法医学杂志

法医学杂志 ›› 2017, Vol. 33 ›› Issue (2): 109-113.DOI: 10.3969/j.issn.1004-5619.2017.02.001

• 论著 •    下一篇

死后CT血管造影对冠状动脉粥样硬化的诊断价值

钱  辉1，2，邵  煜2，李正东2，邹冬华2，秦志强2，万  雷2，陈忆九2   

  1. （1. 苏州大学医学部法医学系，江苏 苏州 215123； 2. 司法部司法鉴定科学技术研究所 上海市法医学重点实验室 上海市司法鉴定专业技术服务平台，上海 200063）
  • 发布日期:2017-04-25 出版日期:2017-04-28
  • 通讯作者: 万雷，男，硕士，主检法医师，主要从事法医临床学和法医影像学研究；E-mail：wanlei-820628@163.com 陈忆九，男，研究员，博士研究生导师，主要从事法医病理学研究；E-mail：chenyj@ssfjd.cn
  • 作者简介:钱辉（1989—），男，硕士研究生，主要从事法医病理学研究；E-mail：qh20160620@163.com
  • 基金资助:

    国家自然科学基金资助项目（81401559，81571851）；十三五国家重点研发计划项目（2016YFC0800702）；上海市法医学重点实验室资助项目（17DZ2273200）；上海市科委社会发展专项（14231202500）；上海市司法鉴定专业技术服务平台资助项目（16DZ2290900）

Diagnostic Value of Postmortem CT Angiography in Coronary Atherosclerosis

QIAN HUI1,2, SHAO YU2, LI ZHENG-DONG2, ZOU DONG-HUA2, QIN ZHI-QIANG2, WAN LEI2, CHEN YI-JIU2   

  1. （1. Department of Forensic Medicine, Medical College of Soochow University, Suzhou 215123, China; 2. Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Institute of Forensic Science, Ministry of Justice, PRC, Shanghai 200063, China）
  • Online:2017-04-25 Published:2017-04-28

摘要： 目的 探讨死后CT血管造影技术在冠状动脉粥样硬化血管狭窄程度诊断中的应用价值。 方法 基于前期实验研究结果，对人死后离体心脏CT造影装置进行改良，选取不同冠状动脉粥样硬化病变程度猝死的检案案例，于心脏解剖前完整取出心脏并立即行CT冠状动脉造影，并将CT血管造影结果与组织病理学所见进行比较；同时比较改良前后造影装置的优、缺点。 结果 改良的离体心脏造影装置可以获得更好的成像效果；死后CT血管造影技术在冠状动脉粥样硬化血管狭窄程度诊断上与解剖和组织病理学所见具有较高的一致性，同时还可以通过三维重建技术将冠状动脉病变更客观、形象地展现出来。但CT血管造影技术只能对病变血管进行检查，在死因的诊断上存在一定的局限性。 结论 死后CT血管造影技术在冠状动脉粥样硬化血管狭窄程度案件中可以作为传统尸体解剖的辅助手段。

关键词: 法医病理学, 冠心病, 冠状血管造影术, CT, 尸体解剖

Abstract: Objective To explore the application value of postmortem computed tomography （CT） angiography on diagnosis of coronary atherosclerotic stenosis degree. Methods Based on the previous experimental results, the postmortem CT angiography device of human isolated heart was improved. Different coronary atherosclerotic stenosis degree of sudden death cases was selected. Before the cardiac anatomy, hearts were removed out completely and CT angiography was performed immediately. The CT angiography results were compared with histopathological findings. Meanwhile, the advantages and disadvantages of the angiography device before and after improvement were compared. Results The improved angiography device of isolated heart could get better imaging results. The postmortem CT angiography results had high consistency with the histopathological findings on diagnosis of coronary atherosclerotic stenosis degree. And the coronary artery lesions could be revealed more objectively and vividly by 3D reconstruction technology. However, CT angiography could only be used to examine the pathological changes of blood vessels, which might have some limitations on the diagnosis of cause of death. Conclusion Postmortem CT angiography can be used as an additional method for the conventional autopsy in the cases of coronary atherosclerosis.

Key words: forensic pathology, coronary disease, coronary angiography, CT, autopsy

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