冠状动脉血管炎 (CAV) 和冠状动脉包绕很少被诊断出来，但却是重要的诊断考虑因素，特别是对于没有传统心血管危险因素或全身性疾病的急性冠状动脉综合征患者。血管炎是指血管壁的炎症，可以是原发性的或继发性的。这一过程应与冠状动脉的肿瘤性病变（称为冠状动脉包绕）区分开来。这些疾病的前瞻性诊断具有挑战性，通常需要多学科检查，并仔细注意临床表现和多器官发现。虽然冠状动脉 CT 血管造影无法区分 CAV 和冠状动脉包绕，但某些影像学特征有助于鉴别诊断。当圆周和/或连续的平滑壁增厚时，应考虑 CAV。当存在与血管腔偏心的不规则或结节状壁增厚时，倾向于诊断冠状动脉包绕。与 CAV 相比，心外膜脂肪绞合也可能显得更广泛。 CAV 的潜在模拟包括动脉粥样硬化、急性斑块破裂、冠状动脉瘤和自发性冠状动脉夹层。 CAV 的检测和诊断可能有助于避免与加速动脉粥样硬化和梗塞相关的并发症。放射科医生应该熟悉除了动脉粥样硬化之外可能影响冠状动脉的一系列病理状况，因为他们可能是第一个提出此类诊断可能性的人，指导患者检查和管理的后续步骤。 ©RSNA，2024 本文提供了补充材料。

Coronary artery vasculitis (CAV) and coronary artery encasement are rarely diagnosed conditions that are important diagnostic considerations, particularly in patients with acute coronary syndrome without traditional cardiovascular risk factors or systemic illness. Vasculitis refers to inflammation of the blood vessel walls, which can be primary or secondary. This process should be distinguished from neoplastic involvement of the coronary arteries, termed coronary artery encasement. Prospective diagnosis of these diseases is challenging, often requiring multidisciplinary workup with careful attention to clinical presentation and multiorgan findings. While CAV and coronary artery encasement can be indistinguishable at coronary CT angiography, certain imaging features help order the differential diagnosis. CAV should be considered when there is smooth wall thickening that is circumferential and/or continuous. A diagnosis of coronary artery encasement is favored when there is irregular or nodular wall thickening that is eccentric to the vessel lumen. Epicardial fat stranding may also appear more extensive compared with CAV. Potential mimics of CAV include atherosclerosis, acute plaque rupture, coronary artery aneurysm, and spontaneous coronary artery dissection. Detection and diagnosis of CAV may help avoid complications related to accelerated atherosclerosis and infarction. Radiologists should be familiar with the range of pathologic conditions that can affect the coronary arteries beyond atherosclerosis as they may be the first to raise such diagnostic possibilities, guiding next steps in patient workup and management. ©RSNA, 2024 Supplemental material is available for this article.