【作者】 王建华；

【导师】 黄海青；

【作者基本信息】 南京中医药大学 ， 中西医结合临床（专业学位）， 2014， 硕士

【摘要】 目的：探讨多排螺旋CT冠状动脉成像对冠状动脉变异临床应用中的价值。方法：回顾性分析2012年8月-2014年3月间在江苏省中医院放射科行冠状动脉CTA检查的患者数目,共1356人,其中发现冠状动脉变异者共69人,发现存在变异的数目有82处;69名患者中男性37人,女性32人,年龄43-76岁,平均58.7±10.3岁。其中5人患者无任何症状,52人患者自感胸闷、气短,55人有心悸病史,57人有高血压病史,35人有冠心病病史,4人检查前曾被超声心动图诊断先天性心脏病。检查完后由两名放射科CTA专项高年质医生对图像质量进行评分后,再在飞利浦CT后处理工作站用冠状动脉CTA分析专用软件包对原始图像进行后处理重建,对患者多期图像分别进行容积重现(VR)、多平面重建(MPR)、最大密度投影(MIP)和曲面重建(CPR)等多种方法重建观察,选取显示最佳的一期或多期图像进行仔细观察分析,最终判定患者冠状动脉变异的数目、位置及类型。结果：在本组病例中我们发现右冠状动脉高位开口的病例2例,右侧冠状动脉开口在左冠窦的3例,并且这三例患者均合并有右侧冠状动脉起始部壁内冠状动脉变异,右侧副冠状动脉15例；左冠状动脉主干高位开口4例,左冠状动脉主干缺如的5例,左冠状动脉旋支开口于右冠状窦2例；心肌桥42例,其中有7人存在不止1处的心肌桥,浅表型心肌桥37例,有5例为深埋型心肌桥；冠状动脉瘘2例,一例为左冠状动脉前降支肺动脉瘘,另一例为左冠前降支右心室瘘；冠状动脉未发育及发育不良共9例,其中左旋支发育不良最多见,为4例。所有类型冠脉变异均在多期重建图像上得到二位医生的证实。结论：128层MSCT冠状动脉成像可清晰显示冠状动脉变起源、行程、终止等各项变异表现,可为临床医生提供具有很高诊断价值的影像图片,使临床医生可以直观、清晰、准确、方便的对患者冠状动脉变异的情况进行判定,引导临床进行合理诊疗。更多还原

【Abstract】 Objective:To discuss the value of 128 slice spiral CT for evaluation of coronary artery anomalies.Methods:Retrospective analysis of 2012 August -2014 year in March the number of images in radiology Jiangsu Province of Traditional Chinese Medicine Hospital coronary artery CTA examination, a total of 1356 people, which found that coronary artery anomalies were a total of 69 people, found that the number of mutations in 82 patients; 69 patients were 37 male,32 female, age 43-76 years old, average 58.7±at the age of 10.3. Among the 5 patients without any symptoms,52 patients felt chest tightness, shortness of breath, palpitation history 55,57 have a history of hypertension,35 had coronary heart disease, have been Beckoning diagram of ultrasonic diagnosis of congenital heart disease 4 people before the examination. After the check by two radiology CTA special high quality doctors on the image quality was scored, then in Philips CT workstation with coronary artery CTA analysis software package of the original image post-processing, the patients with multiple phase images were volume rendering (VR) multi planar reconstruction (MPR), maximum intensity projection (MIP) and curved planar reconstruction (CPR) methods reconstruction observation.Results:In these cases we found the right high origin of coronary artery in 2 cases, the right coronary artery in 3 patients with The left coronary sinus, the three patients were complicated with variation of the right coronary artery intramural coronary artery,15 cases of right accessory coronary artery; left coronary artery main stem high opening in 4 cases,5 patients with left main coronary artery agenesis, left circumflex coronary artery opening in the right coronary sinus in 2 cases; 42 cases of myocardial bridge, superficial myocardial bridge in 37 cases,5 cases of deep buried myocardial bridge; 2 cases of coronary artery fistula, a cases of left anterior descending coronary artery pulmonary artery fistula, another case of left anterior descending coronary artery right ventricle fistula; undeveloped and dysplasia in 9 cases.Conclusion:128 slice MSCT coronary artery imaging can clearly show the anomalous origin of coronary artery stroke, and abnormal termination, can provide the image has a very high value for clinicians.更多还原