冠状动脉瘤样扩张征象在CT诊断冠状动脉瘘中的意义  

The significance of aneurismal dilatation in diagnosing coronary artery fistula by CT angiography

作　　者：曹志坚[1] 许茂盛[1] 陈智能[1] 丁国苗[1] 王世威[1] 陈刚[1] 

机构地区：[1]浙江中医药大学附属第一医院医学影像科,浙江杭州310006

出　　处：《医学影像学杂志》2015年第4期625-627,共3页Journal of Medical Imaging

基　　金：浙江省中医药管理局一般项目(2009CA022);浙江中医药大学资助项目(2C00608)

摘　　要：目的探讨冠状动脉瘤样扩张征象在CT血管成像(CTA)诊断冠状动脉瘘(coronary artery fistula,CAF)中的临床意义。方法回顾性分析冠状动脉CTA检查10460例,采用64层螺旋CT,用VRT、MPR和MIP等多种方法观察,分析冠状动脉瘘合并动脉瘤样扩张的CTA特点及其诊断价值。结果 CTA诊断CAF 21例(0.20%),冠状动脉左心室瘘2例,左心房瘘2例,肺动脉瘘16例,肺动脉瘘合并左心房瘘1例。共有17例(80.9%)出现病变动脉瘤样扩张征象,其中梭型2例,囊状15例。瘤体位于开口处8例,非瘘口处9例。16例为单个,1例为2个。1例瘤体附壁血栓形成。结论冠状动脉瘤样扩张征象的CT表现对诊断CAF有较大帮助,CTA能清晰显示瘤体位置及是否有血栓形成,为CAF治疗方案制定提供重要参考。Objective To investigate the clinical significance of coronary aneurismal dilatation in diagnosing coronary ar‐tery fistula （CAF） by CT angiography （CTA） .Methods Totally ,10460 cases underwent coronary CTA were retrospec‐tively reviewed .Electrocardiography gated 64‐slice cardiac CT scans were performed .Postprocessing techniques included volume rendering technique （VRT） ,multi‐planner reformation （MPR） and maximum intensity projection （MIP） .The findings of CAF especially aneurismal dilatation were analyzed .Results 21 cases of CAF （0 .20% ） were detected by CTA in 10460 patients .The communication of the fistula included coronary artery to left atrium （2 cases） ,to left ventricle （2 cases） ,to pulmonary artery （16 cases） ,and to pulmonary artery and left ventricle （1 case） .Feeding coronary artery dila‐tations were noted in all 21 cases of CAFs .Eighteen aneurismal dilatations were detected in 17 cases of CAF （80 .9% ） . The morphologic finding of aneurismal dilatation was fusiform （2 cases） and saccular （15 cases） .The location of the aneu‐rismal dilatation was near （8 cases） and not near （9 cases） by the fistula .Mural thrombus was noted in 1 case .Conclusion It’s very helpful for diagnosis of CAF by carefully investigating the findings of aneurismal dilatation in CT angiography . Coronary CTA is capable of displaying the fistulas ,the aneurysms ,and the mural thrombus within the aneurysm sac , which can provide important reference for the planning of CAF treatment .

关 键 词：冠状动脉瘘 瘤样扩张 体层摄影术  X线计算机 血管成像 

分 类 号：R541[医药卫生—心血管疾病] R814.42[医药卫生—内科学]