Reliability of MDCT in characterizing pulmonary venous drainage, diameter and distance to first bifurcation: an interobserver study

RATIONALE AND OBJECTIVES: To evaluate the interobserver agreement of readers in evaluating pulmonary venous anatomy and in measuring pulmonary vein ostial diameters and distance to first bifurcation. MATERIALS AND METHODS: This study was approved by our institutional review board. Thin-section contrast material-enhanced multidetector computed tomography examinations of the thorax were retrospectively reviewed in 200 consecutive patients (38 females and 162 males), age 24-79 years (mean, 52.8) referred for imaging before radiofrequency ablation therapy for atrial fibrillation. For each patient, pulmonary venous anatomy and drainage patterns including the number of venous ostia was assessed independently by experienced cardiothoracic radiologists. Pulmonary vein ostial diameter and distance to the first bifurcation of the four major pulmonary veins (right inferior and superior, left inferior and superior), the middle lobe pulmonary vein, and any anomalous pulmonary veins (common trunks and accessory veins) were measured independently at a workstation. Interreader assessment of pulmonary venous anatomy was evaluated using the Kappa statistic. Interreader variation in measurements of venous diameter and distant to first bifurcation were estimated by Bland-Altman plots and Pitman's test of difference in variance. RESULTS: Very good to excellent interreader agreement in detection of anomalous pulmonary venous anatomy, middle lobe pulmonary venous drainage, and other thoracic venous anomalies. No significant variation between readers in pulmonary vein ostial diameter measurements for the four major and middle lobe pulmonary veins, or the anomalous pulmonary veins. Significant interreader variability was noted in measurements of the pulmonary vein distance to first bifurcation for the right inferior (P = .017), middle lobe (P = .005), and left inferior (P = .015) pulmonary veins. CONCLUSIONS: There is excellent interobserver agreement when evaluating normal and anomalous pulmonary venous drainage patterns, and when measuring normal or anomalous pulmonary vein diameters. However, measurements of distances to first bifurcation were less reliable across readers.     

Pulmonary vein diameter, cross-sectional area, and shape: CT analysis

PURPOSE: To retrospectively establish normal values for pulmonary vein diameter, cross-sectional area, and shape depicted at computed tomography (CT). MATERIALS AND METHODS: Institutional review board waived patient consent requirement and approved the study. Thin-section contrast material-enhanced spiral chest CT scans in 104 patients, 68 women and 36 men (age range, 19-86 years; mean, 49 years) referred to exclude pulmonary embolism, were retrospectively reviewed. Short-axis diameter and cross-sectional area of the four major pulmonary veins (right inferior and superior, left inferior and superior) were measured at a workstation by using oblique reconstructions. Each vein was measured at six locations, 5 mm apart, starting at atrial ostium. Each measurement was performed three times by an experienced thoracic radiologist, and the mean value was recorded. Roundness was estimated by comparing the ratio of the calculated cross-sectional area to that measured. Mixed effects model was used to compare men and women relative to the distribution of diameters and surface areas and to compare roundness of the right and left veins. RESULTS: Mean pulmonary vein diameters at the ostia were variable: right superior, 11.4-12.4 mm; left superior, 9.6-10.5 mm; right inferior, 12.3-13.1 mm; and left inferior, 9.0-9.9 mm. Diameter and cross-sectional area of the left superior pulmonary vein were significantly larger in men than in women (P < .005). As expected, the caliber of three of the four veins gradually increased as they approached the left atrium. Caliber of the left inferior pulmonary vein decreased as it entered the left atrium. None of the veins were round; all were ovoid. Left-sided veins and venous ostia were less round than right-sided veins (P < .001). CONCLUSION: Pulmonary vein diameter, cross-sectional area, and shape vary. Particular care must be taken when the left inferior pulmonary vein is evaluated for stenosis, as it normally narrows as it enters the left atrium.     

