Tommasini G, Camerini A, Gatti A, Derchi G, Bruzzone A, Vecchio C
Department of Cardiology, E.O. Ospedali Galliera, Genoa, Italy.
J Am Coll Cardiol. 1998 Mar 15;31(4):871-7. doi: 10.1016/s0735-1097(98)00014-x.
We describe a new imaging technique for coronary angiography.
The conventional approach to coronary angiography exploits static perspective imaging over multiple cardiac cycles, using a limited number of empirically selected views. This approach entails both lack and redundancy of information and may result in suboptimal visualization of the individual lesion, contributing to diagnostic inaccuracy.
We developed a new imaging technique exploiting dynamic perspective, obtained by transverse 180 degree rotation of the C arm of a conventional angiographic unit during standard selective coronary opacification and filming. This technique yields a picture of the coronary tree isocentrically rotating around the longitudinal axis and conveying complete three-dimensional information.
A complete diagnostic run for both coronary arteries, including two 25 degree cranial and two 25 degree caudal scans is accomplished with a total cine time of 16 s and 45 ml of contrast medium, about half of that required by conventional angiography. In a series of 129 consecutive patients studied by both the conventional and the new technique with quantitative measurements of the severity of the stenoses, the final diagnosis was identical in 65. In no case was a stenosis detected only by the conventional approach. However, in 31 patients the new technique permitted identification of 34 critical stenoses (79+/-8% [mean +/- SD]) either underestimated (61+/-3% n = 24, p < 0.001) or undetected (21+/-22%, n = 10, p < 0.001) in the standard projections. In a further 28 cases, 33 subcritical lesions (60+/-5%) were visualized in the rotational images but were insignificant (24+/-22% p < 0.001) in the standard projections. In five additional patients, distinct laminar plaques were clearly visualized only by the panoramic approach.
This new technique can be easily implemented on conventional angiographic equipment at no additional cost. It provides complete, operator-independent exploitation of the angiographic information, resulting in enhanced diagnostic accuracy.
我们描述一种用于冠状动脉造影的新成像技术。
传统的冠状动脉造影方法利用多个心动周期的静态透视成像，采用有限数量的经验性选择视图。这种方法存在信息不足和冗余的问题，可能导致单个病变的可视化效果欠佳，从而造成诊断不准确。
我们开发了一种利用动态透视的新成像技术，通过在标准选择性冠状动脉造影和拍摄期间将传统血管造影设备的C臂横向旋转180度获得。该技术产生一幅冠状动脉树围绕纵轴等中心旋转并传递完整三维信息的图像。
对两条冠状动脉进行完整诊断扫描，包括两次25度头位和两次25度足位扫描，总电影时间为16秒，造影剂用量为45毫升，约为传统血管造影所需用量的一半。在一系列129例连续患者中，同时采用传统技术和新技术对狭窄严重程度进行定量测量，最终诊断在65例中相同。没有病例仅通过传统方法检测到狭窄。然而，在31例患者中，新技术能够识别出34处严重狭窄（79±8%[平均值±标准差]），这些狭窄在标准投照中被低估（61±3%，n = 24，p < 0.001）或未被检测到（21±22%，n = 10，p < 0.001）。在另外28例中，33处次临界病变（60±5%）在旋转图像中可见，但在标准投照中不明显（24±22%，p < 0.001）。在另外5例患者中，仅通过全景方法能清晰地看到明显的层状斑块。
这项新技术可以在传统血管造影设备上轻松实现，无需额外成本。它能提供完整的、与操作者无关的血管造影信息利用方式，从而提高诊断准确性。
