冠状动脉瘘的双源CT诊断

Dual-source CT diagnosis for coronary artery fistula

目的:探讨双源CT(DSCT)冠状动脉成像对冠状动脉瘘的诊断价值。方法:对1000例患者行DSCT冠状动脉增强扫描,分析其断层图像,结合最大密度投影(MIP)、曲面重组(CPR)、多平面重组(MPR)和容积再现(VR)等方法观察冠状动脉的走行及心内外机构。结果:11例患者有冠状动脉瘘,其中右冠状动脉主干-肺动脉瘘5例,右冠状动脉、前降支-肺动脉瘘1例,左冠状动脉主干和(或)前降支-主肺动脉瘘3例,左冠状动脉起自肺动脉根部并动静脉瘘1例,起源于左右冠状动脉、支气管动脉及左侧胸廓内动脉-上腔静脉及肺动脉复杂动静脉瘘1例。结论:断层图像及各种重建方法可以不同程度的显示冠状动脉瘘的起源和走行,双源CT冠状动脉造影方便、快捷、无创,可以作为诊断先天性冠状动脉瘘的首选方法。

Objective：To investigate the dual-source CT（DSCT） coronary artery imaging in the coronary artery fistula diagnosis.Methods：1,000 patients underwent DSCT enhanced scanning of the coronary artery.The images were analyzed by combining with maximum intensity projection（MIP）,curved planar reformation（CPR）,multi-planar reconstruction（MPR） and volume rendering（VR） to observe the course of coronary artery and the inside and outside heart structures.Results：11 patients had coronary artery fistula,of which the right coronary artery-pulmonary artery fistula in 5 cases,right coronary artery,left anterior descending artery-pulmonary artery fistula in 1 case,left main coronary artery and（or） left anterior descending artery-main pulmonary artery fistula in 3 cases,left coronary artery starting from the root of pulmonary artery with the coronary artery fistula in 1 case,arteriovenous complexity fistula originating from the left and right coronary artery,the bronchial artery and the left internal thoracic artery-the superior vena cava and pulmonary artery in 1 case.Conclusion：CT images and various reconstruction methods can display coronary artery origin and course in varying degrees.The dual-source CT coronary angiography is convenient,fast and noninvasive in the diagnosis of congenital coronary artery fistula and can be considered as the method of first choice.