双源CT在先天性冠状动脉起源异常的临床应用
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摘要
目的:探讨双源CT在先天性冠状动脉起源异常的临床应用价值。方法:回顾性分析2014年1月-2018年11月本院冠脉CTA 6 307例的检查结果,统计先天性冠状动脉起源异常的类型、数量,分析其发生率。同时对40例已知先天性冠状动脉起源异常需随访复查患者随机分成A、B两组,每组20例,复查时A组进行前瞻性心电触发序列扫描,B组进行回顾性心电门控螺旋扫描,评估两种成像方法的辐射剂量及图像质量。结果:6 307例冠脉CTA中,先天性冠状动脉起源异常77例,检出率1.22%。其中冠状动脉高位起源22例,右冠状动脉起源于左冠状动脉窦25例,左冠状动脉起源于右冠状动脉窦3例,左回旋支独立起源于右冠状动脉窦5例,左冠状动脉起源于无冠状动脉窦2例,左主干缺如18例,单支冠状动脉2例。检查患者心率为56～121次/min,A组较B组辐射剂量明显降低,差异有统计学意义(P<0.05)。两组图像质量评分比较,差异无统计学意义(P>0.05)。结论:双源CT在检查先天性冠状动脉起源异常方面具有很高的临床应用价值,检查前不需要控制心率,前瞻性心电触发序列扫描和回顾性心电门控螺旋扫描均能提供优质图像质量,但前者辐射剂量明显降低。
Objective:To explore the clinical application value of dual-source CT in congenital coronary artery origin abnormality.Method:Retrospectively analyzed the results of 6 307 cases of coronary CTA in our hospital from January 2014 to November 2018.The types and numbers of congenital anomalies of coronary artery origin were counted and the incidence was analyzed.At the same time,40 patients with known congenital anomalous origin of coronary artery were randomly divided into two groups,20 cases in each group.Prospective ECG trigger sequence scanning was performed in group A,and retrospective ECG-gated spiral scanning was performed in group B the radiation dose and image quality of the two imaging methods were evaluated.Result:Among the 6 307 cases of coronary CTA,77 cases had congenital abnormal origin of coronary artery,the detection rate of 1.22%.Coronary artery origin of high were 22 cases,right coronary artery from the left coronary sinus of 25 cases,the left coronary artery from the right coronary sinus of 3 patients,left circumflex branch independent originated from the right coronary sinus of 5 cases,left coronary artery from without coronary sinus of 2 cases,left main deficiency such as 18 cases,single coronary artery of 2 cases.The heart rate of the patients was 56-121 beats/min,the radiation dose of group A was significantly lower than that of group B,the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups of the image quality scores(P>0.05).Conclusion:Dual-source CT has a very high clinical application value in the detection of congenital coronary artery origin abnormality,and the heart rate does not need to be controlled before the examination.Both prospective ecg triggering sequence scanning and retrospective ecg controlled spiral scanning can provide excellent image quality,but the radiation dose of the former is significantly reduced.
Objective:To explore the clinical application value of dual-source CT in congenital coronary artery origin abnormality.Method:Retrospectively analyzed the results of 6 307 cases of coronary CTA in our hospital from January 2014 to November 2018.The types and numbers of congenital anomalies of coronary artery origin were counted and the incidence was analyzed.At the same time,40 patients with known congenital anomalous origin of coronary artery were randomly divided into two groups,20 cases in each group.Prospective ECG trigger sequence scanning was performed in group A,and retrospective ECG-gated spiral scanning was performed in group B the radiation dose and image quality of the two imaging methods were evaluated.Result:Among the 6 307 cases of coronary CTA,77 cases had congenital abnormal origin of coronary artery,the detection rate of 1.22%.Coronary artery origin of high were 22 cases,right coronary artery from the left coronary sinus of 25 cases,the left coronary artery from the right coronary sinus of 3 patients,left circumflex branch independent originated from the right coronary sinus of 5 cases,left coronary artery from without coronary sinus of 2 cases,left main deficiency such as 18 cases,single coronary artery of 2 cases.The heart rate of the patients was 56-121 beats/min,the radiation dose of group A was significantly lower than that of group B,the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups of the image quality scores(P>0.05).Conclusion:Dual-source CT has a very high clinical application value in the detection of congenital coronary artery origin abnormality,and the heart rate does not need to be controlled before the examination.Both prospective ecg triggering sequence scanning and retrospective ecg controlled spiral scanning can provide excellent image quality,but the radiation dose of the former is significantly reduced.
引文
[1]Jaydip D,Charles S,Robert C,et al.Anomalous coronary arteries in adults:depiction at multi-detector row CTangiography[J].Radiology,2005,235(3):812-818.
[2]鲍红梅,苏雪娟,李运奇,等.双源CT冠状动脉成像检出冠状动脉起源异常的价值[J].中国社区医师,2012,14(15):293.
[3]Zhu X,Chen W,Li M,et al.Contrast material injection protocol with the flow rate adjusted to the heart rate for dual source CTcoronary angiography[J].Int J Cardiovasc Imaging,2012,28(6):1557-1565.
[4]张娣,武新英,张娅梅,等.二代双源CT冠状动脉成像对冠状动脉起源异常的诊断价值[J].江苏医药,2015,41(24):2994-2998.
