CAJ | 학술논문

目的利用SPECT/CT完成同机核素MPI和CTCA,探讨冠状动脉(简称冠脉)心肌桥(MB)对心肌血液供应的影响.方法回顾性分析2008年3月至2013年3月间294例以胸闷、胸痛或心悸为主要症状、接受MPI及同机CTCA检查的患者资料,筛选出冠脉MB患者49例[男26例,女23例,年龄32～85(55.4±16.6)岁].统计MB和缺血发生部位;将MPI和CTCA图像进行融合,对融合图像上MB-壁冠脉穿行心肌缺血区域、且CAG证实该区域供血冠脉不存在粥样斑块所致管腔狭窄者,判定心肌缺血为MB所致.利用x2检验比较不同部位MB引发心肌缺血改变的发生率差异.结果 49例冠脉MB患者中,MB位于前降支近段3例,前降支中段34例,前降支远段4例,间隔支3例,回旋支远段2例,中间支1例,右冠脉近中段2例;MPI显示心肌缺血41例(缺血部位46处),其中心尖部3例,前壁心尖部5例,前壁中部17例,间隔心尖部4例,前间隔中部3例,前侧壁中部2例,下侧壁中部2例,下侧壁基底段4例,下壁近心尖部3例,下壁基底段3例;融合图像示MB引发的心肌缺血有32例,其中23例由前降支中段MB所致.MB位于好发部位组(前降支中段,34例)与非好发部位组(15例)的心肌缺血发生率分别为67.6％ (23/34)和60.0％(9/15),差异无统计学意义(x2=0.27,P＞0.05).结论左冠脉前降支中段是MB的好发部位,不同部位的MB引发心肌缺血的发生率无显著差异.MPI/CTCA融合影像可同时探测心肌缺血和冠脉MB的部位,判断MB对心肌血液供应的影响.
목적 이용SPECT/CT완성동궤핵소MPI화CTCA,탐토관상동맥(간칭관맥)심기교(MB)대심기혈액공응적영향.방법 회고성분석2008년3월지2013년3월간294례이흉민、흉통혹심계위주요증상、접수MPI급동궤CTCA검사적환자자료,사선출관맥MB환자49례[남26례,녀23례,년령32～85(55.4±16.6)세].통계MB화결혈발생부위;장MPI화CTCA도상진행융합,대융합도상상MB-벽관맥천행심기결혈구역、차CAG증실해구역공혈관맥불존재죽양반괴소치관강협착자,판정심기결혈위MB소치.이용x2검험비교불동부위MB인발심기결혈개변적발생솔차이.결과 49례관맥MB환자중,MB위우전강지근단3례,전강지중단34례,전강지원단4례,간격지3례,회선지원단2례,중간지1례,우관맥근중단2례;MPI현시심기결혈41례(결혈부위46처),기중심첨부3례,전벽심첨부5례,전벽중부17례,간격심첨부4례,전간격중부3례,전측벽중부2례,하측벽중부2례,하측벽기저단4례,하벽근심첨부3례,하벽기저단3례;융합도상시MB인발적심기결혈유32례,기중23례유전강지중단MB소치.MB위우호발부위조(전강지중단,34례)여비호발부위조(15례)적심기결혈발생솔분별위67.6％ (23/34)화60.0％(9/15),차이무통계학의의(x2=0.27,P＞0.05).결론 좌관맥전강지중단시MB적호발부위,불동부위적MB인발심기결혈적발생솔무현저차이.MPI/CTCA융합영상가동시탐측심기결혈화관맥MB적부위,판단MB대심기혈액공응적영향.
Objective To evaluate the cause of ischemia related to myocardial bridge (MB) by using SPECT/CT MPI and CTCA.Methods A total of 294 patients with chest pain,tightness or palpitation undergoing both CTCA and MPI were retrospectively enrolled in this study from March 2008 to March 2013.Among them,49 patients (26 males,23 females,age:32-85 (55.4± 16.6) years) had MB.Locations of MB and myocardial ischemia were recorded.Fused MPI/CTCA was analyzed.If there was no mural atherosclerotic plaque-related stenosis on CAG at the same location of coronary artery where ischemic myocardium was found,then MB was considered as the ischemic cause.Myocardial ischemia rates of different MB locations were compared by x2 test.Results Among 49 patients with MB,3 cases had MB in proximal segment of LAD,34 in mid LAD,4 in distal LAD,3 in septal branch,2 in distal LCX,1 in intermedius,and 2 in mid RCA.There were 41 cases with myocardial ischemia.Myocardial ischemia in 32 cases was caused by MB,including 23 caused by MB in mid LAD.The myocardial ischemia rates of the most common MB location (mid LAD,n =34) and other locations (n =15) were not significantly different (67.6％ (23/34) vs 60.0％ (9/15),x2 =0.27,P＞0.05).Conclusions MB is commonly found in the mid LAD.The myocardial ischemia rates caused by MB is not related the MB location.Hybrid MPI/CTCA could evaluate the sites of coronary MB and myocardial ischemia simultaneously and therefore may be useful to evaluate the relationship between MB and myocardial ischemia.