Reliability of MDCT measurements of pulmonary vein ostial diameter and distance to first bifurcation: an interobserver study comparing radiologists with a semiautomated software

The purpose of this study was to evaluate agreement between radiologists and semiautomated software measurements of pulmonary vein ostial diameters and distance to the first bifurcation. Computed tomography (CT) examinations of the thorax were retrospectively reviewed in 50 consecutive patients. The pulmonary vein ostial diameter and distance to the first bifurcation of the four major, and the middle lobe pulmonary veins, were measured independently by two experienced cardiothoracic radiologists, and using CardEP semiautomated software. The two measurement methods were compared. Analyses were performed using a Bland-Altman test. There is no significant variation between readers or between readers and the software in pulmonary vein ostial diameter measurements for the four major pulmonary veins. There is significant variation between the first reader (P = 0.03) and between the second reader and the software (P = 0.01) in vein diameter measurements for the middle lobe vein. And, also between the second reader and the first reader for the right inferior (P = 0.02) and left inferior (P = 0.02) pulmonary vein distance to first bifurcation, and between the second reader and the software for the right inferior (P = 0.01) and left inferior vein (P = 0.02) distance to first bifurcation. There is good interobserver agreement when measuring the major pulmonary vein diameters. Measurements of distances to first bifurcation were less reliable across readers and the readers and the semiautomated software.     

Atrial fibrillation: multi-detector row CT of pulmonary vein anatomy prior to radiofrequency catheter ablation--initial experience

PURPOSE: To evaluate multi-detector row computed tomographic (CT) depiction of pulmonary veins to provide a road map for radiofrequency catheter ablation. MATERIALS AND METHODS: For patients, institutional review board (IRB) approval was not required, and consent was obtained for treatment. Control subjects were part of an IRB-approved research protocol at the institution, in which they had consented to participate. Multi-detector row CT was performed in 23 patients (17 men, six women; mean age, 48 years +/- 11 [standard deviation]) with atrial fibrillation who were admitted for isolation of pulmonary veins by means of radiofrequency catheter ablation. Pulmonary vein anatomy was evaluated, and diameters of pulmonary vein ostia were measured. To determine the shape of ostia, a venous ostium index was calculated for all veins by dividing anterior-posterior measurements by superior-inferior measurements. Results were compared with those in a control group of 11 patients (eight men, three women; mean age, 56 years +/- 11) without atrial fibrillation. Images were evaluated by two observers in consensus. RESULTS: Pulmonary veins additional to the four main veins were found in seven (30%) of 23 patients. Common ostia of left and right pulmonary veins were detected in 19 (83%) and nine (39%) patients, respectively. Early branching occurred more often with right than with left veins (19 [83%] vs three [13%] cases, P <.05) in both patients and control subjects. Anterior-posterior diameter of ostia was 12.8 mm +/- 3.3 for left veins, 16.2 mm +/- 3.8 for right veins, and 18.8 mm +/- 7.7 and 28.7 mm +/- 5.1 for left and right common ostia, respectively. Ostia of right pulmonary veins were more round than were ostia of left pulmonary veins (venous ostium index in patients, 0.91 +/- 0.21 vs 0.75 +/- 0.17, P <.05; in control subjects, 0.93 +/- 0.12 vs 0.82 +/- 0.17, P <.05). The CT data were used to determine ablation strategy and guide catheters during radiofrequency ablation. CONCLUSION: Multi-detector row CT provides a valuable road map for pulmonary vein anatomy prior to radiofrequency catheter ablation. Variations in number and insertion of pulmonary veins were observed in a considerable number of patients and control subjects.     

Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation

PURPOSE: To evaluate and classify the various drainage patterns of the pulmonary veins as depicted with thin-section chest computed tomography (CT). MATERIALS AND METHODS: Thin-section (2.5-mm collimation) contrast material-enhanced CT scans of 201 consecutive patients obtained over a 3-month period for diagnosis of pulmonary embolism (n = 197), pulmonary vein stenosis (n = 2), or aortic injury (n = 2) were routinely reviewed in transverse and (if necessary) coronal and coronal-oblique imaging planes. A classification was formulated based on both the number of venous ostia on each side and the drainage patterns of pulmonary veins. The frequency of each pattern was determined, and association with atrial arrhythmia was assessed with the chi(2) and Fisher exact tests. RESULTS: Most patients (n = 142, 71%) had two ostia on the right side for upper and lower lobe veins. Fifty-six patients (28%) had three to five ostia on the right side, which were due to one or two separate middle lobe vein ostia in 52 (26%) patients. Three patients (2%) had a single venous ostium on the right side. Most patients (n = 173, 86%) had two ostia on the left side for upper and lower lobe veins. The remainder (n = 28, 14%) had a single ostium. There was no significant association between any particular venous drainage pattern and atrial arrhythmia; however, patients with a separate ostia for the right middle lobe pulmonary vein(s) tended to have a higher frequency of atrial arrhythmia than those with other patterns (P =.053). CONCLUSION: A classification system to succinctly describe pulmonary venous drainage patterns was developed. Right-sided venous drainage was more variable than left-sided venous drainage. One-quarter of patients had more than two venous ostia on the right side.     

