双源CT在先天性冠状动脉起源异常的临床应用

罗立镇 刘东旭 赵欣

【摘要】 目的：探討双源CT在先天性冠状动脉起源异常的临床应用价值。方法：回顾性分析2014年1月-2018年11月本院冠脉CTA 6 307例的检查结果，统计先天性冠状动脉起源异常的类型、数量，分析其发生率。同时对40例已知先天性冠状动脉起源异常需随访复查患者随机分成A、B两组，每组20例，复查时A组进行前瞻性心电触发序列扫描，B组进行回顾性心电门控螺旋扫描，评估两种成像方法的辐射剂量及图像质量。结果：6 307例冠脉CTA中，先天性冠状动脉起源异常77例，检出率1.22%。其中冠状动脉高位起源22例，右冠状动脉起源于左冠状动脉窦25例，左冠状动脉起源于右冠状动脉窦3例，左回旋支独立起源于右冠状动脉窦5例，左冠状动脉起源于无冠状动脉窦2例，左主干缺如18例，单支冠状动脉2例。检查患者心率为56～121次/min，A组较B组辐射剂量明显降低，差异有统计学意义（P<0.05）。两组图像质量评分比较，差异无统计学意义（P>0.05）。结论：双源CT在检查先天性冠状动脉起源异常方面具有很高的临床应用价值，检查前不需要控制心率，前瞻性心电触发序列扫描和回顾性心电门控螺旋扫描均能提供优质图像质量，但前者辐射剂量明显降低。

【关键词】 双源CT; 先天性冠状动脉起源异常; 图像质量; 辐射剂量

【Abstract】 Objective：To explore the clinical application value of dual-source CT in congenital coronary artery origin abnormality.Method：Retrospectively analyzed the results of 6 307 cases of coronary CTA in our hospital from January 2014 to November 2018.The types and numbers of congenital anomalies of coronary artery origin were counted and the incidence was analyzed.At the same time，40 patients with known congenital anomalous origin of coronary artery were randomly divided into two groups，20 cases in each group.Prospective ECG trigger sequence scanning was performed in group A，and retrospective ECG-gated spiral scanning was performed in group B the radiation dose and image quality of the two imaging methods were evaluated.Result：Among the 6 307 cases of coronary CTA，77 cases had congenital abnormal origin of coronary artery，the detection rate of 1.22%.Coronary artery origin of high were 22 cases，right coronary artery from the left coronary sinus of 25 cases，the left coronary artery from the right coronary sinus of 3 patients ，left circumflex branch independent originated from the right coronary sinus of 5 cases ，left coronary artery from without coronary sinus of 2 cases ，left main deficiency such as 18 cases ，single coronary artery of 2 cases .The heart rate of the patients was 56-121 beats/min，the radiation dose of group A was significantly lower than that of group B，the difference was statistically significant（P<0.05）.There was no statistically significant difference between the two groups of the image quality scores（P>0.05）.Conclusion：Dual-source CT has a very high clinical application value in the detection of congenital coronary artery origin abnormality，and the heart rate does not need to be controlled before the examination.Both prospective ecg triggering sequence scanning and retrospective ecg controlled spiral scanning can provide excellent image quality，but the radiation dose of the former is significantly reduced.

【Key words】 Dual-source CT; Congenital coronary artery origin anomaly; Image quality; Radiation dose

First-authors address：Foshan Chancheng District Center Hospital，Foshan 528031，China

doi：10.3969/j.issn.1674-4985.2019.16.019

正常冠状动脉起源于左、右冠状动脉窦中部，先天性冠状动脉起源异常即冠状动脉开口解剖位置发生变异，可能是一种具有潜在威胁生命的解剖学上的变异，先天异常的发生率约为1%多[1-5]。较多研究者对于冠状动脉起源良性、恶性异常达……