64层螺旋CT三维重组对左心房及肺静脉的形态学评价

Evaluation of 64-slice spiral CT with 3D reconstruction techniques in assessing the morphology characteristics of pulmonary vein and left atrium

目的:探讨64层螺旋CT心电门控血管成像及三维重组后处理技术对左心房及肺静脉结构的形态学评价价值。方法:回顾性分析50例行心电门控血管造影患者的左心房及肺静脉结构,按年龄和性别分组,利用仿真血管内镜(VIE)、容积再现(VR)、多平面重组(MPR)等多种三维重组技术进行后处理,了解肺静脉及左心房的形态学结构,评价其临床应用价值。结果:①VR技术可良好构建肺静脉形态,50例患者中,42例患者双侧肺静脉均为2支(84%),8例存在变异(16%);双上肺静脉明显较双下肺静脉粗(P<0.05),男性左上肺静脉、右上下肺静脉均较女性粗(P<0.05),左下肺静脉男女间差异无统计学意义(P>0.05);中年组和老年组肺静脉口径差异无统计学意义(P>0.05);双上肺静脉开口角度明显较双下肺静脉大(P<0.05)。②VIE技术可良好显示左侧肺静脉开口、右侧肺静脉开口、左心耳开口与左上肺静脉开口的关系以及左心耳与左上肺静脉之间界嵴的四种形态。③50例患者中,29例左心房顶部形态为平坦型(58%),19例为突起型(38%),2例为凹陷型(4%);测得50例患者左心房平均容积为(84.5±26.1)cm3。老年组左心房平均容积较中年组大(P<0.05),男性左心房平均容积较女性大(P<0.05)。④冠状窦汇入右房处与矢状面之间的角度范围为0度～130.9度,平均为(68.4±32.3)度。结论:64层螺旋CT三维重组技术能够直接对肺静脉及左心房进行形态学观察,明确肺静脉开口及左心房的形态变异,为临床指导导管射频消融治疗房颤等提供解剖信息,提高成功率,减少并发症。

Objective：To study the value of ECG-gated angiography with 3D reconstruction techniques in assessing the morphologic characteristics of pulmonary vein and left atrium using 64-slice spiral CT.Methods：The anatomic structures of pulmonary vein and left atrium displayed on ECG-gated 64-slice CT coronary angiography in 50 patients were retrospectively analyzed.Patients were grouped by age and sex.Post-processing techniques including multi-planar reformation（MPR）,volume rendering（VR） and virlual intravascular endoscopy（VIE） were used to observe the morphologic characteristics of pulmonary vein and left atrium,their clinical values were evaluated.Results：①The morphology of pulmonary veins（PVs） could be properly assessed on VR.42 of 50 cases（84%） showed typical pattern of two PVs bilaterally,8 with anatomic variation（16%）.The calibers of superior PVs were bigger than that of inferior PVs（P0.05）,and the calibers of left superior PVs and right PVs were bigger in males than that of females（P0.05）,but no significant statistical difference was showed in the caliber of left inferior PVs between male and female（P0.05）.The calibers of PVs were similar between middle aged group and old aged group（P0.05）.The angle between the ostia of superior PVs and LA were much larger than that of inferior PVs（P0.05）.②VIE could properly showed the ostia of PVs and the relationship of the ostia of the PVs with that of left atrial appendage（LAA）;as well as the 4 patterns of the crista between LAA and left PVs.③The roof of left atrium was revealed in 50 cases including plateau type（29 cases,58%）,convex type（19 cases,38%） and concave type（2 cases,4%）.The mean volume of left atrium was（84.5±26.1）cm3,which of the old aged group was bigger than the middle aged（P0.05）,as well as that of male was bigger than that of female（P0.05）.④The angle of the coronary sinus entered the right atrium ranged from 0°~130.9° [mean（68.4±32.3）°].Conclusion：The morphology of pulmonary vein and left atrium as well as the morphology of the ostia of PVs and LAA and its variation could be displayed clearly on 64-slice spiral CT with multiple reconstruction techniques,which is of important value in the guidance of radiofrequency catheter ablation for treatment of atrial fibrillation and to improve the success rate as well as to reduce complications.