成人冠状动脉-肺动脉瘘CT冠状动脉造影征象分析:与冠状动脉导管造影、经胸超声心动图对比  

Evaluation of coronary artery-to-pulmonary artery fistula in adulthood on CT coronary angiography: comparison with coronary catheter angiography and transthoracic echocardiography

作　　者：李景雷[1] 朱伟 叶维韬 颜丽芬[1] 钟小梅[1] 罗海营[1] 黄美萍[1] LI Jing-Lei;ZHU Wei;YE Wei-Tao;YAN Li-Fen;ZHONG Xiao-Mei;LUO Hai-Ying;HUANG Mei-Ping(Department of Radiology,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangdong 510080,China)

机构地区：[1]广东省人民医院广东省医学科学院放射科,广东广州510080 [2]广东省医学科学院心研所

出　　处：《影像诊断与介入放射学》2019年第1期11-15,共5页Diagnostic Imaging & Interventional Radiology

摘　　要：目的分析冠状动脉-肺动脉瘘(CPAF)的CT冠状动脉造影(CTCA)征象,并比较CTCA与冠状动脉导管造影(CCA)与经胸超声心动图(TTE)的诊断效能。方法在连续19855例CTCA中回顾性收集CPAF共72例。分析瘘血管的起源、数目、大小及走行(管状扩张或蚯蚓状扩张或动脉瘤及附壁征)、瘘口位置、数目、大小及征象(穿通征、等密征、烟雾征及喷射征),以及肺动脉是否增宽。结果瘘血管起源于圆锥支、左前降支(LAD)或兼有者分别为55、67和50例;管状扩张、蚯蚓状扩张及瘤样扩张分别为14、58和35例;附壁征69例。所有病例均为1个瘘口,位于主肺动脉左侧壁、左前侧壁、前壁、右侧壁、右前侧壁分别为44、21、5、1和1例;瘘口平均直径为2.6±1.3 mm;穿通征、等密征、烟雾征及喷射征分别为72、46、41和24例。主肺动脉扩张20例。25例CCA中仅20例可显示CPAF,47例TTE中仅9例显示CPAF。结论CTCA是评估、诊断CPAF的首选检查方法 ,具有良好的诊断效能。Objective To review the imaging features of coronary artery-to-pulmonary artery fistula(CPAF)on CT coronary angiography(CTCA)and evaluate its diagnostic performance compared with coronary catheter angiography(CCA)and transthoracic echocardiography(TTE).Methods We retrospectively reviewed diagnosis of CPAF from 19855 consecutive CCTA for suspected coronary artery disease.CT images were evaluated with origin,number,size and course(tubular/worm-like dilation/significant aneurysm formation/wall attachment sign)of fistula vessels,drainage site,drainage site imaging features(pierced sign,isodensity sign,smoke sign,jet sign),and main pulmonary artery(MPA)enlargement.Since 25 patients of CPAF underwent CCA and 47 patients underwent TTE.Results CPAF originated from conus artery,left anterior descending artery(LAD),combined conus artery and LAD was 55,67,50 cases,respectively.Tubular dilation,worm-like dilation and aneurysm was seen in 14,58 and 35 cases,respectively.Wall attachment sign was noted in 69 cases.All the cases demonstrated only a single drainage site,with left lateral wall,left anterolateral,anterior,right lateral and right anterolateral walls of MPA in 44,21,5,1 and 1 cases,respectively.The mean diameter of the fistula drainage site was 2.6±1.3 mm.Pierced sign,jet sign,smoke sign,isodensity sign was seen in 72,46,41 and 24 cases,respectively.MPA enlargement was seen in 20 patients.CCA showed CPAF in only 20 cases among 25 patients;while TTE showed CPAF in only 9 patients among 47 patients.Conclusion CTCA is competent in detecting and characterizing CPAF with an excellent diagnostic performance as the first imaging modality of choice.

关 键 词：冠状动脉-肺动脉瘘 CT冠状动脉造影 冠状动脉导管造影 经胸超声心动图 

分 类 号：R543[医药卫生—心血管疾病] R540.45[医药卫生—内科学] R816.2[医药卫生—临床医学]