[5]蔡军,张龙江,卢光明,等.1879例成人非先天性心脏病患者双源CT检出的冠状动脉起源异常24例分析[J].医学影像学杂志,2009,19(8):973-977.
[6]魏丹,王鹏,王宪雯,等.冠状动脉异常起源的CTA表现及分型[J].中国临床医学影像杂志,2014,25(11):168-771.
[7]戴沁怡,吕飙,张兆琪.64层螺旋CT诊断先天性冠状动脉异常起源[J].中华放射学杂志,2006,40(8):804-807.
[8]吴瑛,姚民,高润霖,等.成人冠状动脉造影中动脉起源异常分析[J].中华心血管病杂志,2004,32(7):587-591.
[9]姚倩东,王虎,郑敏之,等.双源CT在冠状动脉起源异常诊断中的应用[J].中国临床医学影像杂志,2010,21(12):848-851.
[10]黄美萍,崔燕海,刘辉,等.64层CT检测婴幼儿左侧冠状动脉起源于肺动脉[J].中国医学影像技术,2009,25(12):2232-2235.
[11]Drighil A,Chraibi S,Bennis A,et al.Adult type anomalous origin of the left coronary artery from the pulmonary artery:when should we be aware[J].Int J Cardiol,2006,113(3):e119-e121.
[12]Angelini P.Anomalous origin of the left coronary artery from the pulmonary artery:the location of the ectopic ostium and the course of the proximal left coronary artery make a difference[J].Tex Heart Inst J,2008,35(1):36-37.
[13]李建民,朱莉.冠状动脉起源异常的研究进展[J/OL].中华临床医师杂志(电子版),2013,7(3):1205-1208.
[14]马国军,于淑靖,李忠信.64层螺旋CT对冠状动脉起源异常及预后的评价[J].中国临床医学影像杂志,2007,18(8):537-539.
[15]Wong A J,Habib F K.A variant epidermal growth factor receptor protein is similarly expressed in benign hyperplastic and carcinomatous prostatic tissues in black and white men[J].West Afr J Med,2007,26(1):42-47.
[16]孙宏亮,任安,于洪伟,等.256层螺旋CT对成人冠状动脉起源异常的诊断价值[J].中华全科医学,2011,9(10):1622-1624.
[17]王秀平,夏建国,张波.冠状动脉起源异常的双源CT冠状动脉成像影像表现分析[J].现代医用影像学,2014,23(1):48-51.
[2]鲍红梅,苏雪娟,李运奇,等.双源CT冠状动脉成像检出冠状动脉起源异常的价值[J].中国社区医师,2012,14(15):293.
[3]Zhu X,Chen W,Li M,et al.Contrast material injection protocol with the flow rate adjusted to the heart rate for dual source CTcoronary angiography[J].Int J Cardiovasc Imaging,2012,28(6):1557-1565.
[4]张娣,武新英,张娅梅,等.二代双源CT冠状动脉成像对冠状动脉起源异常的诊断价值[J].江苏医药,2015,41(24):2994-2998.
[5]蔡军,张龙江,卢光明,等.1879例成人非先天性心脏病患者双源CT检出的冠状动脉起源异常24例分析[J].医学影像学杂志,2009,19(8):973-977.
[6]魏丹,王鹏,王宪雯,等.冠状动脉异常起源的CTA表现及分型[J].中国临床医学影像杂志,2014,25(11):168-771.
[7]戴沁怡,吕飙,张兆琪.64层螺旋CT诊断先天性冠状动脉异常起源[J].中华放射学杂志,2006,40(8):804-807.
[8]吴瑛,姚民,高润霖,等.成人冠状动脉造影中动脉起源异常分析[J].中华心血管病杂志,2004,32(7):587-591.
[9]姚倩东,王虎,郑敏之,等.双源CT在冠状动脉起源异常诊断中的应用[J].中国临床医学影像杂志,2010,21(12):848-851.
[10]黄美萍,崔燕海,刘辉,等.64层CT检测婴幼儿左侧冠状动脉起源于肺动脉[J].中国医学影像技术,2009,25(12):2232-2235.
[11]Drighil A,Chraibi S,Bennis A,et al.Adult type anomalous origin of the left coronary artery from the pulmonary artery:when should we be aware[J].Int J Cardiol,2006,113(3):e119-e121.
[12]Angelini P.Anomalous origin of the left coronary artery from the pulmonary artery:the location of the ectopic ostium and the course of the proximal left coronary artery make a difference[J].Tex Heart Inst J,2008,35(1):36-37.
[13]李建民,朱莉.冠状动脉起源异常的研究进展[J/OL].中华临床医师杂志(电子版),2013,7(3):1205-1208.
[14]马国军,于淑靖,李忠信.64层螺旋CT对冠状动脉起源异常及预后的评价[J].中国临床医学影像杂志,2007,18(8):537-539.
[15]Wong A J,Habib F K.A variant epidermal growth factor receptor protein is similarly expressed in benign hyperplastic and carcinomatous prostatic tissues in black and white men[J].West Afr J Med,2007,26(1):42-47.
[16]孙宏亮,任安,于洪伟,等.256层螺旋CT对成人冠状动脉起源异常的诊断价值[J].中华全科医学,2011,9(10):1622-1624.
[17]王秀平,夏建国,张波.冠状动脉起源异常的双源CT冠状动脉成像影像表现分析[J].现代医用影像学,2014,23(1):48-51.