冠状动脉-肺动脉瘘的MSCT诊断价值和征象分析

Diagnostic value and features analysis of MSCT in coronary-pulmonary artery fustula

目的探讨冠状动脉-肺动脉瘘（CPF）的多层螺旋CT（MSCT）诊断价值和征象分析。方法回顾性分析16例确诊为CPF患者的临床和CT影像资料,其中男性11例,女性5例,平均年龄56.4岁。观察瘘血管起源、走行和分布,瘘口位置、大小及征象（穿通征、射血征和浓染征）,肺动脉增宽与否。结果 16例CPF中,右圆锥支1例,右冠状动脉供血9例（56.3%）,左冠状动脉供血4例（25.0%）,左右冠状动脉同时供血2例（12.5%）;2例瘘口为2个,14例瘘口为1个;瘘口位于主肺动脉左侧壁12例、前壁4例;肺动脉瘘口大小约1.2-5.0 mm。MSCT直接征象：穿通征16例（100.0%）;射血征7例（43.8%）,均在75%期相显示;浓染征10例（62.5%）,8例在45%期相显示,2例在75%期相显示。间接征象：表现为瘘血管增粗、迂曲,部分呈蚯蚓状改变,贴附于肺动脉表面,其中5例合并动脉瘤。肺动脉增粗4例,瘘口大小约3.8-6.9 mm,平均瘘口大小为4.8 mm。结论MSCT结合三维重组技术对诊断CPF具有极高的临床价值,可作为首选的检查方法。

Objective To study the diagnostic value and features analysis of coronary-pulmonary artery fustula（CPF） by multislice computer tomography（MSCT）. Methods A total of 16 CPF patients were enrolled, which included 11 males and 5 females, with mean age of 56.4 years old. All of the clinical data and MSCT imaging features were assessed. The origin, direction and distribution of fistula vessels, fistula location, size and signs（penetrating sign, ejection sign and densely stained sign） and pul-monary artery widened or not were observed. Results Of 16 CPF cases, there was 1 case with originated from right conus branch, 9 cases（56.3 %） with right coronary artery blood supply, 4 cases（25.0 %） with left coronary artery blood supply and 2cases（12.5 %） with both cornary arteries supply; There were 2 cases with 2 fistula and 14 with 1 fistula; There were 12 cases with the location of main pulmonary fistula at the left lateral wall and 4 cases located anterior wall; The size of fistula was about 1.2-5.0 mm. Direct sign of MSCT features showed penetrating sign in 16 cases（100.0 %）, ejection sign in 7（43.8 %）, which displayed in 75 % phase, and densely stained sign in 10 cases（62.5 %）, of which 8 cases displayed in 45 % phase and 2 in 75 %phase. The indirect features showed CPF characterized by fistula vascular enlargement and circuity, some with worm shaped changes, attached to the surface of pulmonary artery, and 5 cases combined with aneurysm. The pulmonary artery widened was found in 4 cases, fistula size was about 3.8-6.9 mm（mean 4.8 mm）. Conclusion It is demonstrated that MSCT combined with dimensional technique is an ideal and valuable method in high clinical value for CPF diagnosis, which could become the first choice.