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目的应用256层CT冠状动脉成像(CTCA)结合负荷/静息核素心肌灌注显像(MPI)探讨心肌桥(MB)对心肌供血的影响。方法回顾性分析经256层CTCA及负荷/静息核素MPI检查的88例孤立性LAD-MB的影像资料。依据MB类型分为不完全与完全MB组,比较两组壁冠状动脉(MCA)收缩期狭窄率及MPI的差异;比较完全MB中MPI正常与异常组MB厚度、长度及MCA收缩期狭窄率的差异;比较MCA收缩期狭窄Noble分级中MB类型及MPI的差异。结果不同MB类型组MCA收缩期狭窄率分别为(13.2±10.1)%、(39.8±11.4)%,MPI正常与异常分别为45、5例,15、23例,差异有统计学意义(t=11.574;χ2=25.408,P均<0.01)。完全MB中不同MPI组MB厚度分别为(1.6±0.4)mm、(2.6±0.7)mm,MCA收缩期狭窄率分别为(29.3±9.8)%、(46.7±10.3)%,差异有统计学意义(t=5.672;t=5.187,P均<0.01),MB长度分别为(11.2±5.6)mm、(12.8±6.3)mm,差异无统计学意义(t=0.800,P=0.429)。MCA收缩期狭窄Noble分级中2、3级完全MB(15/15、2/2)及MPI异常(10/15、2/2)比例明显高于1级(21/71、16/71)。结论 MB的类型、厚度及MCA收缩期狭窄程度均与心肌缺血密切相关,而MB长度对心肌供血无明显影响。
Objective To investigate the effect of myocardial bridge (MB) on myocardial blood supply with 256-slice CT coronary angiography (CTCA) combined with load / resting myocardial perfusion imaging (MPI). Methods We retrospectively analyzed the image data of 88 isolated cases of LAD-MB with 256-slice CTCA and load / resting nuclide MPI. According to the type of MB, the patients were divided into incomplete and complete MB groups. The differences of stenosis rate and MPI between the two groups were compared. The MB thickness, length and MCA systolic stenosis rate in MPI normal and abnormal group were compared Differences; MBA type and MPI in Noble classification MCS systolic stenosis were compared. Results The stenosis rates of MCA in different MB groups were (13.2 ± 10.1)% and (39.8 ± 11.4)%, respectively. The normal and abnormal MPI were 45.5 and 15.23, respectively, with significant difference (t = 11.574; χ2 = 25.408, P <0.01). The MB thicknesses in different MPI groups were (1.6 ± 0.4) mm and (2.6 ± 0.7) mm in complete MB, respectively, and the stenosis rates in MCA were (29.3 ± 9.8) and (46.7 ± 10.3)%, respectively (t = 5.672; t = 5.187, P <0.01). The length of MB was (11.2 ± 5.6) mm and (12.8 ± 6.3) mm respectively. There was no significant difference between the two groups (t = 0.800, P = 0.429). Noble grades of MCA systolic grade 2,3 grade MB (15/15, 2/2) and MPI abnormalities (10/15, 2/2) were significantly higher than grade 1 (21/71, 16/71). Conclusions The type and thickness of MB and the degree of stenosis of MCA are closely related to myocardial ischemia, while MB length has no significant effect on myocardial blood supply.