冠状动脉瘘的双源CT诊断

目的:探讨双源CT(DSCT)冠状动脉成像对冠状动脉瘘的诊断价值.方法:对1000例患者行DSCT冠状动脉增强扫描,分析其断层图像,结合最大密度投影(MIP)、曲面重组(CPR)、多平面重组(MPR)和容积再现(VR)等方法观察冠状动脉的走行及心内外机构.结果:11例患者有冠状动脉瘘,其中右冠状动脉主干-肺动脉瘘5例,...     

Coronary artery anomalies: Role of contrast enhanced MDCT coronary angiography

Objective

The purpose of this study is to evaluate the role of MDCT in the depiction of coronary artery anomalies.

Patients and methods

Sixteen patients were included in this study. Retrospectively gated coronary CT angiography was performed in 11 patients and prospectively gated CT coronary angiography was performed in 5 patients. Post-processing techniques as maximum-intensity projection, curved multiplanar reconstruction, and volume rendering were applied to assess the origin and course of the coronary vessels.

Results

Origin and course anomalies of the central coronary artery segments were seen in 11 patients (67%), anomalies of only coronary artery origin in 2 patients (13%), origin and course anomalies of the peripheral coronary segments in 2 patients (13%) and coronary arterio-venous fistula in one patient (7%). The origin and course anomalies of the central coronary artery segment were more common in the left coronary artery involving 8 patients (73%). Malignant inter-arterial course between aortic root and pulmonary artery or the right ventricle outflow tract was seen in 3 anomalous arteries.

Conclusion

MDCT coronary angiography can precisely depict the origin and course coronary artery anomalies and is recommended in young patients and before cardiac intervention or surgery to prevent possible complications.     

64MSCTA对冠状动脉变异的诊断及临床评价

目的评价64层螺旋CT冠状动脉血管成像（CTCA）对冠状动脉变异的诊断价值及临床评价。方法回顾性分析3529例临床疑为心肌缺血患者及常规体查者冠状动脉CTA影像检查结果并对发现的变异冠状动脉进行分类。结果3529例冠状动脉CTA受检者中,共检出冠状动脉变异42例（1．19％,42／3529）,MIP、VRT、CPR重建图像均明确显示其开口及走行;其中右冠状动脉起自主动脉左冠状窦者9例,左冠状动脉起自主动脉右冠状窦者2例,左回旋支异位开口于右冠窦1例,冠状动脉高位开口于升主动脉壁者6例．并行左主干3例（前降支、旋支分别开口于左冠窦）,左主干开口于肺动脉伴右冠状动脉瘤1例,左旋支-冠状静脉瘘者2例,副冠状动脉9例,右冠状动脉-左心室瘘合并右冠状动脉瘤l例。冠状动脉发育不良8例。结论冠状动脉CTA能准确显示各种类型冠状动脉变异,可作为无创性诊断冠状动脉变异的首选方法。     

An unusual case of coronary artery fistula to the pulmonary artery,diagnosed with 64-MDCT coronary angiography

This report describes a case of complex coronary–pulmonary artery fistula with one feeding vessel from the proximal part of the right coronary. The complex anatomy of the fistula was shown in detail by multidetector computed tomography using multiplanar reconstruction and 3D volume rendering techniques.Traditionally, conventional angiography has been used for the diagnosis of coronary anomalies. With more frequent use of 64-row multi-detector computed tomography (CT) in chest and cardiac imaging, the number of incidentally found coronary artery fistulas has been increasing.     

Coronary artery to pulmonary artery fistulae with multiple aneurysms: radiological features on dual-source 64-slice CT angiography

Coronary artery fistula is a rare vascular anomaly in which there is abnormal communication between the coronary artery and the great vessels or cardiac chambers. We report the case of a 66-year-old man with two separate coronary artery to pulmonary artery fistulas (one of which demonstrated multiple aneurysms), which were diagnosed on dual-source 64-slice coronary CT and reconfirmed by coronary catheter angiography.     

