冠状动脉-肺动脉瘘的CT冠状动脉造影征象分析  

Imaging features of computed tomography coronary angiography in patients with coronary-pulmonary fistula

作　　者：杨智明[1] 毛定彪[1] 齐琳[1] 陈阳[1] 滑炎卿[1] Yang Zhiming Mao Dingbiao Qi Lin Chen Yang Hua Yanqing(Department of Radiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, Chin)

机构地区：[1]复旦大学附属华东医院放射科,上海200040

出　　处：《中华解剖与临床杂志》2017年第2期103-107,共5页Chinese Journal of Anatomy and Clinics

基　　金：上海市老年医学临床重点实验室建设项目（13dz2260700）

摘　　要：目的 探讨冠状动脉-肺动脉瘘（CPF）的CT冠状动脉造影（CTCA）的影像特点.方法 回顾性分析复旦大学附属华东医院2008年1月-2015年9月经CTCA检查确诊的26例CPF患者的临床资料,采用多平面重组、曲面重组及VR技术观察冠状动脉异常分支（瘘血管）的起源、数目,冠状动脉有无斑块及狭窄,瘘口位置、大小以及瘘管形态、大小、继发改变等.选取其中6例行冠状动脉造影（CAG）检查的患者,比较两种检查方法的结果.结果 26例CPF患者共发现瘘血管44支,起源于双侧冠状动脉13例,均由双侧圆锥支发出;起源于左冠状动脉9例,由左侧圆锥支发出7例,左侧钝圆支发出1例,左主干发出1例;起源于右冠状动脉4例,均由右侧圆锥支发出.瘘血管直径4~11 mm,平均7 mm.11例患者见冠状动脉斑块形成,4例狭窄程度大于50%.5例呈正常血管形态,2例呈蔓状血管网形式,19例伴动脉瘤形成;单发动脉瘤3例,多发16例;共45个动脉瘤形成,椭圆形33个、梭型8个、不规则形4个.瘘口全部开口于肺动脉主干左侧壁,瘘口大小1.2~5.0 mm,平均2.7 mm,18例患者肺动脉内可见造影剂＂浓染＂或＂喷射征＂.6例患者CAG所显示的瘘血管起源、瘘管形态、瘘口位置与CTCA观察结果一致.结论 对于CPF患者,CTCA具有无创性,可提供3D图像,反应血管变异的空间关系,能够提供更多的影像学信息,可作为首选影像学检测方法.Objective To investigate imaging features of computed tomography coronary angiography （CTCA） in patients with coronary-pulmonary fistula（CPF）.Methods The clinical data of 26 patients with CPF diagnosed by CTCA from January 2008 to September 2015 in Huadong Hospital Affiliated to Fudan University were analyzed retrospectively.The origin and number of coronary artery abnormalities, the coronary artery plaque and stenosis, fistula location, size and fistula morphology, size, secondary changes were observed.Six patients underwent coronary angiography, and the differences between the two methods were compared.Results Twenty-six patients with a total of 44 fistula blood vessels, 13 patients originated from bilateral coronary arteries （all from the bilateral conus）, 9 patients originated from left coronary artery （7 patients from left bilateral conus, 1 patient from left blunt branches, 1 patient from left main trunk）, 4 patients originated from right coronary artery （all from right bilateral conus）.Fistula vascular diameter 4-11 mm, average 7 mm.Eleven patients with coronary plaque formation, 4 patients the stenosis more than 50%.Five patients showed normal vascular morphology, 2 patients were in the form of vascular network, 19 patients with aneurysm formation.All the patients had fistula into the pulmonary trunk.The size of the fistula was 1.2-5.0 mm, average 2.7 mm.Eighteen patients with aneurysm patients could be seen contrast agent concentration.The origin, location, and fistula morphology of the 6 patients who underwent CAG were consistent with those of the CTCA.Conclusions Compared with CAG, coronary artery CTCA is noninvasive, which can provide three-dimensional image and reflect the spatial relationship of vascular variation.It can provide more information about coronary artery-pulmonary artery fistula and can be used as the preferred imaging method for CPF.

关 键 词：动脉动脉瘘 冠状动脉-肺动脉瘘 冠状血管造影术 体层摄影术 X线计算机 

分 类 号：R816.2[医药卫生—放射医学] R541.1[医药卫生—临床医学]