摘要
目的:利用双源CT观察心肌桥(MB)的出现率和解剖病理学特征,探讨其检出的临床意义。材料与方法:2006年12月～2007年3月,共有272例患者因怀疑冠状动脉疾病或体检而进行了双源CT冠状动脉血管成像(DSCTCA)检查。根据美国心脏病学会的冠状动脉分段标准确认其有无、位置和解剖病理学改变。根据DSCTCA表现及临床症状,将所有病例分为3组:1组,合并冠状动脉疾病组;2组,无冠状动脉疾病但有临床症状组;3组,无冠状动脉疾病也无临床症状组。对3组患者MB的解剖学特点进行统计学处理。15例患者进行了常规冠状动脉造影(CAG),观察两组MB检出率的差别。随机选择10例前降支MB患者进行4D电影显示以观察MB在心动周期内的变化情况。结果:272例进行了DSCTCA的患者中,63例检出79支MB,出现率为23.2%(63/272)。MB的平均长度为(2.14±0.83)cm,深度为(0.33±0.10)cm。63例中,49例(78%,49/63)患者为单支MB,其中7段29支,8段17支,9段1支,16段2支;12例(19%,12/63)为双支MB,其中以7段和8段共存最常见(42%,5/12);2例(3%,2/63)3支MB。79支MB中,40支位于7段,24支位于8段,7支位于9段,4支位于16段,3支位于13段,1支位于10段。3组患者之间的统计学分析显示,1组患者的年龄明显大于2组和3组(P=0.001),MB更长(P=0.041),深度更深(P=0.021)。CAG提示4支MB,而DSCTCA显示20支MB,两者之间的差别有统计学意义(P<0.001)。10例MB患者的4D电影显示MB收缩期变窄,舒张期恢复正常,类似CAG的"挤牛奶"效应。结论:本组冠状动脉MB的检出率为23.2%。利用DSCTCA可以可靠而生动地检测MB,确认其解剖病理学改变,解释一些患者的临床症状,在可疑冠状动脉疾病患者的处理中有重要的临床意义。
Objective： To observe the prevalence and anatomical features of myocardial bridging（MB） on dual-source computed tomography （DSCT）, and to discuss their clinical significance. Material and Methods： Between December 2006 and March 2007, 272 patients with suspected coronary artery disease or others were referred to undergo DSCT coronary angiography（DSCTCA）. Coronary arteries were segmented according to the guideline of the American Heart Association（AHA）. The presence, locations, and associated pathological lesions of MB were recorded. All patients with MB on DSCTCA were subdivided into three groups according to DSCTCA findings and their clinical symptoms： first group, patients with MB associated with coronary lesions （atherosclerosis or stent）; second group, patients with clinical symptoms but without coronary lesions; third group, patients without demonstrated coronary lesions and clinical symptoms. Fifteen patients underwent conventional coronary angiography（CAG）. Anatomical features and diagnostic accuracy of MB on DSCTCA were analyzed using SPSS 11.5 version. 4D cine mode was performed in 10 patients with MB selected randomly to observe changes of MB in the entire cardiac cycle. Results： Sixty-three patients had MB in the 272 patients who underwent DSCTCA, giving the prevalence of 23.2% （63/272）. Seventy-nine MB were detected with the mean length of （2.14±0.83）cm and mean depth of （0.33±0.10）cm. Of the 63 patients with MB, 49 patients with single MB （78%, 49/63）; 29 in 7 segment, 17 in 8 segment, 1 in 9 segment, 2 in 16 segment. Twelve patients had double MB（19%, 12/63）, which was common in both 7 and 8 segment（42%, 5/12）. Two patients had triple MB（3%, 2/63）. Of the 79 MB, 40 in 7 segment, 24 in 8 segment, 7 in 9 segment, 4 in 16 segment, 3 in 13 segment, and 1 in 10 segment. Statistical analysis showed the patients in group 1 were older than those in groups 2 and 3（P=0.001）, and with longer and deeper MB （P=0.041, 0.021, respectively）. Four MB showed in 15 patients who underwent CAG; however, 20 MB were detected on DSCT in the 15 patients, with two consistent MB on both methods （P〈0.001）. 4D cine mode showed typical ＂milking effect＂ induced systolic compression of tunneled segment. Conclusions： The prevalence of MB in this study is 23.2%. DSCTCA can be used to show MB reliably and vividly, to demonstrate associated lesions of coronary arteries, and to uncover some patients symptoms with important value in the management of suspected coronary diseases.
出处
《中国临床医学影像杂志》
CAS
北大核心
2007年第12期874-878,共5页
Journal of China Clinic Medical Imaging
