Post J C, van Rossum A C, Bronzwaer J G, de Cock C C, Hofman M B, Valk J, Visser C A
Department of Cardiology, Free University Hospital, Amsterdam, Netherlands.
Circulation. 1995 Dec 1;92(11):3163-71. doi: 10.1161/01.cir.92.11.3163.
The clinical significance of anomalously originating coronary arteries depends on their proximal course. Diagnosis of this course by conventional x-ray coronary angiography alone may be equivocal. We postulated that with fast magnetic resonance (MR) angiography, accurate detection of anomalous coronary arteries and unambiguous delineation of their proximal course is feasible.
In a selected group of 38 patients, 19 of them having an anomalously originating coronary artery, a fast MR angiographic technique was used to study the proximal coronary anatomy. Blinded analysis of randomly ordered MR studies was performed independently by two observers. Both origin and proximal course of the coronary arteries were defined. Two cardiologists reviewed all x-ray coronary angiograms. After the separate analyses, a final consensus result was defined for each patient. In 37 patients, successful MR coronary angiography could be performed. Interobserver agreement for determining both origin and proximal course was 100%. An x-ray coronary angiogram was available in 36 patients. In 3 patients (all with an anomalous left main coronary artery originating from the right aortic sinus), there was disagreement about the proximal course between the results of MR and x-ray coronary angiography. Review of these cases demonstrated that MR angiography had unambiguously visualized the proximal coronary artery course, whereas the results of x-ray angiography had been equivocal. Thus, sensitivity and specificity for detecting anomalous coronary arteries and delineating their proximal course were 100%.
These data suggest that fast MR angiography is highly accurate in determining the origin and delineating the proximal course of anomalous coronary arteries, even in those cases in which x-ray coronary angiographic diagnosis is difficult or even erroneous.
异常起源的冠状动脉的临床意义取决于其近端走行。仅通过传统的X线冠状动脉造影诊断该走行可能存在歧义。我们推测，利用快速磁共振（MR）血管造影，准确检测异常冠状动脉并清晰描绘其近端走行是可行的。
在一组选定的38例患者中，其中19例有异常起源的冠状动脉，采用快速MR血管造影技术研究冠状动脉近端解剖结构。两名观察者对随机排序的MR研究进行独立的盲法分析。确定了冠状动脉的起源和近端走行。两名心脏病专家复查了所有X线冠状动脉造影。在单独分析后，为每位患者确定最终的共识结果。37例患者成功进行了MR冠状动脉造影。观察者间在确定起源和近端走行方面的一致性为100%。36例患者有X线冠状动脉造影结果。在3例患者（均为异常左主冠状动脉起源于右主动脉窦）中，MR和X线冠状动脉造影结果在近端走行方面存在分歧。对这些病例的复查表明，MR血管造影清晰显示了冠状动脉近端走行，而X线血管造影结果存在歧义。因此，检测异常冠状动脉及其近端走行的敏感性和特异性均为100%。
这些数据表明，快速MR血管造影在确定异常冠状动脉的起源和描绘其近端走行方面高度准确，即使在X线冠状动脉造影诊断困难甚至错误的情况下也是如此。