64排螺旋CT冠状动脉血管成像诊断冠状动脉-肺动脉瘘的应用价值

目的 评价64排螺旋CT三维重组技术诊断冠状动脉-肺动脉瘘(CPF)的应用价值。 方法 回顾性分析20例行64排螺旋CT冠状动脉血管成像的CPF患者的资料, 其图像行容积再现、多平面重组、曲面重组、最大密度投影, 分析CPF的检出率、异常血管的CT特征及多排螺旋CT的诊断意义。 结果 CPF血管起源:左冠状动脉分支或左圆锥支11例, 左冠状动脉分支及右圆锥支(或左右圆锥支)7例, 右圆锥支1例, 双侧冠状动脉多分支1例。异常血管形态:迂曲扩张血管网19例, 单纯扩张血管1例, 匍匐于肺动脉壁20例; 合并囊状动脉瘤5例, 梭形动脉瘤1例。肺动脉瘘口的位置:主肺动脉左侧壁14例, 左前壁1例, 前壁2例, 左侧壁和前壁1例, 左前壁和右侧壁1例, 未见明确瘘口1例。瘘口的CT特征:开窗征17例, 射血征8例, 烟雾征3例, 飘带征1例, 等密度征10例。 结论 多排螺旋CT重组技术可清晰显示CPF的异常血管及瘘口特征, 为临床诊治提供重要信息, 可作为诊断的首选方法。     

Duplicated right coronary artery: multidetector CT angiographic findings

Multidetector CT is becoming an alternative method for the diagnosis of coronary artery anomalies. We present the multidetector coronary CT angiography findings from a patient with right coronary artery duplication. Two separate right coronary arteries originating from the right aortic sinus were observed. Their anatomical course was well depicted, and atherosclerosis was excluded based on the CT angiography findings.     

Bronchial to coronary artery fistulas: an important sign of silent coronary artery disease and potential complication during bronchial artery embolization

Coronary artery fistulas are rare and usually asymptomatic congenital anomalies generally diagnosed incidentally during coronary angiographies. Herein, we present a case of bronchial to coronary artery fistula which was diagnosed incidentally during bronchial artery embolization. Embolization was performed successfully without complication, and an underlying important coronary artery stenosis was subsequently found by coronary computed tomography angiography.     

Coronary artery fistula in adults: evaluation with dual-source CT coronary angiography

Objective:

To evaluate the clinical value of dual-source CT (DSCT) coronary angiography in the diagnosis of coronary artery fistula (CAF) in adults.

Methods:

A large cohort of 17,548 patients, who underwent DSCT coronary angiography in our hospital between January 2008 and October 2013, were retrospectively reviewed for CAF. The origin, course and drainage site of CAF and coexisting abnormalities were analysed. The conventional angiography results, treatments and follow-up DSCT images were also evaluated.

Results:

A total of 33 CAFs from 17,548 patients were detected. The incidence of CAF was 0.19% by DSCT. CAF originating from the left coronary artery (LCA) was found in 14 (42.4%) patients, from right coronary artery (RCA) in 4 (12.1%) cases and from both LCA and RCA in 15 (45.5%) patients. The pulmonary artery was the most common site of drainage (28/33, 84.8%). 8 of the 33 (24.2%) cases were associated with aneurysms. Six cases were associated with coronary artery atherosclerosis. Four patients underwent conventional angiography.

Conclusion:

Coronary–pulmonary artery fistula in adults was found more often than in previous studies. CAF commonly originates from LCA or both LCA and RCA in adults. DSCT is a robust tool for investigating the origin, course and drainage site of CAF and coexistent abnormalities.

Advances in knowledge:

A large adult patient cohort who underwent DSCT angiography was reviewed to assess CAFs. Coronary–pulmonary artery fistula in adults was found more often than in previous studies. CAF was observed to originate from the LCA or both coronary arteries in adults. DSCT could clearly depict the fistula origin, course, drainage site and coexisting abnormalities. Conventional angiography results, treatments and follow-up DSCT images were analysed.Coronary artery fistulas (CAFs) are anomalous connections of the coronary arteries. The phenomenon was first described in 1865 by Krause.¹ CAF is considered as a major coronary anomaly by Ogden''s classification.² Most CAFs are congenital. CAFs have an estimated prevalence of 0.002% in the general population; however, they are present in 0.05–0.25% of patients who undergo coronary angiography.^3–5 The traditional diagnosis tool for CAFs is conventional angiography. With the advent of 64-slice multidetector CT in chest and cardiac imaging, the number of incidentally found CAFs has been increasing. The advanced electrocardiogram (ECG)-gated technique of dual-source CT (DSCT) could provide high diagnostic accuracy for the assessment of coronary artery disease.According to prior studies, CAF arises from the right coronary artery (RCA) in approximately 50% of patients.^6–8 In particular, 70% of the CAFs in children (mean age, 2.9 years) originated from the RCA.⁹ In this study, we focused on adult patients. A large cohort of adult patients who underwent DSCT angiography was reviewed to assess CAFs. The CAFs and coexisting abnormalities were analysed.     

