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目的以常规X线冠状动脉造影(CAG)为标准,评价16层螺旋CT在鉴别右冠状动脉(RCA)异常起源和异常行程中的价值。方法回顾性分析8例先天性RCA变异患者的多层螺旋CT造影(MSCTA)表现,其中7例有CAG资料。对比分析两者在显示RCA异位开口和异常行程方面的差异。仿真内镜技术用于评价异位开口及其与邻近正常冠状动脉开口的关系。采用多平面重组(MPR)、曲面多平面重组(CMPR)、最大密度投影(MIP)、容积成像(VR)重组方法评价冠状动脉的异常行径及其与邻近大血管的关系。CAG所显示的RCA,至少有2个不同的视角用于评价其起源和行程。结果8例患者变异的RCA全部为MSCTA所显示。其中6例患者的RCA起源于左冠状动脉窦,1例起源于左主冠状动脉的末端,另1例则起源于扩大前移的后冠窦。所有异常开口均未见狭窄。8支异常冠状动脉均穿过主动脉根部和肺动脉或右室流出道的间隙。7例CAG则仅5例显示异常。结论MSCTA显示先天性变异的RCA明显优于CAG,凡疑为冠状动脉变异的患者,可首选非创伤性的16层MSCTA检查。
Objective To evaluate the value of 16-slice spiral CT in differentiating the abnormal origin and abnormal stroke of right coronary artery (RCA) by using routine X-ray coronary angiography (CAG) as the standard. Methods Retrospective analysis of 8 cases of congenital RCA variation in patients with multi-slice spiral CT (MSCTA) performance, of which 7 cases with CAG data. The differences between the two in displaying RCA ectopic opening and abnormal stroke were compared. Emulated endoscopic technique was used to evaluate the relationship between the ectopic opening and its adjacent normal coronary artery opening. Multi-planar reconstruction (MPR), multiplanar surface reconstruction (CMPR), maximum density projection (MIP) and volumetric imaging (VR) were used to evaluate the abnormal coronary artery function and its relationship with adjacent macrovascular. The RCA shown by CAG has at least 2 different perspectives for evaluating its origin and course of travel. Results The RCA of 8 patients was all showed by MSCTA. Of the 6 patients, RCA originated in the left coronary artery, 1 in the distal part of the left main coronary artery and 1 in the posterior coronary artery. None of the abnormal openings were narrowed. Eight anomalous coronary arteries all passed through the aortic root and pulmonary artery or right ventricular outflow tract. Only 7 cases of CAG showed abnormalities. Conclusion The MSCTA showed that RCA of congenital variation was superior to that of CAG. The nontraumatic 16-slice MSCTA was the first choice in patients with suspected coronary artery variation.