多层螺旋CT肺静脉成像在房颤射频消融术中的应用价值  

Clinical application of pulmonary vein imaging of multi-slice spiral computed tomography in radiofrequency ablation for atrial fibrillation

作　　者：虞康惠[1] 江桂华[1] 成官迅[2] 

机构地区：[1]广东省第二人民医院影像科,广东广州510317 [2]北京大学深圳医院医学影像科,广东深圳518036

出　　处：《中国医学物理学杂志》2016年第5期515-521,共7页Chinese Journal of Medical Physics

摘　　要：目的:探讨多层螺旋CT(MSCT)肺静脉成像对房颤射频消融治疗的指导意义。方法:回顾分析34例经导管射频消融治疗的房颤患者,术前行MSCT肺静脉增强扫描,术中行选择性肺静脉造影(CPV)。MSCT重建肺静脉-左心房图像,观察肺静脉的解剖类型,测量各支肺静脉的口径,并与术中CPV结果比较。所有患者均采用环肺静脉线性消融术,其中14例术前MSCT原始图像数据整合入Carto系统。结果:MSCT共识别肺静脉136根,其中22例为标准型肺静脉解剖(64.7%),5例为有单独开口的右副肺静脉(14.7%),6例为左肺静脉共同开口(17.6%),还有1例混合变异(3.0%)。CPV仅识别肺静脉130根。MSCT及CPV对各支肺静脉直径的测量无显著差异,(P>0.05)。20例传统Carto系统标测及14例Carto-Merge技术指导下的环肺静脉消融术平均手术时间分别为(190.46±35.13)min和(162.63±33.74)min(P<0.05)。结论:MSCT肺静脉成像可以替代CPV评估肺静脉,其显示肺静脉-左心房区域解剖学细节的能力优于CPV;Carto-Merge技术融合MSCT重建图像指导房颤射频消融手术,有利于保证环肺静脉线性消融的连续性,并有效缩短手术时间。Objective To explore the guiding significance of pulmonary vein imaging of multi-slice spiral computed tomography（MSCT） in radiofrequency ablation for atrial fibrillation. Methods Totally, 34 patients with atrial fibrillation treated by radiofrequency ablation were retrospectively analyzed. The patients were examined by preoperative MSCT scanning and intraoperative conventional pulmonary venography（CPV）. The images of pulmonary-left atrium were reconstructed by MSCT to observe the anatomical type of pulmonary vein, measure the size of each branch of pulmonary vein ostium, and be compared with the results of intraoperative CPV. All the patients were operated with circumferential pulmonary vein ablation. And 14 cases of preoperative MSCT original image data were integrated into the Carto system. Results MSCT showed 136 pulmonary veins,including 22 cases of typical pattern of pulmonary veins（64.7%）, 5 cases of right additional pulmonary vein（14.7%）, 6 cases of common trunk left pulmonary vein（17.6%）, and 1 case of mixed variation（3.0%）. CPV only distinguished 130 pulmonary veins. No significant differences were found in the diameter measurements of each branch of pulmonary vein between MSCT and CPV（P0.05）. The average operation times of circumferential pulmonary vein ablation for 20 cases with the guidance of traditional Carto system mapping and 14 cases with the guidance of Carto-Merge technology were respectively（190.46±35.13）min and（162.63±33.74） min（P0.05）. Conclusion MSCT displays better anatomical details of the pulmonary vein and left atrium area than CPV, which makes the MSCT can replace CPV to evaluate the pulmonary vein. The radiofrequency ablation for atrial fibrillation with the guidance of Carto-Merge technology combined with MSCT constructed images is conducive to ensure the continuity of circumferential pulmonary vein ablation and effectively shorten the operation time.

关 键 词：多层螺旋CT 肺静脉造影 心房颤动 导管射频消融 Carto-Merge 

分 类 号：R445.2[医药卫生—影像医学与核医学] R541.75[医药卫生—诊断学]