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目的探讨心肌桥-壁冠状动脉(MB-MCA)的多层螺旋CT(MSCT)诊断和与冠脉硬化的关系。方法应用64层螺旋CT对可疑冠心病(CHD)者,行冠状动脉血管成像(CTA),3名CT诊断医师独立判断MB-MCA的存在,结果一致时确定为MB-MCA。测量壁冠状动脉(MCA)长度、肌桥(MB)厚度,结果用平均数±标准差表示,记录MB-MCA近、远段血管形态变化。根据这三项指标,提出载MB-MCA冠脉积分计算方法。确定载MB-MCA冠脉硬化情况,应用秩和统计分析,判断血管硬化与MB-MCA的关系。结果900例可疑CHD者,冠脉CTA发现MB-MCA167例(18.56%,167/900),180处。MB-MCA位于左前降支者占92.78%(167/180)。MSCT显示MCA可被心肌完全包绕(36.11%,65/180)或不完全包绕(63.89%,115/180)。MCA长度为18.7mm±10.2mm。MB厚度为1.7mm±1.2mm。70%的MCA前段和/或远段邻近血管走行迂曲成角。载MB-MCA冠脉积分评分方法MCA长度<10mm、MB不全包绕血管、邻近血管平滑,每项1分;MCA长度10~20mm、MB<1mm、邻近血管一侧成角,每项2分;MCA程度>20mm、MB>1mm、邻近血管近、远段两侧成角,每项3分。167例中,88例可见冠状动脉硬化征象(52.69%),统计学结果提示载MB-MCA冠脉硬化与MB-MCA形态积分无明显相关(u=1.234,P>0.05)。结论64层螺旋CT可用于判断MB-MCA和载MB-MCA冠脉的结构特征;临床怀疑CHD者MB-MCA检出率为18.56%;载MB-MCA冠脉硬化与MB-MCA形态积分无明显相关。
Objective To investigate the relationship between multi-slice spiral CT (MSCT) diagnosis and coronary atherosclerosis in myocardial bridge-wall coronary artery (MB-MCA). Methods The presence of MB-MCA was independently evaluated by 64-slice spiral CT in suspected coronary heart disease (CHD), coronary artery angiography (CTA) and three CT diagnosticians. MB-MCA was determined when the results were consistent. The length of coronary artery (MCA) and the thickness of muscle bridge (MB) were measured. The results were expressed as mean ± standard deviation, and the morphological changes of proximal and distal segments of MB-MCA were recorded. According to these three indicators, MB-MCA coronary artery integral calculation method is proposed. To determine the status of MB-MCA coronary atherosclerosis, rank sum statistical analysis to determine the relationship between vascular sclerosis and MB-MCA. Results Among 900 suspected CHD patients, 167 (18.56%, 167/900) MB-MCA were found in coronary CTA, 180 cases. MB-MCA located in the left anterior descending branch accounted for 92.78% (167/180). MSCT showed that MCA could be completely surrounded by myocardium (36.11%, 65/180) or incompletely wound (63.89%, 115/180). MCA length of 18.7mm ± 10.2mm. MB thickness of 1.7mm ± 1.2mm. Seventy percent of MCA’s anterior and / or distal segments of adjacent vessels travel tortuous angulations. The length of MCA coronary artery integral score method is less than 10mm, the MB is incomplete and surrounds the blood vessel, adjacent to the blood vessel is smooth, each one point; MCA length 10 ~ 20mm, MB <1mm, angulation adjacent to the side of the blood vessel, ; MCA degree> 20mm, MB> 1mm, adjacent to the blood vessels near the distal angled sides, each 3 points. Among 167 cases, 88 cases showed signs of coronary atherosclerosis (52.69%). There was no significant correlation between MB-MCA coronary atherosclerosis and MB-MCA (u = 1.234, P> 0.05). Conclusion 64-slice spiral CT can be used to judge the structural characteristics of MB-MCA and MB-MCA coronary artery. The clinical suspicion of MB-MCA in CHD was 18.56%. The integral of MB-MCA and MB-MCA Obviously related.