Right top pulmonary vein: evaluation with 64 section multidetector computed tomography

PURPOSE: To evaluate the incidence and anatomic features of the rare variant of the pulmonary veins named "right top pulmonary vein" as depicted with 64 section multidetector computed tomography (MDCT). MATERIALS AND METHODS: MDCT of 610 patients obtained over 12 months period for diagnosis of suspected thoracic or cardiac pathology were routinely reviewed in transverse and 3D images. The frequency of right top pulmonary vein (RTPV) was determined and anatomic features were also documented. RESULTS: Right top pulmonary vein (RTPV) is a supernumerary vein arising from the roof of the right part of the left atrium separately from the orifice of the right superior pulmonary vein. It crosses behind the intermediate bronchus and drains mainly posterior segment of the right upper lobe but also receives few subsegmental branches of superior segment of the right lower lobe. It was detected in 2.2% of patients (14/610). The mean diameter of RTPV was 5.1 mm. CONCLUSION: The RTPV is a rare venous drainage variation of pulmonary veins. It is important to be aware of this anatomic pattern for avoiding misinterpretation of pulmonary venographic findings, inadvertent ablation of pulmonary vein and perioperative bleeding during video assisted thorocoscopic lobectomy.     

右肺上叶肺静脉分型的多层螺旋CT评价及临床应用探讨

目的探讨MSCT对健康人右肺上叶肺静脉解剖及引流模式分型,为解剖性肺段切除术靶静脉解剖分型提供帮助。方法收集200例肺部无异常胸部CT平扫影像资料,通过VR重建获得静脉\支气管融合图,观察并统计各静脉分型出现率。结果右上肺静脉根据中央静脉存在与否分为三类1)中央静脉型(Iab型、Ⅰb型);2)半中央静脉型;3)无中央静脉型,其出现率分别为81%(162/200)、7%(14/200)、12%(24/200)。中央静脉型特点为见沿纵隔向上延伸的V.ant,在B2与B3分叉处见V.cent横断面;半中央静脉型特点为纵隔侧不存在V.ant,在B3后外方见V.cent;无中央静脉型特点为中央静脉缺如,多见终末静脉(V2t),管径粗大,并可见多个属支。结论MSCT所得静脉\支气管融合图能清楚显示肺静脉解剖分型,5mm轴位MIP图优于显示肺静脉细微解剖,可作为其解剖识别常规手段。     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段:上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段;左肺8段:上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点:(1)横断面双肺由肺尖至肺底选取11个层面:胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面;(2)双肺由内向外分别选取6个层面,左肺:左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面;右肺:右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外;(3)冠状面双肺由前向后选取7个层面:胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段：上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段 左肺8段：上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点：（1）横断面双肺由肺尖至肺底选取11个层面：胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面 （2）双肺由内向外分别选取6个层面,左肺：左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面 右肺：右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外 （3）冠状面双肺由前向后选取7个层面：胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段:上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段;左肺8段:上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点:(1)横断面双肺由肺尖至肺底选取11个层面:胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面;(2)双肺由内向外分别选取6个层面,左肺:左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面;右肺:右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外;(3)冠状面双肺由前向后选取7个层面:胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

