64排螺旋CT心脏扫描在显示非心房颤动患者肺静脉和左心房结构中的价值

Evaluation of pulmonary veins and pouches of left atrium by 64-row multislice computed tomography angiography

目的探讨64排螺旋CT心电门控血管造影在显示非心房颤动患者肺静脉和左心房结构中的价值。方法回顾性分析2007年8～12月160例行64排螺旋CT心电门控心脏血管造影患者的肺静脉和左心房解剖结构,利用工作站后处理,通过最大密度投影(MIP)、多平面重组(MPR)及容积再现(VR)图像了解肺静脉数目、开口大小,左心房囊样结构,并评价其临床应用价值。结果160例患者共发现肺静脉642根。3支肺静脉者8例(5.00%),其中左侧共干者4例,右侧共干者4例;5支肺静脉者10例(6.25%),其中左侧3支者6例,右侧3支者4例;4支肺静脉者142例(88.75%)。左上肺静脉最大径为(24.30±4.54)mm、最小径为(17.76±4.24)mm、开口面积为(352.92±124.11)mm^2;左下肺静脉最大径为(19.10±4.45)mm、最小径为(12.27±3.52)mm、开口面积为(201.96±93.65)mm^2;右上肺静脉最大径为(22.99±5.04)mm、最小径为(16.19±4.87)mm、开口面积为(316.53±144.20)mm^2;右下肺静脉最大径为(18.63±4.60)mm、最小径为(14.46±3.48)mm、开口面积为(219.20±95.85)mm^2。有左心房囊样结构者25例(15.63%),其中男性21例,女性4例,年龄38～74岁,平均57岁。25例患者共发现囊样结构29个(有4例存在2个囊样结构),19个(65.51%)位于左心房右顶壁,6个为Ⅰ型,13个为Ⅱ型;6个(20.69%)位于左顶壁,3个为Ⅰ型,3个为Ⅱ型;4个(13.80%)位于左心房左下壁,3个为Ⅰ型,1个为Ⅱ型;未发现位于右下壁者。结论64排螺旋CT心电门控心脏扫描能够很好地显示肺静脉的数目、开口大小,左心房囊样结构,为研究肺静脉和左心房提供了一个很好的工具。

Objective To evaluate pulmonary veins and left atrium structure in patients without atrial fibrillation by multisliee computed tomography （MSCT） angiography. Methods By ECG-gated 64-row MSCT coronary angiography, the anatomies of pulmonary veins and left atrium in 160 consecutive patients from august 2007 to december 2007 were retrospectively reviewed. The data were transfered to the workstation and postproeessor with maximum intensity projection （MIP）, multi-planar reformatting （MPR） and volume rendering （VR） to observe the pulmonary veins and the pouches of the left atrium. Results A total of 642 pulmonary veins were found in 160 eases, 8 cases with three pulmonary veins （5.00%）, 10 cases with five pulmonary veins （6.25%） and 142 cases with four pulmonary veins （88.75%）. The maximal diameter, the minimal diameter and the size of pulmonary venous ostia were （24. 30 ± 4. 54 ） mm, （ 17. 76 ±4. 24 ） mm and （352.92 ± 124. 11 ） mm^2 in left superior pulmonary vein （ LSPV）, （ 19. 10 ＋ 4.45 ） mm, （ 12. 27 ± 3.52） mm and （201.96 ±93.65） mm2 in left inferior pulmonary vein （LIPV）, （22. 99 ±5.04） mm, （16. 19 _＋4. 87） mm and （316. 53 ± 144. 20） mm2 in right superior pulmonary vein （ RSPV）, （ 18.63 ±4. 60） mm, （ 14. 46 ± 3.48 ）mm and （219. 20 ± 95.85 ） mm^2 in right inferior pulmonary vein （RIPV）. Twenty-five （ 15.63 % ） patients had 29 pouches of left atrium （4 natients had two）.Nineteen （65.51%） pouches were located on the right top atrial wall, six were type I ,thirteen were type Ⅱ. Six （20. 69% ） were located on the left top atrial wall, three were type I , three were type Ⅱ. Four （13.80%） were located along the left inferior atrial wall, three were type Ⅰ , one was type Ⅱ. None was detected on the right inferior atrial wall. Conclusions The numbers of pulmonary veins, the size of pulmonary venous ostia and pouches of left atrium can be evaluated by ECG-gated 64-row MSCT coronary angiography, provides a useful tool for the study of the left atrium and its accessory structures.