多層螺旋CT 對先天性右冠狀動脈
起始變異的評價
史河水 韓萍 孔祥泉 馮敢生 Hans-Juergen Brambs Martin H. K. Hoffmann
【摘要】 目的 以常規X 線冠狀動脈造影( CAG) 為標準, 評價16 層螺旋CT 在鑒別右冠狀動脈
( RCA) 異常起源和異常行程中的價值。方法 回顧性分析8 例先天性RCA 變異患者的多層螺旋CT
造影( MSCTA) 表現, 其中7 例有CAG 資料。對比分析兩者在顯示RCA 異位開口和異常行程方面的
差異。仿真內鏡技術用于評價異位開口及其與鄰近正常冠狀動脈開口的關系。采用多平面重組
( MPR) 、曲面多平面重組( CMPR) 、最大密度投影( MIP) 、容積成像( VR) 重組方法評價冠狀動脈的異
常行徑及其與鄰近大血管的關系。CAG 所顯示的RCA, 至少有2 個不同的視角用于評價其起源和行
程。結果 8 例患者變異的RCA 全部為MSCTA 所顯示。其中6 例患者的RCA 起源于左冠狀動脈
竇, 1 例起源于左主冠狀動脈的末端, 另1 例則起源于擴大前移的后冠竇。所有異常開口均未見狹
窄。8 支異常冠狀動脈均穿過主動脈根部和肺動脈或右室流出道的間隙。7 例CAG 則僅5 例顯示異
常。結論 MSCTA 顯示先天性變異的RCA 明顯優于CAG, 凡疑為冠狀動脈變異的患者, 可首選非創
傷性的16 層MSCTA 檢查。
【關鍵詞】 體層攝影術, X 線計算機; 冠狀血管造影術; 冠狀血管畸形
Evaluation of r ight cor onar y anomalous or igin with mulpi-slice spiral CT SHI He-shui* , HAN
Ping, KONG Xiang-quan, FENG Ga n-sheng, Ha ns-Juergen Brambs, Martin H. K. Hoffmann. * Department
of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430022, China
【Abstra ct 】 Obj ective To evaluate the role of 16-slice spiral computed tomography angiography
( MSCTA) to identify the anomalous origin and anatomic course of the right coronary artery ( RCA) with
conventional X-ray coronary angiography ( CAG) serving as standard of reference. Methods MSCTA data
in 8 patients with anomalous RCA were retrospectively analyzed for the study, 7 of them had also undergone
CAG examinations. MSCTA and CAG images were analyzed in blinded fashion for accuracy of anomalous
artery origin and path detection. Results were compared in a secondary consensus evaluation. Virtual
endoscopy ( VE) was used to evaluate the orifice of the anomalous arteries and its relationship with the
adjacent ostia of normal arteries. Multi-planar reconstruction ( MPR) , curved MPR, thin-slab maximum
intensity projection ( MIP) , volume rendering ( VR) or slab VR ( cut-plane VR) were used to assess the
aberrant path of the RCA and its relationship with the adjacent large vessels. At least two views of the RCA
were analyzed on CAG. Results The anomalous RCA for all 8 patients were correctly displayed on
MSCTA. RCA originated from the left sinus of Valsalva in 6 patients, one RCA from the end of left main
coronary artery, another RCA arose from the posterior sinus of Valsalva. The anomalous ostia showed no
stenosis. All of them passed between the aortic root and the pulmonary artery. For 7 patients with CAG alone
correct identification of the abnormality was achieved in only 71% . Conclusion MSCTA was superior to
show the anomalous orifice and path of the RCA, it should be considered as a prime non-invasive imaging
tool for suspected coronary anomalies.
【Key wor ds】 Tomography, X-ray Computed; Coronary angiography; Coronary vessel anomalies

多層螺旋CT 對先天性右冠狀動脈--心血管.rar