多层螺旋计算机断层扫描测量冠状动脉分叉角度
Measurement of coronary artery bifurcation angles by multidetector computed tomography.
作者信息
Pflederer Tobias, Ludwig Josef, Ropers Dieter, Daniel Werner G, Achenbach Stephan
机构信息
Department of Internal Medicine II (Cardiology), University of Erlangen, Erlangen, Germany.
出版信息
Invest Radiol. 2006 Nov;41(11):793-8. doi: 10.1097/01.rli.0000239318.88270.9f.
OBJECTIVE
Optimal stent deployment in coronary artery bifurcations requires information about the angle between main vessel and side branch. We evaluated the accuracy and interobserver variability of bifurcation angle measurements by contrast-enhanced 16-slice multidetector computed tomography (MDCT) in comparison with invasive angiography and examined the average angles of 4 main coronary bifurcations.
METHODS
To determine the accuracy of MDCT for measurement of bifurcation angles, we scanned a coronary artery phantom containing 6 bifurcations (2-mm metal rods with angles between 25 degrees and 90 degrees ) using MDCT, and angles determined in the MDCT data set were compared with the true values. To assess interobserver variability of angle measurements in comparison to invasive angiography, the angles of 3 bifurcation sites (left anterior descending and left circumflex coronary artery [LAD/LCX], LAD and first diagonal branch [LAD/Diag 1], and posterior descending coronary artery and right posterolateral branch [PDA/Rpld]) were determined in 15 patients both in 16-detector row MDCT data sets and invasive coronary angiograms by 2 independent observers each. To assess the natural distribution of the 4 main coronary artery bifurcation angles (LAD and LCX, LAD and Diag 1, LCX and OM1, PDA and Rpld), the average angles of these bifurcations were determined in 16-slice MDCT data sets acquired for coronary artery visalization in a group of 100 consecutive patients with suspected coronary artery disease.
RESULTS
The phantom study revealed a mean difference between measured and true angles of 0.7 +/- 0.5 degrees . In the comparison MDCT versus invasive angiography, the 45 angles were significantly lager in MDCT (mean: 66 +/- 20 degrees vs. 56 +/- 24 degrees , P = 0.027). Interobserver variability was significantly lower in MDCT (r = 0.91) than invasive angiography (r = 0.62). Analysis of the natural distribution of bifurcation angles by MDCT revealed average values of 80 +/- 27 degrees (LAD/LCX), 46 +/- 19 degrees (LAD/Diag1), 48 +/- 24 degrees (LCX/OM1), and 53 +/- 27 degrees (PDA/Rpld), respectively.
CONCLUSION
MDCT allows assessment of coronary bifurcation angles with high accuracy, which may be of future potential for planning interventional treatment.
目的
冠状动脉分叉处支架的最佳置入需要了解主血管与分支血管之间的夹角信息。我们通过对比增强16层多排螺旋计算机断层扫描（MDCT）评估了分叉角测量的准确性和观察者间的变异性，并与有创血管造影进行比较，同时研究了4个主要冠状动脉分叉的平均角度。
方法
为确定MDCT测量分叉角的准确性，我们使用MDCT扫描了一个包含6个分叉（角度在25度至90度之间的2毫米金属棒）的冠状动脉模型，并将MDCT数据集中测得的角度与真实值进行比较。为评估与有创血管造影相比角度测量的观察者间变异性，两名独立观察者分别在15例患者的16排MDCT数据集和有创冠状动脉造影中确定3个分叉部位（左前降支和左旋支冠状动脉[LAD/LCX]、LAD和第一对角支[LAD/Diag 1]以及后降支冠状动脉和右后外侧支[PDA/Rpld]）的角度。为评估4个主要冠状动脉分叉角（LAD和LCX、LAD和Diag 1、LCX和OM1、PDA和Rpld）的自然分布，在一组100例连续怀疑患有冠状动脉疾病的患者中，对用于冠状动脉可视化的16层MDCT数据集中这些分叉的平均角度进行了测定。
结果
模型研究显示，测量角度与真实角度的平均差值为0.7±0.5度。在MDCT与有创血管造影的比较中，MDCT测得的45个角度明显更大（平均值：66±20度对56±24度，P = 0.027）。MDCT中观察者间的变异性（r = 0.91）明显低于有创血管造影（r = 0.62）。通过MDCT对分叉角自然分布的分析显示，平均值分别为80±27度（LAD/LCX）、46±19度（LAD/Diag1）、48±24度（LCX/OM1）和53±27度（PDA/Rpld）。
结论
MDCT能够高精度地评估冠状动脉分叉角，这可能对未来介入治疗的规划具有潜在价值。
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