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双源CT对大动脉转位冠状动脉评估的应用价值
Assessment of coronary artery anatomy in patients with transposition of the great arteries using dual-source computed tomography
- 第三军医大学学报 2018年40卷第20期 页码：1876-1882
- 作者机构：
1.610041 成都，四川大学华西医院放射科
2.610041 成都，四川省肿瘤医院放射科
- 作者简介：
[余建群，E-mail: cjr.yujianqun@vip.163.com YU Jianqun, E-mail: cjr.yujianqun@vip.163.com
- 基金信息：
DOI：10.16016/j.1000-5404.201805041
中图分类号： R541.1;R814.42收稿：2018-05-07，
修回：2018-06-05，
纸质出版：2018-10-30
- 稿件说明：
移动端阅览
曾涵江, 徐忠孜, 张丽芝, 等. 双源CT对大动脉转位冠状动脉评估的应用价值[J]. 第三军医大学学报, 2018,40(20):1876-1882.
Hanjiang ZENG, Zhongzi XU, Lizhi ZHANG, et al. Assessment of coronary artery anatomy in patients with transposition of the great arteries using dual-source computed tomography[J]. Journal of Third Military Medical University, 2018, 40(20): 1876-1882.
曾涵江, 徐忠孜, 张丽芝, 等. 双源CT对大动脉转位冠状动脉评估的应用价值[J]. 第三军医大学学报, 2018,40(20):1876-1882. DOI： 10.16016/j.1000-5404.201805041.
Hanjiang ZENG, Zhongzi XU, Lizhi ZHANG, et al. Assessment of coronary artery anatomy in patients with transposition of the great arteries using dual-source computed tomography[J]. Journal of Third Military Medical University, 2018, 40(20): 1876-1882. DOI： 10.16016/j.1000-5404.201805041.
摘要
目的
2
探讨双源CT(dual-source computed tomography，DSCT)对大动脉转位(transposition of the great arteries，TGA)患者术前冠状动脉解剖及相关畸形的诊断价值和优势。
方法
2
回顾性分析四川大学华西医院2010年1月至2017年10月同时行双源CT和超声心动图检查的大动脉转位患者43例(TGA组)，根据TGA组年龄分布纳入该院经DSCT诊断为心脏形态和结构正常者43例作为对照组。分析大动脉转位类型、主动脉与肺动脉的空间关系、冠状动脉及相关畸形，并与手术结果对照，比较DSCT和超声心动图(transthoracic echocardiogram，TTE)诊断冠状动脉解剖结构的准确率。分析比较TGA组和对照组冠状动脉走行、冠状动脉开口与主动脉瓣距离和冠脉角。
结果
2
TGA组有34例(79%)主动脉位于肺动脉左前(AL)或右前(AR)。12例患者合并冠状动脉畸形(12/43，28%)，其中11例冠状动脉开口异常，1例冠状动脉起始部狭窄。完全性TGA最常见的冠脉类型为prR; plACx，而矫正性TGA为arR; pACx。TGA组左冠脉角和左、右冠脉至主动脉瓣距离均较对照组大(
P
<
0.01)，而右冠脉角较对照组小(
P
<
0.01)。DSCT和TTE的大血管异常诊断准确率分别为100%(43/43)、76.7%(33/43)
冠状动脉解剖结构诊断准确率分别为97.7%(42/43)、62.8%(27/43)，显示DSCT在心外畸形方面明显优于TTE。
结论
2
DSCT能客观、准确显示大动脉转位患者的冠状动脉解剖特征，对术前冠状动脉评估具有重要价值。
Abstract
Objective
2
To assess the value of dual-source computed tomography (DSCT) in preoperative diagnosis of anatomical abnormalities of the coronary artery in patients with transposition of the great arteries (TGA).
Methods
2
The clinical and image data were retrospectively analyzed for 43 patients with TGA
who underwent DSCT and transthoracic echocardiography (TTE) examination between January
2010 and October
2017 in West China Hospital. Another forty-three age-matched individuals with normal cardiac structures as confirmed by DSCT were enrolled to serve as the control group. The morphological types of TGA
the spatial relationship between the aorta and the pulmonary artery
coronary artery-associated abnormalities and accompanying defects were retrospectively assessed based on the findings by DSCT and TTE
and the diagnostic accuracy of these two modalities were determined with surgical or digital subtraction angiography (DSA) findings as the reference. The type of the coronary arteries
the distance between the coronary ostia and the aortic valve
and the coronary angle were compared between the patients with TGA and the control individuals.
Results
2
Among the 43 patients with TGA
34 (79%) had great arteries with an oblique spatial relationship shown by DSCT; 12 (28%) patients were found to have coronary artery malformations
including 11 with an abnormal coronary origin and 1 patient with stenosis of the coronary ostium. The most common coronary type of complete TGA was prR; plACx
as compared with arR; pACx in congenitally corrected transposition. The left coronary angle and bilateral coronary-aortic valve distance were significantly greater (
P
<
0.01)
while the right coronary angle was significantly smaller in TGA patients than in the control group (
P
<
0.01). According to DSA or
surgical findings
DSCT had significantly higher sensitivities than TTE in diagnosing anomalies of the great vessels (100%
vs
76.7%) and coronary artery-associated abnormalities (97.7%
vs
62.8%).
Conclusions
2
DSCT allows objective and accurate anatomical assessment of the coronary artery in patients with TGA and thus offers a valuable imaging modality for preoperative assessment of the coronary artery to assist in surgical decision-making.
关键词
Keywords
references
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