成人冠状动脉瘘的超声心动图与CT血管造影影像学特征及诊断效能分析

目的分析成人冠状动脉瘘的超声心动图以及冠状动脉CT血管造影（CTA）表现特征,并探讨超声心动图与冠状动脉CTA对成人冠状动脉瘘的诊断价值。 方法回顾性选取2011年1月至2018年12月于海军军医大学附属长征医院就诊的疑似冠状动脉瘘患者30例。所有患者均行经胸超声心动图和冠状动脉CTA检查,并最终经手术或冠状动脉造影确诊。以手术结果或冠状动脉造影检查作为"金标准",最终确诊冠状动脉瘘患者23例,非冠状动脉瘘患者7例。分析23例冠状动脉瘘患者的超声心动图和冠状动脉CTA表现特征,并对超声心动图和冠状动脉CTA诊断冠状动脉瘘的效能进行比较分析。 结果23例冠状动脉瘘患者中,超声心动图准确诊断20例,漏诊3例,其中2例为左冠状动脉-肺动脉瘘,1例为右冠状动脉-右心室瘘;冠状动脉CTA准确诊断22例,漏诊1例为左冠状动脉-肺动脉瘘。以手术结果或冠状动脉造影为"金标准",超声心动图诊断冠状动脉瘘的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为86.96%、71.43%、90.90%、62.50%、83.33%;冠状动脉CTA诊断冠状动脉瘘的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为95.65%、85.71%、95.65%、85.71%、93.33%。超声心动图与CTA这2种方法的诊断结果分别与"金标准"比较,一致性均较高,Kappa值分别为0.757、0.911（P均<0.001）。 结论冠状动脉CTA和超声心动图2种影像学检查方法各有优势,对冠状动脉瘘均具有较好的诊断价值,可为冠状动脉瘘的诊断提供有效和可靠的信息和参考依据。

Echocardiography and computed tomography angiography for diagnosing coronary artery fistula in adults: imaging features and diagnostic efficacy

ObjectiveTo analyze the imaging characteristics and diagnostic value of echocardiography and computed tomography angiography (CTA) in coronary artery fistula in adults. MethodsThirty patients with suspected coronary artery fistula admitted to Changzheng Hospital Affiliated to Naval Medical University from January 2011 to December 2018 were retrospectively selected. All patients underwent transthoracic echocardiography and CTA, and were eventually diagnosed by surgery or coronary angiography. Twenty-three patients with coronary artery fistula and seven patients with non-coronary artery fistula were diagnosed based on surgical exploration or coronary angiography. The efficacy of echocardiography and CTA in the diagnosis of coronary artery fistula was analyzed and compared. ResultsOf the 23 patients with coronary artery fistula, 20 were accurately diagnosed by echocardiography and 3 had a misdiagnosis, of whom 2 were misdiagnosed as having left coronary artery-pulmonary artery fistula, and 1 was misdiagnosed as having right coronary artery-right ventricular fistula. Of the 23 patients with coronary artery fistula, 22 were accurately diagnosed by coronary CTA, and 1 was misdiagnosed with left coronary artery-pulmonary artery fistula. Taking surgical results or coronary angiography as the "gold standard", the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of echocardiography for diagnosing coronary artery fistula were 86.96%, 71.43%, 90.90%, 62.50%, and 83.33%, respectively; the corresponding percentages of coronary CTA were 95.65%, 85.71%, 95.65%, 85.71%, and 93.33%, respectively. Both methods had a good consistency with the gold standard (κ₁=0.757, P<0.001; κ₂=0.911, P<0.001). ConclusionBoth echocardiography and CTA are of good value for the diagnosis of coronary artery fistula, and can provide effective and reliable information for the diagnosis of this disease.