摘要
目的探讨冠状动脉左主干病变(LMCD)的双源CTA影像特征及临床应用。方法回顾性分析经双源CTA诊断的LMCD患者33例,分析其临床资料,按照左主干>50%,左前降支、回旋支或右冠状动脉≥70%定义目标血管,经CT图像后处理,于心脏短轴层面观察节段心肌密度,分析其影像特点,同期行CAG,术后随访3个月。结果 33例患者中,双源CTA确定目标血管75支,以CAG为金标准,CTA诊断主要血管病变72支,准确率96.00%(72/75),9支(9/33,27.27%)冠状动脉左主干为单纯LMCD,24支(24/33,72.73%)LMCD合并其他主要血管病变,其中20支冠状动脉左主干合并末端岔口病变。29例(29/33,87.88%)例患者46节段CTA显示心肌密度减低,23例34节段位于心内膜下,6例12节段为透壁性。对42支(42/75,56.00%)血管行经皮冠状动脉介入治疗(PCI),其中22支病变局限、行单纯PCI,20支为左主干末端岔口病变、行PCI同时覆盖左前降支或回旋支开口。13支(13/75,17.33%)采用冠状动脉旁路移植术,20支(20/75,26.67%)采用药物保守治疗,随访3个月,未发现主要不良心血管事件。结论冠状动脉双源CTA可发现LMCD部位及范围,发现其他血管病变及异常血流灌注的节段心肌,为临床病情评估及治疗提供客观依据。
Objective To evaluate the imaging characteristics and clinical value of left main coronary disease（LMCD）with dual-source CTA（DSCTA）.Methods Clinical data from 33 patients with LMCD diagnosed by DSCTA were analyzed retrospectively.The target vessels were defined by left main coronary（LM）50%,left anterior descending branch（LAD）,left circumflex artery（LCX）or right coronary artery（RCA）≥70%.In post-processing images,the segmental myocardium density was analyzed at the short axial plane,and then the imaging characteristics were analyzed.The CAG was performed in the same time period,the patients were followed up 3months,and then the clinical value was evaluated.Results There were 75 vessels diagnosed with DSCTA,the accuracy was 96.00%（72/75）contrast to the gold standard of CAG.There were 9vessels（9/33,27.27%）of LM only with LMCD,24vessels（24/33,72.73%）accompanied with other vessel lesions.Among the total of the 24 vessels,20vessels of LM were accompanied with the fork lesions.There were 29cases（29/33,87.88%）with low density in 46 segments,23cases were locating at the subendocardial myocardium in 34 segments,6cases at the transmural myocardium in 12 segments,42target vessels（42/75,56.00%）underwent percutaneous coronary intervention,including 22 vessels with simple stent implantation,20 vessels of LM with the stent overlapping the peristome of LAD or LCX,13vessels（13/75,17.33%）underwent coronary artery bypass grafting,20vessels（20/75,26.67%）underwent drug conservative treatment.There was no any major adverse cardiovascular event in 3 months follow-up.Conclusion DSCTA can not only find the lesion position,the range of LM,and the lesions of other major vasculars,but also find abnormal perfusion of segmental myocardium,which can be used to provide objective clues for the assessment and treatment.
出处
《中国介入影像与治疗学》
CSCD
北大核心
2016年第5期297-301,共5页
Chinese Journal of Interventional Imaging and Therapy
基金
湖北省自然科学基金(WJ2015MB170)
