成人冠状动脉-肺动脉瘘的MSCT和超声影像诊断

Value of MSCT angiography and echocardiography in the diagnosis of coronary artery-pulmonary artery fistula in adults

目的:探讨多层螺旋CT(MSCT)和超声心动图(USG)在诊断成人单纯冠状动脉-肺动脉瘘(CPF)中的价值。方法:回顾性分析临床怀疑冠状动脉病变的218例成人患者的病例资料,所有患者同时接受64层螺旋CT、USG和传统冠状动脉造影(CAG)检查。以CAG为金标准,比较MSCT和USG诊断CPF的效能。结果:218例患者CAG发现冠状动脉异常血管网21例,诊断为CPF患者19例,未发现明确瘘口2例;MSCT诊断为CPF患者20例,诊断为冠状动脉分支畸形患者1例;CPF的MSCT影像征象包括:纡曲扩张血管网匍匐于肺动脉壁,瘘口表现为开窗征、射血征、烟雾征、飘带征、等密度征。以CAG为金标准,MSCT诊断成人CPF的符合率、敏感度、特异度、阳性预测值、阴性预测值分别为98.6%、94.7%、99.0%、90.0%、99.5%。USG诊断为CPF患者5例,漏诊14例,敏感度为26.3%,漏诊率为73.7%。所有患者未发现其他先天性心脏畸形。结论:USG诊断成人CPF的漏诊率高,而MSCT重组技术对成人CPF的诊断符合率较高,对诊疗有较大指导意义,可作为诊断的首选方法。

Objective：To assess the value of MSCT angiography（MSCTA）and ultrasonic cardiography（UCG）in the diagnosis of coronary artery-pulmonary artery fistula（CPF）in adults.Methods：The clinical materials of 218 adult patients with clinically suspected coronary artery disease were analyzed retrospectively.All patients underwent MSCTA,UCG and coronary angiography（CAG）.Taking CAG as gold standard,the efficacy of MSCTA and UCG were compared and analyzed.Results：Of the 218 patients,abnormal vascular network were revealed in 21 patients on CAG,19 patients were diagnosed as CPF,while the fistula orifice didn＇t display in 2patients.20 patients were diagnosed by MSCT as CPF and one patient was diagnosed as coronary artery branching anomaly.Features of CPF on MSCT included tortuous and enlarged vascular network creep on pulmonary artery wall;fistula orifice showing as window sign,spray sign,smog sign,ribbon sign and iso-density sign.With the results of CAG as golden standard,the accuracy,sensitivity,specificity,positive and negative predictive value of CPF diagnosis using MSCT was 98.6%,94.7%,99.0%,90.0% and 99.5%,respectively.Five patients were diagnosed as CPF and 14 patients were missed by USG.The sensitivity,misdiagnosis rate of USG for CPF was 26.3%and 73.7%,respectively.Conclusion：For the diagnosis of CPF in adults,high misdiagnosis rate was assessed with USG.The accuracy for the diagnosis of CPF using MSCT with reformation technique was high,which could be a significant guide for the diagnosis and treatment of CPF,and could be considered as the first choice modality.