Taylor A M, Thorne S A, Rubens M B, Jhooti P, Keegan J, Gatehouse P D, Wiesmann F, Grothues F, Somerville J, Pennell D J
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.
Circulation. 2000 Apr 11;101(14):1670-8. doi: 10.1161/01.cir.101.14.1670.
There is a high incidence of anomalous coronary arteries in subjects with congenital heart disease. These abnormalities can be responsible for myocardial ischemia and sudden death or be damaged during surgical intervention. It can be difficult to define the proximal course of anomalous coronary arteries with the use of conventional x-ray coronary angiography. Magnetic resonance coronary angiography (MRCA) has been shown to be useful in the assessment of the 3-dimensional relationship between the coronary arteries and the great vessels in subjects with normal cardiac morphology but has not been used in patients with congenital heart disease.
Twenty-five adults with various congenital heart abnormalities were studied. X-ray coronary angiography and respiratory-gated MRCA were performed in all subjects. Coronary artery origin and proximal course were assessed for each imaging modality by separate, blinded investigators. Images were then compared, and a consensus diagnosis was reached. With the consensus readings for both magnetic resonance and x-ray coronary angiography, it was possible to identify the origin and course of the proximal coronary arteries in all 25 subjects: 16 with coronary anomalies and 9 with normal coronary arteries. Respiratory-gated MRCA had an accuracy of 92%, a sensitivity of 88%, and a specificity of 100% for the detection of abnormal coronary arteries. The MRCA results were more likely to agree with the consensus for definition of the proximal course of the coronary arteries (P<0.02).
For the assessment of anomalous coronary artery anatomy in patients with congenital heart disease, the use of the combination of MRCA with x-ray coronary angiography improves the definition of the proximal coronary artery course. MRCA provides correct spatial relationships, whereas x-ray angiography provides a view of the entire coronary length and its peripheral run-off. Furthermore, respiratory-gated MRCA can be performed without breath holding and with only limited subject cooperation.
先天性心脏病患者中异常冠状动脉的发生率很高。这些异常可导致心肌缺血和猝死,或在手术干预期间受损。使用传统的X线冠状动脉造影很难确定异常冠状动脉的近端走行。磁共振冠状动脉造影(MRCA)已被证明在评估心脏形态正常的受试者冠状动脉与大血管之间的三维关系方面有用,但尚未用于先天性心脏病患者。
对25例患有各种先天性心脏异常的成人进行了研究。所有受试者均进行了X线冠状动脉造影和呼吸门控MRCA。由独立的、不知情的研究人员对每种成像方式的冠状动脉起源和近端走行进行评估。然后比较图像并达成共识诊断。根据磁共振和X线冠状动脉造影的共识读数,有可能确定所有25例受试者近端冠状动脉的起源和走行:16例有冠状动脉异常,9例冠状动脉正常。呼吸门控MRCA检测异常冠状动脉的准确率为92%,敏感性为88%,特异性为100%。MRCA结果更有可能与冠状动脉近端走行定义的共识一致(P<0.02)。
对于评估先天性心脏病患者的异常冠状动脉解剖结构,联合使用MRCA和X线冠状动脉造影可改善近端冠状动脉走行的定义。MRCA提供正确的空间关系,而X线血管造影提供整个冠状动脉长度及其外周分支的视图。此外,呼吸门控MRCA可以在无需屏气且受试者配合有限的情况下进行。