正常成人冠状静脉的多层螺旋计算机断层摄影术定量研究
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摘要
目的:采用多层螺旋计算机断层摄影术(MSCT)测量正常成人冠状静脉的定量研究。方法:回顾性分析2015-09至2016-05在我院行MSCT冠状动脉成像检查、临床可疑冠心病或无症状体检95例受试者。95例受试者按照性别因素分为男性组(n=40)与女性组(n=55);又按照年龄分为≤45岁组(n=32)、45~65岁组(n=33)和≥65岁组(n=30)三组。行MSCT冠状动脉成像结果并未发现冠状动脉病变(无冠状动脉畸形、变异,均为右冠优势型)的原始图像选取心动周期舒张期(75%)进行重建,定量测量冠状静脉窦及其主要属支开口径线、截面积,并对各测量值与性别、年龄组进行统计学分析。结果:(1)冠状静脉窦、后室间静脉、左心室后静脉、左边缘静脉显示率分别为100%、100%、98%及46%。(2)男女受试者的冠状静脉窦、后室间静脉、左心室后静脉、左边缘静脉直径及截面积比较;≤45岁组与45~65岁组和≥65岁组受试者比较,冠状静脉窦、后室间静脉、左边缘静脉的直径及截面积均较小,差异均有统计学意义(P均<0.05),45~65岁组与≥65岁组比较,差异无统计学意义(P>0.05)。(3)冠状静脉窦口上下径、冠状静脉窦口面积、冠状静脉窦口直径、冠状静脉窦口前后径,后室间静脉直径、左心室后静脉直径、左边缘静脉直径,后室间静脉面积、左心室后静脉面积、左边缘静脉面积95%参考值范围分别为:11.95~13.09 mm,61.10~76.94 mm~2,8.54~9.54 mm,8.38~9.35 mm;3.41~3.97 mm,3.10~3.56 mm,2.02~2.45 mm;10.41~14.08 mm2,7.84~10.39 mm~2,3.39~5.04 mm~2。结论:MSCT可客观定量测量冠状静脉窦及其主要属支开口径线、冠状静脉截面积,为临床成功实行心脏介入手术提供重要影像参考价值。
Objectives: To quantitatively measure the coronary sinus, mainly branch diameter,sectional area in normal adults by multislice computed tomography(MSCT) and analyze the relationship between the above imaging indexes and the gender and age. Methods: A total of 95 subjects(40 men, 55 women; mean age 53.93±14.08 years) examined by MSCT due to suspected coronary heart disease or routine health check-up between September 2015 and May 2016 were included in this study. Coronary artery disease was excluded by MSCT in this cohort: no coronary artery deformity, variation, and all presented with right dominant type of coronary artery and subjects also had no other heart diseases. Diastolic image(75%) of the original image was reconstructed, and quantitative measurements of coronary sinus, mainly branch diameter,sectional area were performed, and the relationship between the above imaging indexes and the gender and age were analyzed. Results: 1. The display rate of coronary sinus(CS), posterior interventricular vein(PIV), left ventricular posterior vein(PVLV), the left marginal vein(LMV) were 100%, 100%, 98% and 46%, respectively. 2. There was no significant difference between gender in the diameter and sectional area of CS, PIV and LMV(P >0.05). 3. 95 patients were divided into three groups according to their age: Group A(≤ 45)years, n=32; Group B(45-65) years, n=33; and Group C(>65) years, n=30.Coronary sinus vertical diameter(CSVD), left ventricular posterior veins diameter(PVLVD) and left ventricular posterior veins sectional area(PVLVS) were similar among various age group(P >0.05). There were significant differences among the three groups in coronary sinus in anteroposterior diameter(CSAD), coronary sinus diameter(CSD), coronary sinus sectional area(CSS), posterior interventricular vein diameter(PIVD), posterior interventricular vein sectional area(PIVS),the left marginal vein diameter(LMVD) and the left marginal vein sectional area(LMVS), P<0.05. There were significant differences between group A and group B, C(P<0.05). However, values were similar between group B and C, P>0.05. 4. The 95% reference ranges of CSVD, CSS, CSD, CSAD,PIVD, PVLVD, LMVD,PIVS, PVLVS, LMVS were(11.95-13.09) mm,(61.10-76.94) mm~2,(8.54-9.54) mm,(8.38-9.35) mm and(3.41-3.97) mm,(3.10-3.56) mm,(2.02-2.45) mm and(10.41-14.08) mm2,(7.84-10.39)mm~2,(3.39-5.04)mm~2, respectively. Conclusions: MSCT supply objective quantitative measurement of coronary vein main branch diameter, coronary vein sectional area, these measurements might be valuable for the successful implementation of cardiac intervention or surgery by providing the important image reference values of coronary sinus venous system.
