摘要
目的评价多排螺旋CT冠状动脉成像的同时显示冠状静脉窦(CS)形态学特征及在相关疾病中的临床应用价值。方法利用多排螺旋CT扫描171例受检者(高血压组43例,冠心病组40例,高血压并发冠心病组47例,对照组41例),使冠状静脉显影,将图像数据进行三维重建和容积再现等后处理,在轴位上测量冠状静脉窦出口(CSO)最大横径(D1);垂直于CS中心线的斜矢状位上测量CS直径[上下径(D2)和前后径(D3)];平行于CS的斜位上测量CS直径(D4);采用血管分析测量距离CSO 0、10、15、30 mm处CS的直径及血管分析CS长度(D5、D6、D7、D8、D9);左心室后静脉或左心房斜静脉汇入处或CS突然变细处CS的直径(D10)。结果 171例患者进行冠状动脉成像的同时CS及其分支在心脏舒张期(75%R-R间期)能很好地显影。高血压组D1(10.79±2.08)mm、D2(9.77±1.63)mm、D3(8.72±1.48)mm、D4(10.07±1.64)mm、D6(10.07±1.64)mm、D7(9.02±1.76)mm、高血压冠心病组D1(10.99±2.02)mm、D2(9.81±1.63)mm、D3(8.98±1.75)mm、D4(10.36±1.88)mm、D6(9.50±1.94)mm、D7(9.09±1.98)mm,均与对照组D1(8.49±1.84)mm、D2(8.63±1.40)mm、D3(7.46±1.37)mm、D4(9.14±1.57)mm、D6(8.33±1.87)mm、D7(8.03±1.72)mm比较,具有统计学差异(P<0.05),但是D5(P=0.215)、D8(P=0.162)、D9(P=0.083)、D10(P=0.072)变化不显著,无统计学意义;冠心病组与对照组之间CS各参数变化不显著,无统计学差异;四组CS长度比较,差异无统计学意义。结论多排螺旋CT冠状动脉成像能够无创性同时显示冠状动脉和冠状静脉,在观察冠状动脉疾患的同时,通过后处理技术可以清楚显示冠状静脉窦形态学特征,并可以观察冠状动脉、CS及其分支之间的解剖关系。高血压患者和由于高血压引起冠心病患者可以使CS形态学发生改变,为电生理介入治疗提供解剖学依据。
Objective To evaluate MDCT on coronary artery imaging at the same time showing the coronary sinus morphological characteristics and clinical value in related diseases. Methods 171 patients were divided into four groups: 43 patients of hypertension, 40 patients of coronary heart disease(CHD), 47 patients of hypertension complicated with coronary heart disease, 41 patients without hypertension or CHD(the control group). All the 171 patients had MDCT examinations, the coronary artery imaging(CTA) and coronary vein angiography images were got, then we performed post-processing technologies such as multiple planar reconstruction(MPR) and volume rendering(VR) and so on. On the axial image we measured the maximum transverse diameter(D1) of coronary sinus ostium(CSO); On the oblique sagittal image which was perpendicular to the the centerline of coronary sinus(CS) we measured the diameter of CS: the distance from top to bottom was D2, the anteroposterior diameter was D3; On the oblique image parallel to the CS we measured the CS diameter(D4); The diameter of the CS where was 0 mm, 10 mm, 15 mm, 30 mm away from the CSO was D5, D6, D7, D8, D9 respectively, and we measured the length of CS; The diameter of the CS where the posterioor vein of the left ventricle or the oblique vein of left atrium converged with CS or where the CS got thinner suddently was D10. Results All the 171 patients with coronary artery imaging can get excellent image of CS and its branches was in cardiac diastolic period(75% RR interval). The numbers of patients of hypertension was D1 10.79±2.08, D2 9.77±1.63, D3 8.72±1.48, D4 10.07±1.64, D6 10.07±1.64, D7 9.02±1.76, the numbers of patients of high blood pressure complicated with coronary heart disease was D1 10.99±2.02, D2 9.81±1.63, D3 8.98±1.75, D4 10.36±1.88, D6 9.50±1.94, D7 9.09±1.98, the numbers of the control group was D1 8.49±1.84, D2 8.63±1.40, D3 7.46±1.37, D4 9.14±1.57, D6 8.33±1.87, D7 8.03±1.72, the D1, D2, D3, D4, D6, D7 had a significant difference between the patients of hypertension and the control group, the patients of high blood pressure complicated with coronary heart disease and the control group(P<0.05), but there was no significant difference in D5(P=0.215), D8(P=0.162), D9(P=0.083), D10(P=0.072); The parameters of the diameter of CS had no significant difference between the patients of coronary heart disease and the control group; The length of CS had no significant difference the four groups. Conclusions MDCT coronary artery imaging(CTA) can provide excellent images of coronary artery and coronary sinus all at once by a non-invasive way, and can show the morphological character of CS clearly by post-processing technique, we can observe the anatomic relationship of coronary artery, CS and its branches. The morphology of CS in patients with hypertension and patients with hypertension complicated with coronary heart disease had changed, which can provide anatomical evidence for cardiac electrophysiological treatment.
出处
《中华临床医师杂志（电子版）》
CAS
2016年第20期3037-3042,共6页
Chinese Journal of Clinicians(Electronic Edition)
关键词
冠状窦
体层摄影术
X线计算机
冠心病
高血压
Coronary sinus
Tomography
X-ray computed
Coronary disease
Hypertension
