Liang Jackson J, Prasad Megha, Tweet Marysia S, Hayes Sharonne N, Gulati Rajiv, Breen Jerome F, Leng Shuai, Vrtiska Terri J
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
J Cardiovasc Comput Tomogr. 2014 May-Jun;8(3):189-97. doi: 10.1016/j.jcct.2014.02.001. Epub 2014 Apr 4.
Spontaneous coronary artery dissection (SCAD) is associated with extracoronary vascular abnormalities, which depending on type and location may warrant treatment or provide additional diagnostic or prognostic information about this uncommon entity. Fibromuscular dysplasia (FMD), aneurysms, and dissections have been detected in multiple vascular territories by magnetic resonance angiography, CT angiography (CTA), and catheter angiography. The optimal modality to detect extracoronary vascular abnormalities is unknown. We highlight the technique and feasibility of a novel CTA protocol to detect extracoronary vascular abnormalities in these patients, incorporating patient safety and convenience.
The complete CTA protocol consisting of a single CTA of the neck, chest, abdomen, and pelvis was performed on 39 SCAD outpatients. All examinations were performed with 200 mL of low-osmolar contrast agent and used radiation dose modulation techniques. Average volume CT dose index was 9 mGy for the chest, abdomen, and pelvis portions and 21 mGy for the neck portion. Studies were independently reviewed by 2 senior vascular radiologists.
Two patients had nondiagnostic CTA neck evaluation because of technical acquisition errors. Extracoronary vascular abnormalities were detected in 27 of 39 patients (69%). Catheter angiography detected brachial artery FMD in 1 patient, a vascular bed not included in the SCAD CTA protocol. Extracoronary vascular abnormalities were common, including FMD, aneurysms, dissection, and aortic tortuosity, and were seen in the iliac (36%), carotid and/or vertebral (31%), splanchnic (10%), and renal (26%) arteries and in the thoracic and/or abdominal aorta (10%).
The frequency of extracoronary vascular abnormalities and extent of territories identified the CTA protocol in our cohort are high. A tailored CTA may be the optimal imaging technique for detecting extracoronary vascular abnormalities in patients with suspected underlying vasculopathy. Although the clinical significance of extracoronary vascular abnormalities remains unclear, detection of these abnormalities has identified patients in whom cerebral imaging and serial monitoring have been recommended.
自发性冠状动脉夹层（SCAD）与冠状动脉外血管异常相关，根据类型和位置，这些异常可能需要治疗，或提供有关这种罕见疾病的额外诊断或预后信息。通过磁共振血管造影、CT血管造影（CTA）和导管血管造影已在多个血管区域检测到纤维肌发育不良（FMD）、动脉瘤和夹层。检测冠状动脉外血管异常的最佳方式尚不清楚。我们强调了一种新型CTA方案在检测这些患者冠状动脉外血管异常方面的技术和可行性，同时兼顾了患者的安全性和便利性。
对39例SCAD门诊患者进行了完整的CTA方案，包括对颈部、胸部、腹部和骨盆进行单次CTA检查。所有检查均使用200 mL低渗造影剂，并采用辐射剂量调制技术。胸部、腹部和骨盆部分的平均容积CT剂量指数为9 mGy，颈部部分为21 mGy。研究由2名资深血管放射科医生独立审查。
2例患者因技术采集错误导致CTA颈部评估未得出诊断结果。39例患者中有27例（69%）检测到冠状动脉外血管异常。导管血管造影在1例患者中检测到肱动脉FMD，这是SCAD CTA方案未涵盖的血管床。冠状动脉外血管异常很常见，包括FMD、动脉瘤、夹层和主动脉迂曲，见于髂动脉（36%）、颈动脉和/或椎动脉（31%）、内脏动脉（10%）、肾动脉（26%）以及胸主动脉和/或腹主动脉（10%）。
在我们的队列中，冠状动脉外血管异常的发生率以及CTA方案所识别的血管区域范围都很高。定制的CTA可能是检测疑似潜在血管病变患者冠状动脉外血管异常的最佳成像技术。尽管冠状动脉外血管异常的临床意义仍不明确，但这些异常的检测已确定了推荐进行脑成像和连续监测的患者。
