成人冠状动脉解剖的三维CT研究

目的 用多层螺旋CT(MSCT)扫描三维重建方法探讨成人冠状动脉的形态、结构、变异及其与临床冠心病(CAD)发生的相关性.方法 用Toshiba Aquilion 16层螺旋CT行冠状动脉造影,通过工作站Vitrea 2软件三维重建,观察、测量成人冠状动脉的分支、位置、形态及其变异,并分析其临床意义.结果成功行MSCT冠状动脉造影的患者1057例,其中以右优势型为主,共793例;左优势型126例;其他(包括均衡型和变异)138例.MSCT能够发现冠状动脉起源和走行的多种变异,但对冠状动脉瘘的特征未能准确表现.左优势型的冠心病发病数似相对较少;但左冠状动脉主干发出角度较大,主干较短.冠状动脉开口于冠状动脉窦之外的变异与冠心病发生有正相关性.结论 MSCT能够大体准确地显示冠状动脉三维形态结构,但尚不能完全取代基础解剖学;冠状动脉的某些形态、结构变异可能造成血液动力学改变,促进临床动脉粥样硬化病变发生.

Study on adult coronary artery anatomy and its clinical correlation with 3D CT

Objective To study three-dimensional anatomy of adult coronary artery and its variations with spiral CT，and to research possible relationships of three variations to coronary artery disease(CAD). Methods Applying multi slice spiral computized tomography(MSCT) of Toshiba Aquilion，by means of the software Vitrea 2 at a workstation to 3D reconstructions of the arteries，we carefully observed and measured adult coronary arterial branches，location，figures and its variation，and then analyzed some relationships of them with the occurrence of CAD. Results There were 1057 cases of coronary arteries checked with MSCT angiography，and among them 793 cases of right dominant，126 of left dominant and 138 of other types(including balancing type). This technique could illustrate the most originations and courses of coronary arteries but coronary arterial fistula. The data indicated that the left coronary dominant type has less occurrence of CAD，whereas a larger angles of emergence of the left coronary artery，a very short main stem of the artery and a variation of the arterial debouchement were factors that have a marked positive correlativity with CAD. Conclusions MSCT could stereoscopically illustrate coronary arteries but it can not yet replace its true anatomy. Intere