64排螺旋CT冠状动脉成像与冠状动脉造影对心肌桥诊断价值的探讨

摘要

Objective To explore the value of 64 multi-slice CT arteriography and coronary angiography in the diagnosis of myocardial bridge-mural coronary artery. Methods 912 patients were collected and their coronary arteries were examined by 64 multi-slice CT and coronary angiography(CAG). The result that whether the myocardial bridgemural coronary arteries existed would be evaluated by CT and CAG diagnosticians, and Kappa test as well as paired t test would be adopted to judge the significant difference. Results The CT diagnosticians found 121 myocardial bridgemural coronary arteries in 104 patients, in which there were 42 deep ones as well as 79 superficial ones. The CAG diagnosticians found that there were 114 myocardial bridge-mural coronary arteries in 97 patients, there were 42 deep ones as well as 72 superficial ones. The average length of the deep ones of CTA and CAG was (11. 25 ± 4. 20) mm vs (9. 56 ± 3. 67) mm. The stegnotic extent of mural coronary arteries of deep ones was CTA(50 ± 12)% vs CAG(59 ± 12)%(all P <0.01). The average length of superficial ones of CTA and CAG was (7.39 ± 3.02) mm vs (5.54 ± 2.18) mm. The stegnotic extent of mural coronary arteries of superrficial ones was CTA(31 ± 10)% vs CAG(38 ± 11)%. The concordance of Kappa was best in diagnosing deep ones and superficial ones by CTA or CAG( Kappa = 1.000,0.877). Conclusion CTA can diagnose exactly the existence of superficial myocardial bridge-mural coronary artery and measure the length of myocardial bridge, while CAG does better in measuring the stegnotic extent of mural coronary.%目的 探讨64排螺旋CT血管造影(CTA)与冠状动脉造影(CAG)对心肌桥诊断的应用价值.方法 912例患者先后进行CTA检查和CAG检查,判断有无心肌桥-壁冠状动脉存在,将两者结果进行Kappa检验和配对t检验,判断两者间差异有无统计学意义.结果 CTA发现104例患者共121段存在心肌桥-壁冠状动脉,其中深在型心肌桥-壁冠状动脉42段,浅表型心肌桥-壁冠状动脉79段;而CAG发现97例患者共114段存在心肌桥-壁冠状动脉,其中深在型心肌桥-壁冠状动脉42段,浅表型心肌桥-壁冠状动脉72段.两者相比较,诊断深在型及浅表型心肌桥-壁冠状动脉两者Kappa一致性好(Kappa=1.000、0.877),42段深在型-壁冠状动脉心肌桥长度CTA(11.25±4.20)mm vs CAG(9.56±3.67)mm,壁冠状动脉狭窄程度CTA(50±12)％vs CAG(59±12)％(均P＜0.01);72段浅表型-冠状动脉心肌桥长度CTA(7.39±3.02)mm vs CAG(5.54±2.18)mm,壁冠状动脉狭窄程度CTA(31±10)％vs CAG(38±11)％(均P＜0.01).结论 CTA能够诊断各型心肌桥-壁冠状动脉存在以及准确测量心肌桥长度,而测量壁冠状动脉狭窄程度则CAG优于CTA.