64排螺旋CT冠状动脉血管成像诊断冠状动脉-肺动脉瘘的应用价值  

Clinical value of coronary artery-pulmonary artery fistula revealed by 64-slice spiral CT coronary angiography

作　　者：周玉祥[1] 蓝博文[1] 黄春榆[1] 饶红萍[1] 李丽红[1] 代海洋[1] 

机构地区：[1]惠州市中心人民医院放射科,516001

出　　处：《国际放射医学核医学杂志》2016年第1期26-30,共5页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：惠州市科技计划项目（2014Y039）

摘　　要：目的 评价64排螺旋CT三维重组技术诊断冠状动脉肺动脉瘘（CPF）的应用价值.方法 回顾性分析20例行64排螺旋CT冠状动脉血管成像的CPF患者的资料,其图像行容积再现、多平面重组、曲面重组、最大密度投影,分析CPF的检出率、异常血管的CT特征及多排螺旋CT的诊断意义.结果 CPF血管起源：左冠状动脉分支或左圆锥支1 1例,左冠状动脉分支及右圆锥支（或左右圆锥支）7例,右圆锥支1例,双侧冠状动脉多分支1例.异常血管形态：迂曲扩张血管网19例,单纯扩张血管1例,匍匐于肺动脉壁20例;合并囊状动脉瘤5例,梭形动脉瘤1例.肺动脉瘘口的位置：主肺动脉左侧壁14例,左前壁1例,前壁2例,左侧壁和前壁1例,左前壁和右侧壁1例,未见明确瘘口1例.瘘口的CT特征：开窗征17例,射血征8例,烟雾征3例,飘带征1例,等密度征10例.结论 多排螺旋CT重组技术可清晰显示CPF的异常血管及瘘口特征,为临床诊治提供重要信息,可作为诊断的首选方法.Objective To evaluate the value of the three dimensional multi-slice spiral CT in the diagnosis of coronary artery-pulmonary artery fistula （CPF）.Methods Retrospectively analyzed the multi-slice spiral CT images of 20 CPF patients diagnosed by coronary CT angiography.All of the cases were used in volume rendering, muhiplanar reformation, curved planar reformation, and maximum intensity projection.Moreover, the incidence, the features of the abnormal vessels revealed by multi-slice spiral CT, and the diagnostic significance of CPF were retrospectively summarized.Results The origin of CPF vessels was the branch of left coronary artery or left conus branch in 11 cases, the branch of left coronary artery and right conus branch in 7 cases, the right conus branch in 1 case, and the multi-branch of left and right coronary artery in 1 case.The abnormal vessels demonstrated a tortuous dilatation in 19 cases and a tubular dilatation in 1 case.CPF extended into the pulmonary artery wall in 20 cases;companied with aneurysm in 5 cases and fusiform aneurysm in 1 case.Moreover, the pulmonary artery fistulas were located in the left wall of the main pulmonary artery in 14 cases, in the left anterior wall in 1 case, in the anterior wall in 2 cases, in the left and anterior wall in 1 case, and in the anterior and right wall in 1 case;pulmonary artery fistulas were absent in 1 case.The CT features of the pulmonary artery fistula concluded a window sign in 17 cases, an ejection sign in 8 cases, a smoke sign in 3 cases, a streamer sign in 1 case, and an isodensity sign in 10 cases.Conclusion The 3D-MSCT can clearly visualize abnormal vessels and fistula.Thus, this method can be considered as the primary choice in CPF diagnosis and treatment.

关 键 词：冠状动脉疾病 肺动脉 体层摄影术 X线计算机 动脉-动脉漏 

分 类 号：R816.2[医药卫生—放射医学] R543.3[医药卫生—临床医学]