Collateral pathways of the left gastric vein in portal hypertension

Since June 1974, 347 percutaneous transhepatic portal venographic studies were performed on 246 patients with portal hypertension who had had bleeding gastroesophageal varices. Of 234 patients in whom left gastric veins (LGV) (coronary) were demonstrated, 177 (75.6%) had a single LGV and 57 (24.4%) had multiple left gastric veins (21.8% had two LGVs, 2.1% had three LGVs, and 0.5% had five LGVs). Of 193 patients undergoing selective left gastric venography, spontaneous portosystemic communications to the left renal vein were found in 55, to the inferior vena cava in two, to the inferior pulmonary veins in five, to the pericardiophrenic vein in eight, to the right inferior phrenic vein in three, and to the left intercostal veins in one. Interportal communications with the left gastric vein and varices occurred from the left portal vein in 13, from the gastroepiploic vein in one, and from a superior mesenteric vein branch in one. The predominant drainage of esophageal varices was to the azygos vein in 78 of 155 patients, to the hemiazygos vein in 13, and to multiple small unnamed veins in the mediastinum in 57. Opacified varices did not extend above the level of the azygos vein arch in 71 of 130 patients; however, 59 continued cephalad to the azygos arch and drained through more superior veins of the thorax. Knowledge of the anatomy and incidence of each of these portosystemic or interportal venous communications is important to properly treat bleeding esophageal varices by surgery or angiographic embolization.     

Assessment of image quality of 64-row Dual Source versus Single Source CT coronary angiography on heart rate: a phantom study

The purpose of this study was to evaluate the agreement between axial, multiplanar reformatted (MPR) and semi-automated software measurements of pulmonary vein ostial diameters and distance to the first bifurcation. CT examinations of the thorax were retrospectively reviewed in 150 consecutive patients. The pulmonary vein ostial diameter and distance to the first bifurcation of the four main pulmonary veins were independently measured. The three measurement methods were compared using a Bland-Altman test. There was no significant variation between pulmonary vein ostial diameter measurements for the superior pulmonary veins across the three measurement methods. There was significant variation between the semi-automated program and both the axial (p = 0.001) and MPR (p < 0.001) measured diameters for the right inferior pulmonary vein ostial diameter and between the MPR and semi-automated program measurements (p = 0.02) for the left inferior pulmonary vein ostial diameter. There was no significant variation between the pulmonary vein distance to first bifurcation measurements for any pulmonary vein across the three measurement methods. However, from a clinical perspective, differences were negligible; therefore, the clinician may confidently use any of the three measurement methods presented.     

MRI of the pulmonary veins: comparison between 3D MR angiography and T1-weighted spin echo

OBJECTIVE: The purpose was to determine the ability of three-dimensional (3D) magnetic resonance (MR) angiography to depict normal pulmonary veins in comparison with spin-echo MR imaging. MATERIALS AND METHODS: MR imaging of 40 patients with cardiovascular disease were reviewed. Patients with known pulmonary venous abnormalities were excluded. Using a standard GE 1.5-T magnet, axial T1-weighted spin-echo 5-mm-thick contiguous slices and 3D MR angiography (contiguous slice thickness of 2.5-3.5 mm, 20-30 c.c. of gadolinium bolus at 1-1.5 c.c./sec, 32-43-second breath-hold, coronal and sagittal plane acquisition) were evaluated retrospectively on separate occasions by two experienced radiologists. Multiplanar imaging projection was used for the identification of pulmonary veins. Each lung was considered to have two drainage veins: a superior vein and an inferior vein. Identification of a pulmonary vein was made by visualizing a connection with the left atrium. RESULTS: 143 pulmonary veins (87.5% +/-5.2) were identified at the level of the left atrium on T1-weighted spin-echo images, and 157 (98.1% +/-1.9) were identified on 3D MR angiography (p<0.01). Overall we identified by T -weighted spin-echo imaging 36 right upper, 38 right lower, 27 left upper, and 38 left lower pulmonary veins. By 3D MR angiography, we identified 38 right upper, 40 right lower, 39 left upper, and 40 left lower pulmonary veins. All four pulmonary veins were detected in 22 patients on spin-echo imaging (55%) and in 37 patients (92.5%) on 3D MR angiography (chi = 3.81, p<0.05). CONCLUSION: A significant difference is demonstrated between 3D MR angiography and spin-echo MR imaging in identifying normal pulmonary veins. MR angiography provides a complete view of normal pulmonary venous anatomy and could be a valuable tool for the assessment of abnormal pulmonary venous drainage.     

