冠状动脉-肺动脉瘘CTA征象分析

An analysis of the computed tomography angiography features of coronary-pulmonary fistula

目的:通过冠状动脉CTA(coronary CT angiograpy,CCTA)检查资料分析冠状动脉-肺动脉瘘(coronary-pulmonary fistula,CPF)的解剖学信息。方法:回顾性分析71例CPF患者CCTA资料,对其供血动脉情况,瘘口位置、大小及与周围解剖结构关系,瘘口流入类型,主、肺动脉直径等进行分析测量,计算瘘口大小、供血动脉管径及瘘口距肺动脉瓣距离的95%置信区间,并统计分析不同来源供血血管管径差异、瘘口宽度与主、肺动脉直径及优势供血动脉直径的相关性,另外统计分析不同流入类型病例间瘘口大小及供血动脉管径差异。结果:98.5%的病例(70/71)集中在肺动脉干12点至3点方向,60.6%的病例(43/71)为双侧供血,9.9%的病例(7/71)为右冠状动脉供血,29.6%的病例(21/71)为左冠状动脉供血,42.3%的病例(30/71)为烟雾型,46.5%的病例(33/71)为喷射型,排除瘘口位于左肺动脉干的孤立病例后,瘘口大小、瘘口与肺动脉瓣距离及供血动脉直径的平均值分别为(2.5±1.1)、(3.1±2.0)、(15.1±6.7)mm,95%置信区间分别为2.6~3.6、13.8~15.5、2.2~2.8 mm。右冠状动脉发出的供血动脉位置近于左冠状动脉(t=11.03,P<0.05),而两侧发出的供血动脉管径无统计学差异(P>0.05);瘘口的大小与主动脉管径及供血动脉管径存在正相关(r=0.505,P<0.05),与肺动脉管径无相关性;不同流入类型的病例在瘘口大小、供血动脉管径方面均无统计学差异(P>0.05)。结论:CCTA能直观显示CPF的解剖特点并测量相关解剖数值,为临床对CPF的评估及治疗方式选择提供有用的信息。

Objective:To analyze the anatomical information of coronary-pulmonary fistula(CPF)based on the examination data from coronary computed tomography angiography(CCTA). Methods:A retrospective analysis was conducted on the CCTA data of 71 patients with CPF. Analyses and calculations were performed on the fistula feeding arteries,location and size of the fistula orifice and its relationship with surrounding anatomical structures,type of inflow to the fistula,and diameters of the aorta and the pulmonary artery with the 95% confidence intervals [ CIs] evaluated for the fistula orifice size,diameter of its feeding arteries,and distance between the fistula orifice and the pulmonary valve. Statistical analyses were made on the differences in diameters of feeding arteries and the correlation of the width of the fistula orifice with the diameters of the aorta,the pulmonary artery,and the dominant feeding arteries. In addition,statistical analyses were made on the differences between cases with different types of inflow to the fistula in terms of the fistula orifice size and the diameter of feeding arteries. Results:Ninety-eight point five percent(70/71)of the cases had a fistula in the pulmonary trunk in the direction of 12 o’clock to 3 o’clock,60.6%(43/71)had bilateral blood supply,9.9%(7/71)had a blood supply from the right coronary artery,29.6%(21/71)had a blood supply from the left coronary artery,42.3%(30/71)showed a "puff of smoke"sign,and 46.5%(33/71) showed an "ejecting"sign. After excluding the isolated case with a fistula in the left pulmonary trunk,mean values of fistula size,distance between the fistula orifice and the pulmonary valve,and diameter of feeding arteries were(2.5±1.1),(3.1±2.0),and(15.1±6.7)mm,respectively,with the corresponding 95%CI as 2.6~3.6,13.8~15.5,and 2.2~2.8 mm,respectively. The location of feeding arteries from the right coronary artery was significantly closer to the fistula compared with that from the left coronary artery(t=11.03,P<0.05),but there was no significant difference in the diameter of feeding arteries from both sides(P>0.05). The fistula orifice size was positively correlated with the diameter of the aorta and the feeding arteries(r=0.505,P<0.05),but not correlated with the diameter of the pulmonary artery. There were no significant differences between cases with different types of inflow to the fistula in terms of fistula orifice size or the diameter of feeding arteries(P>0.05). Conclusion:CCTA can visualize the anatomical characteristics of CPF and measure relevant anatomical structures,thus providing useful information for clinical evaluation and therapeutic method selection for CPF.