Coronary artery anomalies diagnosed by magnetic resonance angiography

Coronary artery anomalies are uncommon entities that may be associated with sudden death. Because of its 2-D projection imaging nature, conventional X-ray coronary angiography may not accurately delineate the origins and course of aberrant coronary arteries with respect to the great vessels. Non-invasive, cross-sectional imaging techniques such as coronary CT angiography and magnetic resonance angiography are increasingly used in clinical practice to diagnose coronary artery anomalies. Although this study reviews coronary artery anatomy and selected anomalies as seen with true fast imaging with steady-state precession magnetic resonance angiography, the information provided is equally applicable to electrocardiogram-gated coronary CT angiography.     

Anomalous coronary arteries in adults: depiction at multi-detector row CT angiography

PURPOSE: To retrospectively determine the imaging features of anomalous coronary arteries depicted at multi-detector row computed tomographic (CT) angiography in 18 patients seen at four institutions. MATERIALS AND METHODS: Eighteen patients underwent imaging with a four- or 16-section multi-detector row CT unit by using retrospective electrocardiographic (ECG) gating after infusion of 120-150 mL of intravenous contrast material. Section thicknesses of 0.8-3.0 mm were achieved during breath holding, and images were reconstructed with a 50% overlap. Volumetric reconstructions were obtained for each patient. Each study was assessed retrospectively for the origin and course of the anomalous coronary artery by two thoracic radiologists; decisions were made in consensus. Institutional review board exemption and informed consent waiver was granted at each institution. The study was compliant with the Health Insurance Portability and Accountability Act. RESULTS: Seventeen patients were referred because of equivocal findings at cardiac catheterization or echocardiography; in one, the anomalous coronary artery was incidental. A total of 20 anomalous vessels were found. Twelve patients with 14 variant vessels had an anomalous origin of a left coronary artery (right cusp, 13; noncoronary cusp, one). In four patients, an anomalous right coronary artery originated from the left side; one patient had a single coronary artery arising from the right cusp. In one patient, a left coronary artery-to-vein fistula was observed. In 10 patients, the anomalous vessel passed between the aorta and the main pulmonary artery or right ventricular outflow track. In each case, the origin of the anomalous coronary artery and its course in relationship to the great vessels were unequivocally demonstrated. Volumetric images were useful for showing the three-dimensional orientation of the anomalous coronary artery with respect to the great vessels and cardiac chambers. CONCLUSION: Multi-detector row CT angiography provided accurate depiction of vessel origin and course in this review of 20 anomalous coronary arteries. The results of this study suggest that CT is a viable noninvasive modality for delineating coronary arterial anomalies, particularly if findings at coronary angiography are equivocal.     

CT冠状动脉成像在冠心病诊断中的应用

目的:研究CT冠状动脉成像在冠心病早期诊断冠状动脉狭窄定性定量判读的作用。方法:对34例临床未发生急性冠脉综合征的冠心病患者,先后进行冠状动脉造影、128排双源CT冠状动脉成像。以冠状动脉造影为"金标准",计算CT冠状动脉成像敏感性、特异性、阳性预测值、阴性预测值。结果:①与冠状动脉造影相比,CT冠状动脉成像的敏感性为68%,特异性为97%,阳性预测值为89%,阴性预测值为90%。②CT冠状动脉成像有65个血管段图像质量差,约占12%,造成图像质量差的原因主要为钙化,心跳、呼吸伪影,少部分为管腔显示不良。结论:冠心病早期诊断中,CT冠状动脉成像可用作冠状动脉造影前筛选,CT冠状动脉成像阴性的患者不必行冠状动脉造影检查;CT冠状动脉成像阳性的患者,可行冠状动脉造影进一步确认病变。     

多层螺旋CT冠状动脉造影扫描技术及图像质量的影响因素

目的探讨多层螺旋CT冠状动脉造影(MSCTA)的方法及影响图像质量的因素。资料与方法对106例临床疑有冠心病的患者进行MSCTA,其中58例疑有冠状动脉狭窄的患者进行了选择性冠状动脉造影,评价MSCT对冠状动脉近段、中段和远段的显示能力,分析影响图像质量的因素。结果MSCTA对冠状动脉近中段的显示率达91．2％以上,对冠状动脉远段的显示较差。结论MSCTA可作为冠状动脉粥样硬化疾病的筛选手段,显示冠状动脉图像清晰可靠。     

Coronary to pulmonary artery fistula associated with significant coronary atherosclerosis and severe aortic valve stenosis: A Case Report