The predictive value of cardiac morphology for long-term outcome of patients undergoing catheter ablation for atrial fibrillation

ObjectiveCatheter ablation (CA) is an established therapy for selected patients with atrial fibrillation (AF), but predictors of CA ablation outcome are still not fully elucidated. The aim of the study was to identify structural and morphological parameters from computed tomography (CT) as predictors of successful CA of AF in a single center prospective cohort.MethodsAn analysis of CT scans dedicated to LA evaluation was performed in 99 patients (63 ± 8 years old, 70% males, 59% paroxysmal AF) scheduled for CA of AF. Survival free of atrial fibrillation/flutter/tachycardia at 1- and 3-years was assessed.ResultsIn overall study population, both 1- and 3-year responders had smaller distance to the first division in left superior pulmonary vein (16.3 ± 5.42 mm vs. 19.1 ± 7.0 mm and 14.9 ± 3.6 mm vs. 18.7 ± 7.0 mm; p < 0.05). One-year responders had larger ostium area of left inferior pulmonary vein (median 236 mm² [IQR = 97] vs. 222 mm² [IQR = 71]; p = 0.03) and less acute angle between the interatrial septum and the right superior pulmonary vein (102 ± 20° vs. 95 ± 10°; p = 0.03). Three-years' responders had smaller ostium area of the right superior pulmonary vein (248 ± 94 mm² vs. 364 ± 282 mm²; p = 0.02). Multivariate Cox regression analysis identified different predictors in paroxysmal and non-paroxysmal AF. For patients with paroxysmal AF, the predictors were angle to right superior pulmonary vein and left superior/inferior pulmonary veins carina thickness with hazard ratios of 0.965 (95%CI 0.939 to 0.992, p = 0.010) and 0.747 (95%CI 0.591 to 0.944, p = 0.015). In patients with persistent AF, the predictors were gender and NYHA stage with hazard ratios of 4.9 (95%CI 1.758 to 13.579, p = 0.002) and 0.365 (95%CI 0.148 to 0.899, p = 0.028) respectively.ConclusionsThe anatomy of LA, especially morphology of pulmonary veins, seems to be one of the predictors of clinical outcome after CA for paroxysmal AF. In non-paroxysmal AF LA anatomy is less relevant in prediction of clinical outcome.     

Pulmonary vein morphology by free‐breathing whole heart magnetic resonance imaging at 3 tesla versus breathhold multi‐detector computed tomography

Purpose:

To compare pulmonary vein and left atrial anatomy using three‐dimensional free‐breathing whole‐heart magnetic resonance imaging (MR) at 3 Tesla (T) and multi‐detector computed tomography (MDCT).

Materials and Methods:

Thirty‐three subjects (19 male, age 49 ± 12 years) underwent free‐breathing 3T MR and contrast‐enhanced MDCT during inspiratory breath hold. Pulmonary vein parameters (ostial areas, diameters, angles) were measured.

Results:

All pulmonary veins and anomalies were identified by 3T MR and by MDCT. The right‐sided pulmonary veins were directed more posteriorly, the right superior pulmonary vein more inferiorly, and the right inferior pulmonary vein more superiorly by 3T MR when compared with MDCT. The cross‐sectional area, perimeters and minimum diameters of right‐sided pulmonary vein ostia were significantly larger by MR, as were the maximum diameters of right and left inferior pulmonary veins. There were no significant differences between techniques in distance to first pulmonary vein branch.

Conclusion:

Pulmonary vein measurements demonstrated significant differences in angulations and dimensions when 3T MR is compared with MDCT. These differences likely represent hemodynamic and respiratory variation during free‐breathing with MR versus breath‐holding with MDCT. MR imaging at 3T during free‐breathing offers an alternate method to define pulmonary vein and left atrial anatomy without exposure to radiation. J. Magn. Reson. Imaging 2013;37:846–852. © 2012 Wiley Periodicals, Inc.     