Objectives: To quantitatively measure the coronary sinus, mainly branch diameter,sectional area in normal adults by multislice computed tomography(MSCT) and analyze the relationship between the above imaging indexes and the gender and age. Methods: A total of 95 subjects(40 men, 55 women; mean age 53.93±14.08 years) examined by MSCT due to suspected coronary heart disease or routine health check-up between September 2015 and May 2016 were included in this study. Coronary artery disease was excluded by MSCT in this cohort: no coronary artery deformity, variation, and all presented with right dominant type of coronary artery and subjects also had no other heart diseases. Diastolic image(75%) of the original image was reconstructed, and quantitative measurements of coronary sinus, mainly branch diameter,sectional area were performed, and the relationship between the above imaging indexes and the gender and age were analyzed. Results: 1. The display rate of coronary sinus(CS), posterior interventricular vein(PIV), left ventricular posterior vein(PVLV), the left marginal vein(LMV) were 100%, 100%, 98% and 46%, respectively. 2. There was no significant difference between gender in the diameter and sectional area of CS, PIV and LMV(P >0.05). 3. 95 patients were divided into three groups according to their age: Group A(≤ 45)years, n=32; Group B(45-65) years, n=33; and Group C(>65) years, n=30.Coronary sinus vertical diameter(CSVD), left ventricular posterior veins diameter(PVLVD) and left ventricular posterior veins sectional area(PVLVS) were similar among various age group(P >0.05). There were significant differences among the three groups in coronary sinus in anteroposterior diameter(CSAD), coronary sinus diameter(CSD), coronary sinus sectional area(CSS), posterior interventricular vein diameter(PIVD), posterior interventricular vein sectional area(PIVS),the left marginal vein diameter(LMVD) and the left marginal vein sectional area(LMVS), P<0.05. There were significant differences between group A and group B, C(P<0.05). However, values were similar between group B and C, P>0.05. 4. The 95% reference ranges of CSVD, CSS, CSD, CSAD,PIVD, PVLVD, LMVD,PIVS, PVLVS, LMVS were(11.95-13.09) mm,(61.10-76.94) mm~2,(8.54-9.54) mm,(8.38-9.35) mm and(3.41-3.97) mm,(3.10-3.56) mm,(2.02-2.45) mm and(10.41-14.08) mm2,(7.84-10.39)mm~2,(3.39-5.04)mm~2, respectively. Conclusions: MSCT supply objective quantitative measurement of coronary vein main branch diameter, coronary vein sectional area, these measurements might be valuable for the successful implementation of cardiac intervention or surgery by providing the important image reference values of coronary sinus venous system.
引文
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[2]支爱华,张沛,戴汝平,等.冠状静脉窦闭锁的诊断与临床意义[J].中国循环杂志,2015,30(5):478-481.DOI:10.3969/j.issn.1000-3614.2015.05.016.
[3]孙占国,唐光才,黄新文,等.64层螺旋CT冠状静脉系统心动周期不同时相形态学对比研究[J].实用放射学杂志,2008,24(9):1210-1214.DOI:10.3969/j.issn.1002-1671.2008.09.016.
[4]王筱梅,王照谦,贾崇富,等.心房颤动者冠状静脉窦形态学的多层螺旋计算机断层摄影术研究[J].中国循环杂志,2008,23(6):438-440.
[5]Koos R,Sinha AM,Markus K,et a1.Comparison of left ventricular lead placement via the coronary venous approach versus lateral thoracotomy in patients receiving cardiac resynchronization therapy[J].Am J Cardiol,2004,94(1):59-63.DOI:10.1016/j.amjcard.2004.03.031.
[6]Saremi F,Muresian H,Sánchez-Quintana D.Coronary veins:comprehensive CT-anatomic classification and review of variants and clinical implications[J].Radiographics,2012,32(1):31-32.DOI:10.1148/rg.321115014.
[7]Hasdemir Can.Cardiac resynchronization therapy:implantation tips and tricks[J].Anadolu Kardiyol Derg,2007,7:53-56.
[8]Rizzo V,di Maio F,Petretto F,et al.Ambulatory pulse pressure,left ventricular hypertrophy and function in arterial hypertension[J].Echocardiography,2004,21(1):11-16.