Medcenter One, 300 N. Seventh St., Bismarck, ND 58501, USA.
Int J Cardiovasc Imaging. 2012 Aug;28(6):1525-32. doi: 10.1007/s10554-011-9936-9. Epub 2011 Sep 3.
Certain coronary anomalies are associated with high risk features. We sought to determine the diagnostic accuracy of coronary computed tomographic angiography (CTA) in determining high-risk features, particularly intramural segments. Anomalous coronary arteries can be associated with adverse clinical events. Anomalous coronaries that course between the great vessels (interarterial) have been associated with sudden death. High-risk features of interarterial vessels described in the literature include; a slit-like orifice, acute angle of origin, and intramural segments (within the wall of the aorta). Although computed tomography (CT) findings of acute angle and slit like orifice have been described previously no prior evaluations regarding CT identification of an intramural segment have been reported. An intramural segment has distinct surgical management implications. All interarterial anomalous coronary arteries do not have an intramural segment. Since October 2004, 15 patients were diagnosed by CTA as having an anomalous coronary artery with an interarterial course, which were then confirmed by intraoperative examination of their coronary origins and course during aortic root/coronary artery surgery. The CTA images were retrospectively analyzed for the presence of high-risk features by a radiologist blinded to the surgical findings. Comparison of these findings was made to the findings at surgery. The anomalous coronary was the right coronary artery in 10 patients and the left coronary artery in 5. Eleven patients had an intramural segment identified at surgery. Pre-operative coronary CTA showed that all patients with an intramural course of the anomalous artery, had slit-like orifice, an acute angle of origin (mean 18.4 ± 3.4°), and an elliptical shaped cross-section throughout the intramural segment of the anomalous vessel. The average vessel height/width ratio for anomalous coronary vessels without an intramural segment was 1.03; compared to a ratio of 2.19 for anomalous vessels with an intramural segment (P = 0.003). Coronary CTA can identify an intramural segment of an anomalous interarterial coronary artery by its elliptical shape. Identifying an intramural segment has important clinical and surgical implications.
某些冠状动脉异常与高危特征相关。我们旨在确定冠状动脉计算机断层血管造影（CTA）在确定高危特征，特别是壁内段方面的诊断准确性。异常的冠状动脉可能与不良的临床事件相关。在大血管之间（动脉内）走行的异常冠状动脉与猝死有关。文献中描述的动脉内血管的高危特征包括：裂隙样开口、起源锐角和壁内段（主动脉壁内）。虽然以前已经描述了急性角度和裂隙样开口的 CT 发现，但尚未报道过关于 CT 识别壁内段的先前评估。壁内段具有明确的手术管理意义。并非所有动脉内异常冠状动脉都有壁内段。自 2004 年 10 月以来，15 名患者通过 CTA 诊断为具有动脉内走行的异常冠状动脉，随后在主动脉根部/冠状动脉手术中通过术中检查其冠状动脉起源和走行来证实。一位对手术结果不知情的放射科医生对 CTA 图像进行了回顾性分析，以确定是否存在高危特征。将这些发现与手术中的发现进行了比较。异常冠状动脉在 10 名患者中为右冠状动脉，在 5 名患者中为左冠状动脉。11 名患者在手术中发现壁内段。术前冠状动脉 CTA 显示，所有异常动脉壁内段的患者均有裂隙样开口、起源锐角（平均 18.4 ± 3.4°）和异常血管壁内段的椭圆形横截面。无壁内段异常冠状动脉的平均血管高度/宽度比为 1.03；而有壁内段的异常血管的比值为 2.19（P = 0.003）。冠状动脉 CTA 可以通过其椭圆形形状识别异常动脉内冠状动脉的壁内段。识别壁内段具有重要的临床和手术意义。