Variation of the size of pulmonary venous ostia during the cardiac cycle: optimal reconstruction window at ECG-gated multi-detector row CT

The aim of this study was to investigate the variation of the size of pulmonary vein ostia during cardiac cycle using ECG-gated multi-detector row CT (MDCT). Nineteen patients were included in this study. Transaxial images at the level of right inferior pulmonary vein (RIPV) were reconstructed in increments of 5%. The ostial diameter of RIPV was measured, the reconstruction windows showing maximal and minimal diameters were selected. The ostial areas of four pulmonary veins were measured at axial image sets of two selected reconstruction windows. The measurement of RIPV revealed that the maximal diameter (1.50±0.32 cm) was generally 35% and the minimal diameter (1.28±0.28 cm) was usually at 85%. The measurement of ostial areas showed that the ostia enlarged at the end of ventricular systole when compared with those at the end of ventricular diastole, by the factors of 1.44±0.55 for the right superior, 1.25±0.23 for the right inferior, 1.45±0.81 for the left superior, and 1.31±0.26 for the left inferior pulmonary vein (P<0.05). The size of the pulmonary vein ostia is variable during the cardiac cycle and the measurement of the pulmonary veins should always be in the same phase of the cardiac cycle during the follow-up of patients.     

Computed tomography of partial anomalous pulmonary venous connection in adults

OBJECTIVES: To systematically describe the imaging features and clinical correlates of a partial anomalous pulmonary venous connection diagnosed on computed tomography (CT) in adults. METHODS: Twenty-nine adults with a partial anomalous pulmonary venous connection on CT were retrospectively identified. There were 19 women and 10 men, with a mean age of 53 (range: 19-83) years. Four cases were identified by review of 1825 consecutive chest CT reports from July 2000-July 2001, and 25 cases were culled from chest radiology teaching files at 3 institutions. Inclusion criteria were availability of CT images and medical charts. Chest radiographs (25 of 29 cases) were reviewed for mediastinal contour abnormalities, heart size, and pulmonary vascular pattern. Chest CT scans were reviewed for location, size, and drainage site of the anomalous vein; presence or absence of a pulmonary vein in the normal location; cardiac size and configuration; and pulmonary vasculature. Charts were reviewed for evidence of pulmonary and cardiovascular disease, history of congenital heart disease, and results of other cardiac imaging. RESULTS: The prevalence of a partial anomalous pulmonary venous connection was 0.2% (4 of 1825 chest CT reports). Seventy-nine percent (23 of 29 patients) had an anomalous left upper lobe vein connecting to a persistent left vertical vein, only 5% (1 of 23 patients) of whom had a left upper lobe vein in the normal location. Seventeen percent (5 of 29 patients) had an anomalous right upper lobe vein draining into the superior vena cava, 60% (3 of 5 patients) of whom also had a right upper lobe pulmonary vein in the normal location. One patient (3%) had an anomalous right lower lobe vein draining into the suprahepatic inferior vena cava. Chest radiographic findings were abnormal left mediastinal contour in 64% (15 of 25 patients), abnormal right mediastinal contour in 8% (2 of 25 patients), and cardiomegaly in 24% (6 of 25 patients). Computed tomography findings were cardiomegaly in 48% (14 of 29 patients), right atrial enlargement in 31% (9 of 29 patients), right ventricular enlargement in 31% (9 of 29 patients), and pulmonary artery enlargement in 14% (4 of 29 patients). Pulmonary or cardiovascular symptoms were present in 69% (20 of 29 patients), 55% (11 of 20 patients) of whom had specific alternative diagnoses (excluding congestive heart failure and pulmonary hypertension) to explain the symptoms. Only 1 patient (3%) was diagnosed with a secundum atrial septal defect. CONCLUSIONS: A partial anomalous pulmonary venous connection was seen in 0.2% of adults on CT. In contrast to previous series focusing on children, the anomalous vein in adults was most commonly from the left upper lobe, in women, and infrequently associated with atrial septal defects.     

