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1、冠状动脉管径与分叉角度的CT冠状动脉成像研究张立仁徐冬生刘晓程吴学胜应援宁董智孙凤伟杨丕丕李旭摘要 目的 在冠状动脉CT图像上分析测量成人血管直径与血管分叉的生体信息,进一步加深对冠状动脉应用解剖的认识。方法 选择64排螺旋CT冠状动脉扫描图像质量优秀、血管完全正常的526例成人为观察对象,测量左主干及前降支、回旋支、右冠状动脉自开口至直径2 mm处每间隔1 cm处的管腔直径,计算管腔渐变率;测量大的对角支、钝缘支、锐缘支、后降支、左室后支(直径大于2 mm)开口直径,与同平面交角的主支血管直径和其上方1 cm处主干血管的直径以及分叉的角度。结果 前降支管径从开口的平均3.92 mm经过13
2、cm后移行为2.10 mm,呈逐渐变细的趋势,所有管腔的平均变化率为7.7(男性7.0,女性8.4),管腔在距开口3 5 cm处变化率最大,达8.010.0;回旋支管径从开口平均的3.57 mm经过13 cm后移行为2.10 mm,呈逐渐变细的趋势,所有管腔的平均变化率为9.7(男性9.6,女性9.7),开口至近端3 cm处管径变化率约3.0,其后各点变化在8.310.7;右冠状动脉管径从开口平均的3.97 mm经过18 cm后移行为2.15 mm,呈逐渐变细的趋势,所有管腔的平均变化率为5.1(男性4.9,女性5.3),开口至10 cm处管径变化率4.0,其后变化率加大,在6.115.2之间
3、。前降支与对角支、回旋支与钝缘支、右冠状动脉与后降支(左室后支)、右冠状动脉与锐缘支的夹角分别约为50、55、66和76。结论 64排螺旋CT冠状动脉成像可在生体上测量冠状动脉,获取三支主干血管的渐变率与最大渐变部位以及冠状动脉血管分叉的数据,进一步加深对冠状动脉应用解剖的认识。冠状血管;体层摄影术,螺旋计算机;支架Coronary artery lumen diameter and bifurcation angle derived from CT coronary angiographic image in healthy peopleZHANG Li-renXU Dong-shengLI
4、U Xiao-chengWU Xue-shengYING Yuan-ning DONG ZhiSUN Feng-weiYANG Pi-piLI XuDepartment of Radiology, TEDA International Cardiovascular Hospital, Tianjin 300457, China10. 3760/cma. j. issn. 0253-3758. 2011.12. 008300457天津,泰达国际心血管病医院放射科 Abstract Objective To observe the coronary vessel lumen diameter an
5、d bifurcation angle in subjects with normal CT coronary angiography (CTCA) imaging. Methods 64-row CT coronary angiography imaging from 526 adult people with excellent image quality and normal vascular image were analyzed in this study. The lumen diameter from the origin to distal with 2 mm lumen of
6、 left main coronary artery (LM), anterior descending branch (LAD), left circumflex branch (LCX) and right coronary artery (RCA) was measured at 1 cm interval in CPR image. The vascular tapered ratio was calculated. The bifurcation angle in the diagonal branch, obtuse marginal branch, posterior desce
7、nding branch, acute marginal branch as well as the origin diameter was also measured in VR image. Results The LAD average length was 13 cm and lumen diameter was 3.92 mm at origin and 2.10 mm at distal. The average decremented ratio of LAD was 7.7 ( male 7.0, female 8.4 ). The maximal decremented ra
8、tio 8.0 -10.0 occurred at 3 -5 cm apart from the origin of LAD. The LCX average length was 13 cm and lumen diameter was 3.57 mm at origin and 2.10 mm at distal. The average decremented ratio of LCX was 9.7( male 9.6, female 9.7 ). Lumen decremented ratio was less than 3.0 between origin and proximal
9、 3 cm and 8.3 - 10.7 in the rest portion of the LCX. The RCA average length was 18 cm and lumen diameter was 3.97 mm at origin and 2. 15 mm at distal. The average decremented ratio of RCA was 5.1(male 4.9, female 5.3 ). The decremented ratio of RCR was less than 4.0 between origin and proximal 10 cm
10、 and 6.1 - 15.2 in the rest portion. The bifurcation angle was 50, 55,66 and 76 degree for LAD with diagonal branch, LCX with obtuse marginal branch, RCA with posterior descending branch and RCA with obtuse marginal branch respectively. Conclusion Coronary artery length, lumen diameter and decrement
11、ed ratio as well as bifurcation angel could be identified in 64 row CTCA image in vivo. This information could help us to understand the in vivo coronary artery anatomy.Coronary artery ; Tomography,spiral computed ; Stent1119- 1120112111221王柏林,苗英,邱金海,等.含服硝酸甘油对64层螺旋CT冠状动脉成像质量影响的分析.中华放射学杂志,2009,43:125
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15、心脏病学杂志,2002, 10:70-71.10何静,秦永文.冠状动脉长病变PCI介入治疗现状.中国心血管病研究,2008,6:238-240.11盖鲁粤.冠状动脉分叉病变介入治疗没有解决的技术问题.中国循环杂志,2004,19:313-315. 12 Pflederer T, Ludwig J, Ropers D, et al. Measurement of coronary artery bifurcation angles by multidetector computed tomography.Invest Radiol, 2006, 41:793-798. 13 Lefvre T, Louvard Y, Morice MC,et al. Stending of bifurcation lesions: classification, treatment, and results. Catheter Cardiovasc Interv, 2000,49:274-283.14吕树錚,陈韵岱.冠脉介入诊治技巧及器械选择.2版.北京:人民卫生出版社,2006:158-249.2011-04-25中华心血管病杂志第七届编辑委员会通讯编辑委员名单
