心大静脉异常引流28例CT特征分析

CT features of anomalous drainage of the great cardiac vein: analysis of 28 cases

目的探讨心大静脉异常引流的CT影像特征。方法回顾性研究。收集2007年5月—2018年8月复旦大学附属华东医院放射科53 185例行心脏CT检查资料中。纳入心大静脉异常引流的患者28例,其中男12例、女16例,年龄25~79岁。患者均采用德国西门子双源CT进行扫描,对CT扫描图像进行多平面重建,在CT重建图像上观察心大静脉的走行及异常引流的位置,测量心大静脉的长度,心大静脉异常引流汇入上腔静脉处(汇入点)和左心房入口处(入口处)的直径及CT值,以及冠状静脉窦的直径;观察有无合并心脏畸形。结果 28例患者中,心大静脉引流入上腔静脉19例,引流入心房9例(左心房7例、右心房2例)。心大静脉引流入上腔静脉19例患者,心大静脉的长度为17~26 mm,汇入点距离上腔静脉左心房入口处的距离为1~8 mm,汇入点的直径为2.5~4 mm,入口处的CT值为20~60 HU,冠状静脉窦的直径为2.5~5 mm;其中合并的心脏畸形包括室间隔膜部缺损1例。心大静脉异常引流入心房9例患者,其中引流入左心房前壁者6例、右心房顶部靠近房间隔处2例、左心房左侧壁者1例;心大静脉的长度为15~36 mm,入口处的直径为2.8~4.5 mm,入口处的CT值为400~600 HU,冠状静脉窦的直径为2.5~5 mm;其中合并心脏畸形包括无顶冠状静脉窦2例、卵圆孔未闭1例、冠状动脉瘘1例、右室双出口1例。结论心脏CT检查是发现心大静脉异常引流的有效方法,多种后处理技术相结合可避免漏诊和误诊的发生。

Objective To explore and analyze the CT features of abnormal drainage of the great cardiac vein to understand this variation.Methods A retrospective study of 28 cases of abnormal drainage of great cardiac vein who underwent cardiac CT examination in the radiology Department of Huadong Hospital Affiliated to Fudan University from May 2007 to August 2018 was performed.There were 12 males and 16 females,aged from 25 to 79 years.The CT scan images were multi-planar reconstructed.On the CT reconstructed images,the route of the great cardiac vein and the position of abnormal drainage were observed,and the length of the great cardiac vein,the diameter and CT value of the junction of abnormal drainage,and the diameter of the coronary sinus were measured.The presence of cardiac malformation was also observed.Results Among the 28 patients with abnormal drainage of the great cardiac vein,19 were drained into the superior vena cava,7 into the left atrium,and 2 into the right atrium.In the 19 patients with great cardiac vein drained into the superior vena cava,the length of the great cardiac vein was 17-26 mm,the distance between the great cardiac vein and the entrance to the left atrium of the superior vena cava was 1-8 mm,and the diameter of the entrance of the great cardiac vein drainage into the superior vena cava was 2.5-4 mm.The CT value of the entrance was 20-60 HU,and the diameter of the coronary sinus was 2.5-5 mm.Complicated cardiac malformation,including interventricular septal defect,was detected in 1 case.In 9 patients,the great cardiac vein was drained into the anterior wall of the left atrium in 6 cases,the top of the right atrium near the atrial septum in 2 cases,and the left wall of the left atrium in 1 case.The length of the great cardiac vein was 15-36 mm,and the diameter of the entrance of the great cardiac vein drainage into the atrium was 2.8-4.5 mm.The CT value of the entrance was 400-600 HU.The diameter of the coronary sinus was 2.5-5 mm.Complicated cardiac malformation was also detected,including unroofed coronary sinus in 2 cases,patent foramen ovale in 1 case,coronary artery fistula in 1 case,and double outlet of the right ventricle in 1 case.Conclusions Cardiac CT is an effective method to detect abnormal drainage of the great cardiac vein.The combination of various post-processing techniques can avoid missed diagnosis and misdiagnosis.