冠状动脉瘘的CT冠状动脉成像评价  

CT Coronary Imaging Evaluation of Coronary Artery Fistula

作　　者：胡孝梨 何春丽 徐军 许娟[1] 刘整 陈艳[2] 喻杰 韩萍[2] HU Xiaoli;HE Chunli;XU Jun(Department of Radiology,Wuhan Asian Heart Hospital,Wuhan,Hubei Province 430022,P.R.China)

机构地区：[1]武汉亚洲心脏病医院放射科,430022 [2]华中科技大学同济医学院附属协和医院放射科,武汉430022

出　　处：《临床放射学杂志》2022年第4期634-638,共5页Journal of Clinical Radiology

摘　　要：目的 分析冠状动脉瘘(CAF)CT冠状动脉成像(CTCA)表现,以提高对CAF的诊断水平。方法 回顾性分析2012年1月至2021年5月在武汉亚洲心脏病医院行CTCA并经手术或DSA冠状动脉造影证实的211例CAF患者的临床和CTCA资料,其中男109例,女102例,年龄28天~79岁,平均(43.71±24.80)岁。采用iCT及FLASH双源CT进行CTCA检查,在轴位、最大密度投影(MIP)、多平面重组(MPR)/曲面重组(CPR)、容积再现(VR)图像上评价CAF的起源、瘘管形态、瘘口部位、CTCA表现等。结果 211例CAF中,196例(92.9%)有心血管相关症状,主要表现为呼吸困难、胸痛、心悸。29例(13.7%)合并一种或多种其他先天性心脏畸形。70.6%的瘘管起源于单支冠状动脉,29.4%的瘘管起源于双支冠状动脉。左冠状动脉起源稍多于右冠状动脉。瘘管主要引流入肺动脉,其次流入右心房、室。CTCA直接征象:冠状动脉主干或分支迂曲扩张188例(89.1%),合并冠状动脉瘤104例(49.3%);可见迂曲扩张的瘘管:单支瘘管148例(70.1%),两支瘘管62例(29.4%);瘘口的特征性表现:“开窗征”210例(99.5%),其中合并“等密度征”103例(48.8%),合并“射血征”51例(24.2%),合并“烟雾征”34例(16.1%)。单纯的表现为“飘带征”1例(0.5%)。间接征象:异常引流可导致心腔扩大(108例,51.2%)及肺动脉扩张/增粗(13例,6.2%)。结论 CAF的临床表现缺乏特异性。CTCA可很好显示CAF的起源和引流部位、走行、分类以及心脏大血管的病变,对CAF的诊断及治疗方案的制定具有重要作用。Objective To improve the diagnostic level of coronary artery fistula(CAF) by analyzing the CT coronary imaging performances.Methods The clinical and CT coronary angiography(CTCA) data of 211 patients with CAF confirmed by surgery or DSA coronary angiography from January 2012 to May 2021 at the Wuhan Asian Heart Hospital were retrospectively analyzed,including 109 males and 102 females,with an age range of 28 days-79 years and a mean of(43.71±24.80) years.CTCA examinations were performed using iCT and FLASH dual-source CT to evaluate the origins of CAF,fistula morphologies,fistula sites and CTCA performances on axial,MIP,MPR/CPR,and VR images.Results Among the 211 CAF cases,196 cases(92.9%) had cardiovascular-related symptoms,which mainly manifested as dyspnea,chest pain,and palpitation.29 cases(13.7%) were combined with one or more other congenital cardiac malformations.70.6% of fistulas originated from a single coronary artery and 29.4% from the double coronary artery.The origin of left coro-nary artery was slightly more than the right coronary artery.The fistula mainly drained into the pulmonary artery,secondarilyinto the right atrium and right ventricle.Direct signs of CTCA:tortuous dilatation of the main trunks or branches of the coro-nary artery in 188 cases(89.1%),combined with coronary aneurysm in 104 cases(49.3%);visible tortuous dilatation offistula:single fistula in 148 cases(70.1%),two fistulas in 62 cases(29.4%);characteristic performances of fistula:openwindow sign in 210 cases(99.5%),of which 103 cases( 48.8%) combined with isodensity sign,51 cases(24.2%)combined with ejection sign and 34 cases(16.1%) combined with smoke sign.The simple manifestation was the floatingband sign in 1 case(0.5%).Indirect signs:enlarged heart chambers due to abnormal drainage(108 cases,51.2%) anddilated/coarse pulmonary arteries(13 cases,6.2%).Conclusion The clinical performances of CAF lack specificity.CT-CA can well show the origins and drainage sites,travels,classifications of CAF and the lesions of cardiac great ves

关 键 词：冠状动脉瘘 瘘管 CT冠状动脉成像 

分 类 号：R543.3[医药卫生—心血管疾病] R816.2[医药卫生—内科学]