通过三维工作站后处理CTCA图像分析冠状动脉开口最佳透视角度的研究

摘要/Abstract

摘要： 目的通过三维工作站对患者冠状动脉CT血管造影（computed tomographic coronary angiography, CTCA）图像进行后处理,分析冠状动脉造影时冠状动脉开口的最佳透视角度。方法回顾性分析自2024年3-7月于安徽医科大学附属滁州医院接受CTCA检查的210例疑似冠心病患者的临床资料,然后运用Simens syngoXWP工作站对重建的最佳显示时相进行图像后处理和分析,通过多曲面重建使左（或右）冠状动脉开口垂直截面与主动脉瓣环垂直截面均处于切线位,最后,确定冠状动脉开口的最佳透视角度。绘制患者最佳角度分布的散点图并计算其总体均数的95%可信区间。结果 CTCA数据的分析结果显示,左冠状动脉开口的最佳透视角度是LAO 25°（95%CI：23°-26°）,CRA 18°（95%CI：17°-20°）;右冠状动脉开口的最佳透视角度是LAO 74°（95%CI：71°-76°）,CRA 44°（95%CI：43°-46°）。结论 CTCA图像在分析冠状动脉开口的最佳透视角度方面有重要意义。

史词, 沈童童. 通过三维工作站后处理CTCA图像分析冠状动脉开口最佳透视角度的研究[J]. 心血管病防治知识, 2025, 15(5): 16-20.

参考文献

[1] Li F,Shi GW,Yu XL,et al.Safety and efficacy of coronary angiography and percutaneous coronary intervention via distal transradial artery access in the anatomical snuffbox:a single-centre prospective cohort study using a propensity score method[J]. BMC Cardiovasc Disord,2022;22(1):74.
[2] Ngam PI, Ong CC, Chai P, et al. Computed tomography coronary angiography - past, present and future. Singapore Med[J].2020 Mar;61(3):109-115.
[3] 闫杰. 支架影像增强显影指导冠状动脉开口病变介入治疗临床应用[J].中国医疗器械信息,2022,28(12):36-38.
[4] Reddy PKV, Daibes J, Skaf M, et al. The Use of Bumper Wire Technique and Intravascular Ultrasound for Precise Aorto-Ostial Stenting[J]. Front Cardiovasc Med.2022 Jul 14;9:929472.
[5] 贾小伟,张蛟,金至赓,等.支架影像增强显影技术指导ST段抬高型心肌梗死111例患者介入治疗[J].中国急救复苏与灾害医学杂志,2015,10(8):722-724.
[6] 李利军,罗建平,刘安恒,等.支架影像增强显影技术指导冠状动脉支架球囊后扩张的辐射剂量[J].临床与病理杂志,2019,39(6):1255-1259.
[7] 倪静. 冠状动脉CTA在冠心病早期筛查、病情评估、预后预测中的价值研究[J].影像研究与医学应用,2024,8(18):106-108.
[8] 高雪莲,王瑞,张宏凯,等.冠状动脉CT血管造影影像组学用于冠心病研究进展[J].中国医学影像技术,2024,40(3):451-454.
[9] Elabbassi W, Al Nooryani A. Skirt followed by trouser stenting technique: True anatomical preservation of coronary Y-shaped bifurcation lesions while using "vanishing" bioresorbable scaffolds: A report of two cases[J]. Cardiovasc Revasc Med.2017 Jun;18(4):281-286.
[10] Miller RA, Warkentin DL, Felix WG, et al. Angulated views in coronary angiography[J]. AJR Am J Roentgenol.1980 Feb;134(2):407-12.
[11] Sakakura K, Taniguchi Y, Matsumoto M, et al. How Should We Perform Rotational Atherectomy to an Angulated Calcified Lesion[J]. Int Heart J.2016 May 25;57(3):376-9.
[12] Iyer K, Nallamothu BK, Figueroa CA, et al. A multi-stage neural network approach for coronary 3D reconstruction from uncalibrated X-ray angiography images[J]. Sci Rep.2023 Oct 16;13(1):17603.
[13] Cong C, Kato Y, Vasconcellos HD, et al. Deep learning-based end-to-end automated stenosis classification and localization on catheter coronary angiography[J]. Front Cardiovasc Med.2023 Feb 7;10:944135.
[14] Gollapudi RR, Valencia R, Lee SS, et al. Utility of three-dimensional reconstruction of coronary angiography to guide percutaneous coronary intervention[J]. Catheter Cardiovasc Interv.2007 Mar 1;69(4):479-82.
[15] Amin AM, Khlidj Y, Abuelazm M, et al. Intravascular imaging-guided versus angiography-guided percutaneous coronary intervention: a systematic review and bayesian network meta-analysis of randomized controlled trials[J]. BMC Cardiovasc Disord.2024 Sep 11;24(1):483.
[16] 马清济,陈亮,潘美宇.冠状动脉计算机断层扫描血管造影对老年急性冠状动脉综合征患者斑块特征的诊断效能及对预后的预测价值[J].中华老年多器官疾病杂志,2024,23(1):32-37.
[17] Yamamoto K, Sato T, Salem H, et al. Ostial right coronary artery lesion morphology and outcomes after treatment with drug-eluting stents[J]. EuroIntervention.2024 Feb 5;20(3):e207-e215.
[18] 蒋利,沈卫峰,张建盛,等.冠状动脉开口处病变支架术的预后[J].中国介入心脏病学杂志,2003,(4):42-44.
[19] 汪建兵,凌智瑜.右冠状动脉解剖异常及病变特征对PCI的影响[J].现代医药卫生,2024,40(10):1777-1780,1792.
[20] Kočka V, Thériault-Lauzier P, Xiong TY, et al. Optimal Fluoroscopic Projections of Coronary Ostia and Bifurcations Defined by Computed Tomographic Coronary Angiography[J]. JACC Cardiovasc Interv.2020 Nov 9;13(21):2560-2570.