肺静脉多层螺旋CT成像

Multi-detector row CT imaging of pulmonary veins

目的:评价多排CT血管成像描述肺静脉解剖特征的有效性,为射频消融术前观察肺静脉解剖构筑提供一种实用的影像方法。方法:回顾分析30例因房颤和心肌缺血症状接受多排CT增强心血管成像检查患者的影像数据。图像重建在工作站上使用三维容积再现和多平面重建方法完成,由两位有经验的放射科医师分别对肺静脉数量和左心房开口引流特征进行评价并达成共识。结果:22例(73.3%)有典型的右上叶肺静脉、右下叶肺静脉、左上叶肺静脉和左下叶肺静脉4个心房开口,右中叶肺静脉汇入到右上叶肺静脉。8例(26.6%)存在解剖变异,其中6例(20%)具有独立心房开口的副肺静脉(5例显示1支右中肺静脉,1例显示2支右中肺静脉),2例(6.7%)左肺静脉共干,形成一个大的心房开口。结论:肺静脉数量和汇合方式有较多的变异,多排CT肺静脉成像是观察肺静脉解剖特征和变异的有效方法。

Objective To evaluate multi-detector row computed tomography （CT） depiction of pulmonary veins to provide a pragmatic imaging technique for access construction of pulmonary veins prior to radiofrequency catheter ablation. Methods Contrast material-enhanced multi-detector row CT was performed in 30 patients with clinical manifestation of atrial fibrillation or myocardial ischemia, and the CT data was analyzed retrospectively. Imaging reconstruction was performed on a postprocessing workstation with the use of three-dimensional volume rendering methods and two-dimensional multiplanar reconstruction. The number of pulmonary veins and the pattern of the ostia drainage were assessed by two experienced radiologists in consensus. Results Twenty two patients （73.3%） had typical pattern of pulmonary veins with four separate ostia for the right and left upper and lower pulmonary veins, respectively, and the right middle lobe pulmonary vein joining the right upper lobe pulmonary vein. Eight patients （26.6%） had variant anatomy, among whom six had additional pulmonary vein with separate orifice, and the other two patients had a common left pulmonary vein forming one ostium in the left atrium. Among the 6 patients with additional pulmonary vein ,5 patients had one additional pulmonary vein, 1 patient had two. Conclusion Variations in number and insertion of pulmonary veins are observed in a considerable number of patients. Multi-detector row CT provides a valuable imaging technique for observing pulmonary vein anatomy and variations.