CT冠状动脉造影对成人冠状动脉瘘的诊断价值-东南大学学报医学版

CT冠状动脉造影对成人冠状动脉瘘的诊断价值

单位：东南大学附属中大医院放射科, 东南大学医学院分子与功能影像实验室, 江苏南京 210009

分类号：R543.3

出版年·卷·期（页码）：2020·39·第二期（140-145）

摘要：

目的：探讨成人先天性冠状动脉瘘（CAF）的多排螺旋CT图像特征及诊断价值。方法：回顾性分析2008年1月至2017年7月间在东南大学附属中大医院行计算机断层扫描冠状动脉造影（CTCA）检查的4 139例患者（排除16岁以下患者）的资料。经CTCA诊断为CAF患者共53例，其中27例同时行侵入性冠状动脉造影（CAG）对照。分析每例患者的临床资料，综合CTCA后处理图像，记录CAF的起源、瘘口注入位置、合并其他异常，分析CTCA用于诊断成人CAF的优势。结果：53例经CTCA诊断的CAF患者，起源于左冠状动脉21例（39.6%）、右冠状动脉19例（35.8%）、双侧冠状动脉13例（24.5%）；其中27例行CAG并行堵瘘手术，与CTCA结果均相一致，诊断准确率100%，并对合并畸形作出正确诊断。结论：CTCA成像可清楚显示CAF的起源、走行、管腔形态、瘘口大小、数量、汇入心腔或动静脉的准确解剖位置以及合并畸形，是无创性诊断成人CAF的可靠方法。

Objective: To explore the value of multidetector computed tomography(MDCT) in the diagnosis of coronary artery fistula(CAF) in adults. Methods: Clinical data of 4 139 patients undergoing multidetector computed tomographic coronary angiography(CTCA) from January 2008 to July 2017 in our hospital were retrospectively analyzed,and those under 16 years old were excluded. Fifty-three cases were diagnosed as CAF by CTCA. Comparison of coronary angiography was conducted in 27 cases, which involved analyzing patients' clinical data, processing images of CTCA, documenting the origin of CAF,location of fistula and other concomitant abnormalities. Advantages of CTCA in the diagnosis of CAF in adults were also analyzed. Results: Of the 53 CAF patients detected with CTCA, left coronary artery(LCA) and right coronary artery(RCA) origin was found in 21(39.6%) and 19 patients(35.8%) respectively, and LCA and RCA origin was found in 13 patients(24.5%). Twenty-seven patients received routine CAG surgery,the results of which were completely consistent with those of CTCA, the coincidence rate being 100%. Conclusion: CTCA images can clearly demonstrate the CAF by depicting the origin, course and termination of fistulas; in addition, the size, anatomical structure and complicated malformation of fistulas can be precisely evaluated. It is concluded that CTCA is an effective imaging modality for noninvasive classification of CAF in adults.

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