经冠状动脉造影(coronary angiography,CAG)证实为CTO病变患者的术前冠状动脉CT血管成像(coronary computed tomography angiography,CCTA)影像资料。评估并记录CCTA上所显示的各形态学指标,包括病变位置、闭塞血管长度、闭塞段血管近端呈钝形、闭塞段血管出现钙化;与CAG结果相比较,分析两者间显示的差异。结果80例患者(82个CTO病变)CCTA结果显示82支血管闭塞,CCTA诊断CTO病变的敏感度为95.12%,特异度为97.14%;冠状动脉CTO病变45例(54.88%)位于右冠状动脉,CCTA测量闭塞段长度显著小于CAG测量所得,差异具有统计学意义(28.29±14.15)mm vs.(38.90±23.48)mm,P<0.001]。CCTA显示闭塞段血管近端呈钝形19例(23.17%),与CAG对照一致。CCTA显示58个(70.73%)CTO病变闭塞段血管内可见点状、结节状、条片状钙化灶,而CAG显示闭塞段血管存在钙化55个(67.07%),两者间比较差异无统计学意义(P>0.05)。结论双源CT诊断冠状动脉CTO病变有较高敏感度及特异度,且可以显示闭塞段长度,近端形态及闭塞段钙化等有利于指导PCI治疗的形态学特征。

Morphological characteristics of computed tomography angiography for chronic total coronary artery occlusion

Objectives To analyze the morphological characteristics of coronary chronic total occlusion(CTO) on dual-source computed tomography(CT) angiography,and to evaluate the morphological characteristics that had the value of guiding percutaneous coronary intervention(PCI).Methods The coronary computed tomography angiography(CCTA) imaging data in CTO confirmed by coronary angiography(CAG) were retrospectively analyzed.The morphological index of CCTA,including lesion location,lesion length,a blunt stump at the entry,calcification in any route of the CTO lesion were evaluated.The differences between CCTA and CAG were analyzed.Results Eighty-two coronary artery occlusion vessels were found from 80 patients with 82 leisions.The sensitivity of CCTA for the diagnosis of CTO was 95.12%,and the specificity was 97.14%.Forty-five cases(54.88%) of CTO were located in the right coronary artery.Lesion length of CTO measured by CCTA were significantly shorter than that by CAG and the difference was statistically significant (28.29±14.15) mm vs.(38.90±23.48) mm,P<0.001].CCTA showed a blunt stump at the entry in 19 cases(23.17%),consistent with the CAG control group.CCTA showed that 58(70.73%) CTO lesions had pointlike nodular calcification in occlusive segment,similar to that of CAG group 55(67.07%)](P>0.05).Conclusions Dual-source CT can show the characteristics of CTO with high sensitivity and specificity for its diagnosis.The morphological features of CT,such as the lesion length,proximal cap morphology and calcification are helpful to guiding the intervention therapy for CTO.