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

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

  • 摘要:
    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。

     

    Abstract:
    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.

     

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