64排螺旋CT血管造影对冠状动脉瘘的诊断价值

The Value of 64 Multi-detector CT Coronary Angiography in Diagnosing Coronary Artery Fistula

目的评价64排螺旋CT冠状动脉造影(MDCTA)对冠状动脉瘘(coronary artery fistula,CAF)的诊断价值及CT表现。资料与方法 11例CAF患者行MDCTA对比增强扫描,根据不同心率,采用不同扇区重组方法,获得最满意图像,并将原始图像行容积再现(VR)、最大密度投影(MIP)、曲面重组(CPR)、多平面重组(MPR)后处理,与冠状动脉血管造影(CAG)比较,探讨CAF的MDCTA表现及多种后处理技术联合应用的价值。结果 11例CAF共有21支瘘血管形成,起源分别为左冠状动脉(8支)、右冠状动脉(4支)、同时起源于左右冠状动脉(8支)、左锁骨下动脉(1支),出口共13支,分别为主肺动脉(9支)、左心室(2支)、左心房(1支)、右心室(1支)。在判断CAF瘘血管入、出口方面,VR和MPR均优于MIP,差异有统计学意义,各种技术各有优缺点。结论 CAF瘘血管不仅可起源于右冠状动脉,也常起源于左冠状动脉或同时起源于两侧冠状动脉,流出口多为压力较低的肺动脉、右室。64排螺旋CT多种后处理技术的联合应用能准确直观地显示CAF,与CAG具有高度一致性,能为术前提供详细的影像学信息。

Objective To evaluate 64 detector spiral CT coronary angiography in diagnosing the coronary artery fistula（CAF）and to discuss CT manifestations of CAF.Materials and Methods Multi detector spiral CT enhanced scanning was performed in eleven patients with CAF.Based on individual heart rate,different sector scanning technique was employed in order to get optimal reconstructed images.Three dimensional reconstructions,including volume rendering（VR）,maximum intensity projection（MIP）,curved planar reformation（CPR） and multi-planar reconstruction（MPR）,were carried out.The features of 3 D images were compared with the findings of coronary angiography（CAG）.The CT features were analyzed and the value of CT combined with various post processing techniques for effectively detecting and diagnosing CAF was evaluated.Results A total of 21 fistulas were found in 11 patients with CAF.The origins of the fistulas included left coronary artery（n=8）,right coronary artery（n=4）,both left and right coronary artery（n=8） and left subclavian artery（n=1）.A total of nine outlets of the fistulas were confirmed,which included main pulmonary artery（n=9）,left ventricle（n=2）,left atrium（n=1） and right ventricle（n=1）.In judging the inlet and outlet of CAF,VR and MPR techniques were superior to MIP.There were significant difference in visualizing the inlet and outlet of CAF between the techniques.Every technique had its own advantage and disadvantage.Conclusion CAF may originate not only from the right coronary artery,but also from the left coronary artery or from both coronary arteries.In most cases,the outlet of CAF is the pulmonary artery or the right ventricle with low pressure.Multi detector spiral CT scanning combined with various post-processing techniques can precisely and stereoscopically display the coronary artery fistula,which is quite consistent with CAG.These three dimensional reconstructed images can preoperatively provide detailed anatomical information which is very useful for the surgery.