Kommerell Diverticulum: A Five Year Incidence and Morphology Study Using Computed Tomography

Kommerell憩室：五年電腦斷層盛行率與型態研究

蔡欣宇(Hsin-Yu Tsai) ； 蔡瑋琳(Wei-Lin Tsai) ； 蔡依橙(I-Chen Tsai) ； 林雁婷(Yen-Tin Lin) ； 李覃(Tain Lee) ； 陳明至(Min-Chi Chen) ； 陳啓昌(Clayton Chi-Chang Chen)

《中華放射線醫學雜誌》 35卷4期 (2010/12) Pp. 191-199

摘要

本研究將分析異常鎖骨下動脈與Kommerell憩室的盛行率與型態，以回答過去文獻中的爭議。
我們回溯閱讀近五年、30898位患者的胸腔電腦斷層，發現有195(0.63%)位患者有異常鎖骨下動脈。排除掉四個無注射顯影劑之檢查後，191位患者的影像被收入作進一步的分析。我們記錄患者的動脈分支狀況（「右主動脈弓並有異常左鎖骨下動脈」或「左主動脈弓並有異常右鎖骨下動脈」）、異常鎖骨下動脈的開口(ASCA-O)與位於中線處(ASCA-M)的直徑。ASCA-O/ASCA-M比值大於等於1.5被定義為Kommerell憩室。我們並進一步分析以下參數之間的關係：年齡、性別、主動脈弓分支型態、ASCA-O、ASCA-M、O/M比值以及是否有Kommerell憩室出現。
所有191位異常鎖骨下動脈患者，其異常動脈都是走在食道後方的。多數的Kommerell憩室是在較為年長的患者身上發現。異常鎖骨下動脈之開口處(ASCA-O)生長速率推估為0.12mm/year，是中線處(ASCA-M: 0.08mm/year)的1.5倍。異常左鎖骨下動脈的患者比起異常右鎖骨下動脈的患者有更高的Kommerell憩室發生機會。50歲以上的異常左鎖骨下動脈患者有100%(4/4)的機會產生Kommerell憩室。
本研究說明：(1)所有異常鎖骨下動脈都走在食道後方、(2)Kommerell憩室的形成具有先天與後天混合的成分、(3)異常左鎖骨下動脈以及年齡，是形成Kommerell 憩室的主要因素。

並列摘要

The objective is to study the incidence and morphology of aberrant subclavian arteries (ASCA) and Kommerell diverticulum (KD) to resolve long-standing controversies.
We retrospectively reviewed 30898 chest CT scans/patients over a five-year period and found 195 (0.63%) patients with ASCA. Excluding 4 non-enhanced scans, 191 patients were included for analysis. The branching pattern (right arch with aberrant left subclavian artery (ALSCA) or left arch with aberrant right subclavian artery (ARSCA)), the diameters of ASCA at ostium (ASCA-O) and at midline (ASCA-M) were recorded. ASCA-O/ASCA-M ratio (O/M ratio) equal to or larger than 1.5 was defined as KD. We further analyzed the correlation among several factors including age, sex, A LSCA/ARSCA, ASCA-O, ASCA-M, O/M ratio, and presence of KD.
All 191 ASCA coursed behind the esophagus. Most instances of KD were found in older ASCA patients. The growth rate of ASCA-O (0.12 mm/year) was 1.5 times faster than ASCA-M (0.08 mm/year). ALSCA patients had a higher incidence of KD than ARSCA patients. ALSCA patients older than 50 years had 100% (4/4) incidence of KD formation.
We concluded that (1) all ASCA course behind the esophagus, (2) KD formation is a combination of congenital and acquired processes, and (3) ALSCA and age are the two risk factors for KD formation.