多层螺旋CT在冠状动脉瘘诊断中的价值

目的通过回顾性分析经多层螺旋CT采集的冠状动脉(CTA)影像资料,探讨冠状动脉CTA在冠状动脉瘘(CAF)诊断中的价值。方法回顾性收集2014年1月至2022年12月建德市人民医院与金华市中心医院的CAF的CTA图像资料。采用最大密度投影、容积再现、曲面重建和多平面重建进行图像后处理。分析冠状动脉瘘(CAF)的供血动脉起源、数量,CAF的引流终点,CAF瘘管最大直径,有无合并动脉瘤形成,动脉瘤最大径,有无血栓形成。结果CAF供血动脉大多见于左前降支(66.88%),单一供血动脉多见,有115例。CAF引流终点最常见于肺动脉(79.62%),单一引流终点常见,有153例。多供血动脉CAF的瘘管较单供血动脉瘘管最大直径更大[3.05(2.3,3.98)mm]VS.[2.50(1.70,3.70)mm],差异具有统计学意义。引流终点为血管组较心腔组的CAF瘘管最大直径更大[2.80(2.10,3.80)mm]VS.[1.80(1.45,4.17)mm],差异具有统计学意义。18例CAF合并瘘管动脉瘤样扩张,直径约(13.03±8.14)mm,其中2例伴有动脉瘤内血栓形成。结论CAF具有典型的CT影像表现,CTA能全面评估CAF起源、终点位置、有无动脉瘤,在临床诊断与评估中具有重要作用。

Objective To explore the value of coronary computed tomography angiography(CTA)in the diagnosis of coronary artery fistula(CAF)by retrospective analysis of images obtained from multi-slice CT.Methods Retrospectively collected coronary CTA images from Jiande First People's Hospital and Jinhua Municipal Central Hospital from January 2014 to December 2022.Image post-processing was performed using maximum intensity projection,volume rendering,curved planar reconstruction,and multiplanar reconstruction.The study analyzed the origin and number of feeding arteries of CAF,the drainage endpoint of CAF,the maximum diameter of the CAF fistula,the presence of aneurysm formation,the maximum diameter of the aneurysm,and the presence of thrombus formation.Results The feeding arteries of CAF were predominantly found in the left anterior descending artery(66.88%),with 115 cases having a single feeding artery.The drainage endpoint of CAF was most commonly the pulmonary artery(79.62%),with 153 cases having a single drainage endpoint.The maximum diameter of the fistula in cases with multiple feeding arteries was larger than that in cases with a single feeding artery[3.05(2.3,3.98)mm VS.2.50(1.70,3.70)mm],which was statistically significant.The maximum diameter of the fistula in cases with vascular drainage endpoints was larger than that in cases with cardiac chamber drainage endpoints[2.80(2.10,3.80)mm VS.1.80(1.45,4.17)mm],and the difference was statistically significant.18 cases of CAF were combined with aneurysmal dilatation of the fistula,with a diameter of approximately(13.03±8.14)mm,and 2 cases were accompanied by thrombus formation within the aneurysm.Conclusion CAF has typical CT imaging features,which can be employed comprehensively to assess the origin,endpoint position,and the presence of aneurysm,playing an important role in clinical diagnosis and evaluation.