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目的探讨16层螺旋CT(MSCT)冠状动脉造影诊断先天性单冠状动脉畸形的价值。资料与方法回顾性分析4例先天性单冠状动脉患者的MSCT和常规X线冠状动脉造影(CCA)资料,对比两者在显示和诊断此病中的差异。仿真内镜技术用于评价异位开口及其与邻近正常冠状动脉开口的关系,多平面重建、曲面多平面重建、最大密度投影、容积成像等重建方法则用于评价变异冠状动脉的行径及其与邻近大血管的关系。结果4例患者变异的冠状动脉全部为MSCT造影所显示并明确诊断。MSCT显示3例患者的左主干起源于右冠状动脉的近段,其中1例在CCA中左主干仅近段局部显影,未能明确诊断,另2例左冠状动脉虽显影,但较淡。1例右冠状动脉起源于左主干的末端,CCA则误为起源于回旋支。MSCT显示2例异常开口冠状动脉的近段狭窄,3支异常冠状动脉穿过主动脉根部和肺动脉或右室流出道的间隙,1支绕主动脉根部后方走行,而CCA均不能明确诊断。结论MSCT显示先天性单冠状动脉明显优于CCA,凡疑及冠状动脉变异的患者,可首选非创伤性的MSCT冠状动脉造影检查。
Objective To investigate the value of 16-slice spiral CT (MSCT) coronary angiography in the diagnosis of congenital single coronary artery disease. Materials and Methods Data of MSCT and routine X-ray coronary angiography (CCA) were analyzed retrospectively in 4 patients with congenital single coronary artery. The difference between the two in displaying and diagnosing the disease was retrospectively analyzed. The simulation endoscopic technique was used to evaluate the relationship between the ectopic opening and the adjacent normal coronary artery opening. Multiplanar reconstruction, multiplanar reconstruction, maximum density projection, volume imaging and other reconstruction methods were used to evaluate the variation of coronary artery Relationship with adjacent large vessels. Results All the 4 patients with variant coronary arteries were all shown by MSCT angiography and were definitely diagnosed. MSCT showed that the left main stem of the three patients originated in the proximal segment of the right coronary artery. One of the three cases showed partial development of the proximal left main trunk in CCA, which failed to confirm the diagnosis. The other two left coronary arteries were developed but lighter. One case of right coronary artery originated in the terminal of left main trunk, while CCA mistakenly originated in circumflex branch. MSCT showed two cases of proximal stenosis of anomalous open coronary artery, three anomalous coronary artery through the aortic root and pulmonary artery or right ventricular outflow tract gap, a branch around the aortic root rear, and CCA can not be a clear diagnosis. Conclusion MSCT shows that congenital single coronary artery is superior to CCA, and that noninvasive MSCT coronary angiography is the first choice in patients with suspected coronary artery disease.