320排CT血管成像对冠状动脉瘘的诊断价值

目的探讨320排CT血管成像对冠状动脉瘘的诊断价值。方法回顾性分析34例冠状动脉瘘患者的320排CT血管成像资料及临床资料,其中11例患者同时进行冠状动脉造影检查。结果 26 590例患者中共34例诊断为冠状动脉瘘,发病率为0.13%。34例冠状动脉瘘中冠状动脉-肺动脉瘘26例(76.5%),冠状动脉-左心室瘘3例(8.8%),冠状动脉-右心房瘘3例(8.8%),冠状动脉-左心房瘘1例(2.9%),冠状动脉-右心室瘘1例(2.9%)。起源于左冠状动脉8例(23.5%),起源于右冠状动脉10例(29.4%),同时起源于两侧冠状动脉者16例(47.1%)。16例(47.1%)伴随瘤样扩张。瘘口直径范围2.0~13.0 mm,中位直径2.5 mm。瘘口两端见浓染征15例(44.1%),射血征10例(29.4%),等密度征9例(26.5%)。11例均经冠状动脉造影证实为冠状动脉瘘。结论冠状动脉瘘发病率低,其中冠状动脉-肺动脉瘘是最常见的类型(占76.5%),同时起源于两侧冠状动脉占47.1%。320排CT血管成像能无创、准确地显示冠状动脉瘘的起源、瘘血管走行、瘘口直径及引流部位,可作为诊断冠状动脉瘘的首选检查方法。

Coronary artery fistula: evaluation with 320-row detector CT coronary angiography

Objective To assess the value of 320-row detector CT coronary angiography (CTCA) in the diagnosis of coronary artery fistula (CAF).Methods The CTCA and clinical records of 34 patients with CAF were retrospectively analyzed.The CAF was confirmed by coronary angiography in 11 patients.Results The incidence of CAF was 0.13％ (34/26,590) including 26(76.5％) coronary-pulmonary artery fistulas,3 (8.8％) coronary-left ventricle fistulas,3 (8.8％) coronary-right atrium fistulas,1 (2.9％) coronary-left atrium fistula,and 1 (2.9％) coronary-right ventricle fistula.The CAF originated fiom the left coronary artery (LCA) in 8 (23.5％),right coronary artery (RCA) in 10 (29.4％),both LCA and RCA in 16 (47.1％) patients,with associated aneurysms in 16 patients (47.1％).The diameter of the detected fistula orifice ranged from 2.0 mm to 13.0 mm,with median diameter of 2.5 mm.The fistula orifice was hyperdense (15,44.1％),isodense (9,26.5％),or showed a jet sign (10,29.4％).Conclusion The incidence of CAF was low with a predominance of coronary-pulmonary artery fistulas (76.5％).47.1％ of CAF originated from both LCA and RCA.320-row detector CTCA can noninvasively and accurately show the origin,course,and diameter of the orifice as well as the drainage site of the CAF.