Coronary artery fistulas are anomalous connections between one or two coronary arteries with either a cardiac chamber or any major blood vessels (coronary sinus, superior vena cava, pulmonary veins and pulmonary artery). It is rarely reported, occurring only in 0.1%-0.2% of patients who undergo coronary angiography. We report a very rare case where myocardial ischaemia may have resulted from the presence of coronary artery fistula, significant coronary artery stenosis and severe aortic valve stenosis. Transthoracic echocardiography showed severe aortic stenosis, while coronary angiography showed a tortuous coronary artery fistula originating from the proximal left anterior descending artery, with a single opening in the main pulmonary artery. Angiography also showed significant stenosis in the middle of the left anterior descending artery. Coronary artery fistula with concomitant significant coronary atherosclerosis and severe aortic stenosis requires optimal therapeutic planning.     

先天性心脏病冠状动脉瘘的介入治疗

目的：评价经皮穿刺栓塞术治疗冠状动脉瘘的疗效。材料与方法：１９９５年６月至１９９６年８月，对４名冠状动脉瘘患儿实施了经皮穿刺冠状动脉瘘栓塞术，采用８ｍｍ、１０ｍｍ、１２ｍｍ及１５ｍｍ直径（Ｃｏｏｋ公司产品）弹簧栓子，手术前、后进行左、右心导管检查及冠状动脉造影，以进一步诊断和评价治疗效果。结果：４例操作技术全部成功，通过手术前后心导管检查及选择性冠状动脉造影，证明栓塞效果可靠，术后心电图无异常，其中３例随诊半年，１例随诊２个月，效果良好。结论：经皮穿刺栓塞术是治疗冠状动脉瘘的有效方法。     

Lymphaticopleural fistula: diagnosis by computed tomography

A case of lymphaticopleural fistula demonstrated by CT following lymphography is presented. Computed tomography can depict the course and location of the fistula as well as the chylous nature of the effusion.     

Detection of coronary artery stenoses with multislice helical CT angiography

OBJECTIVES: The authors compared multislice CT angiography and selective angiography for the assessment of coronary artery disease. METHODS: In 28 patients, the presence and degree of coronary artery stenoses were determined in coronary segments prepared with beta-blocker for good image quality with multislice CT. RESULTS: In 187 coronary artery segments, sensitivity, specificity, and negative predictive value for the detection of stenoses >50% with multislice CT angiography were 81%, 90%, and 97%, respectively. The agreement for determining the degree of stenoses with multislice CT angiography and selective coronary angiography was only moderate (kappa = 0.58). CONCLUSIONS: Because of the limited spatial resolution, it is not possible with multislice CT angiography to determine the degree the coronary artery stenoses precisely. However, the high negative predictive value indicates that multislice CT may be a suitable tool to reliably rule out coronary artery disease.     

64层CT冠状动脉成像检测冠状动脉畸形价值初探

目的:探讨64层CT冠状动脉成像检测冠状动脉畸形的方法和诊断价值.方法:采用容积再现(VR)、最大密度投影(MIP)以及多平面重组(MPR)等方法分析2672例64层CT冠状动脉成像资料,总结冠状动脉畸形的发生率和CT表现.结果:2672例中发现冠状动脉起源异常18例(0.67%),其中发生于右冠11例(61.11%),左冠7例(38.89%);发现冠状动脉瘘7例(0.26%).结论:64层CT冠状动脉成像能够准确全面地显示冠状动脉的异常起源、走行和终止.     

Traumatic inferior gluteal artery pseudoaneurysm and arteriovenous fistula managed with emergency transcatheter embolization

We present a case of blunt trauma to the buttock resulting in an inferior gluteal artery pseudoaneurysm and arteriovenous fistula. The characteristic diagnostic features on CT angiography and digital subtraction angiography (DSA), along with the emergency percutaneous management of this traumatic vascular injury, are described. A review of the literature demonstrates inferior gluteal artery pseudoaneurysm is a rare condition, while successful treatment with glue embolization is previously unreported.     

64层螺旋CT诊断先天性冠状动脉变异

目的:探讨多层螺旋CT(MSCT)在成年人先天性冠状动脉变异诊断中的临床应用价值。方法:回顾性分析726例成年人患者的冠状动脉MSCT造影资料,判断各种先天性冠状动脉变异。结果:726例MSCT冠状动脉造影中检出冠状动脉变异39例,包括冠状动脉开口起源异常11例,单支冠状动脉1例,冠状动脉瘤2例,冠状动脉分支起源异常11例,冠状动脉发育不良13例,冠脉开口处急性扭转走行异常1例。结论:MSCT是一种无创、准确、可重复性强的诊断先天性冠状动脉变异的重要手段。