64层螺旋CT左心房和肺静脉成像在心房颤动射频消融术中的价值及应用

目的 应用64层螺旋CT(MSCT)对左心房和肺静脉进行形态学分析,用以指导心房颤动(简称房颤)环肺静脉线性消融术,并评估预后.方法 对232例患者(房颤组146例,对照组86例)行64层MSCT左心房和肺静脉成像,比较房颤组及对照组肺静脉解剖学变异的发生率,测量各支肺静脉开口的径线及形态,观察左心房的大小及左心房耳部的形态.结果 64层MSCT左心房和肺静脉成像可以提供详细的左心房与肺静脉连接方式及肺静脉解剖学变异,肺静脉解剖变异占总样本数的16.8%(39/232).各组肺静脉开口均呈上下径大于前后径的椭圆形.房颤组及对照组中左心房的内径差异存在统计学意义[房颤组:(39.47±8.98)mm;对照组:(36.94±5.49)mm;P=0.02],而2组患者肺静脉开口的径线差异无统计学意义[房颤组肺静脉上下径:左上(18.15±1.35)mm,左下(16.96±1.18)mm,右上(17.50±1.12)mm,右下(17.65±0.94)mm;对照组肺静脉上下径:左上(18.07±0.94)mm,左下(17.50±0.57)mm,右上(18.03±1.02)mm,右下(17.94±0.76)mm,P值均＞0.05;房颤组肺静脉前后径:左上(12.26±1.89)mm,左下(11.96±0.61)mm,右上(12.32±1.08)mm,右下(12.39±0.95)mm;对照组肺静脉前后径:左上(12.74±1.03)mm,左下(12.23 ±0.75)mm,右上(12.64±0.87)mm,右下(12.72±0.67)mm,P值均＞0.05].结论 64层MSCT左心房和肺静脉成像不仅可以了解环肺静脉线性消融术前肺静脉及左心房解剖变异的情况,而且可以进一步评价心房功能和风险,对介入治疗具有重要的指导意义.     

CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation

To characterize pulmonary vein (PV) anatomy and the relative position of the PV ostia to the adjacent thoracic vertebral bodies, two readers reviewed 176 computed tomography pulmonary venous studies. PV ostial dimensions were measured and PV ovality assessed. Anatomical variations in PV drainage were noted. The position of the PV ostium relative to the nearest vertebral body edge was recorded. Right PV ostia were significantly more circular than the left (p<.001). Anatomical variability was greater for right PVs: 82% of patients had 2 ostia, 17% had 3 ostia, 0.5% had 4 ostia and 0.5% a common ostium. For left PVs, 91% of patients had 2 ostia, 8.5% a common ostium and 0.5% 3 ostia. Mean ostial distances from vertebral margin were: right PVs 3.62±7.48 mm; left PVs 3.84±8.46 mm (p=.72). 65% of right upper PV, 60.5% of right lower PV, 51% of left upper PV and 57% of left lower PV ostia were positioned lateral to vertebral bodies. Right PV ostia are rounder than left-sided and right PV drainage is more variable. As a significant proportion of PV ostia overlap the vertebral bodies, prior anatomical evaluation by CT can assist catheter ablation procedures for atrial fibrillation (AF), especially when performed under fluoroscopy.     

64层螺旋CT评价肺静脉与左心房的形态结构

目的评价应用64层螺旋CT观察肺静脉和左心房形态结构的可行性。方法选择房颤患者46例,对照组42例,所有患者均行64层螺旋CT检查,图像后处理运用3D成像及内镜等技术对肺静脉、左心房等解剖结构进行构建。结果①64层螺旋CT可构建肺静脉形态,并测得肺静脉数量、开口大小以及各个肺静脉走行方向,其中房颤组肺静脉开口大小较对照组无明显差异。②64层螺旋CT构建左心耳形态,左心耳与左上肺静脉之间的界嵴及界嵴与左侧上下肺静脉之间连接部位的关系分别存在2种形态变异。③64层螺旋CT构建左房顶部形态分为突起型(9.0%)、凹陷型(32.9%)、平坦型(58.1%)3种,有12.5%存在局部凹陷。结论应用多层螺旋CT可以清晰地构建肺静脉和左心房的形态结构,有助于提高导管射频消融治疗房颤的成功率,减少并发症。