基于冠状动脉CT血管成像及三维重建的室间隔膜部膨出瘤的影像学特征观察

目的 探讨基于冠状动脉CT血管成像（CTA）及三维重建的室间隔膜部膨出瘤（IVMSA）的影像解剖学特征及其临床意义。方法 横断面研究。纳入2013年1月—2022年5月山东大学齐鲁医院德州医院放射科经冠状动脉CTA检出的50例IVMSA,其中男15例、女35例,年龄35~80（59±11）岁。冠状动脉CTA横断面图像上找到室间隔膜部的位置,采用容积再现（VR）、多平面重组（MPR）和最大密度投影（MIP）等后处理技术进行三维重建,分析IVMSA在形态、大小、膨出方向、瘤壁及瘤腔血栓形成情况等方面的CT影像学特征。结果 （1）IVMSA形态：50例IVMSA中多叶状47例,呈分叶大小不均的多分叶状;半球形2例,其表面较光滑,瘤颈直径大于瘤体长径;隧道样1例,表现为弯曲长条形瘤腔,游离于右心室内,瘤体长径超过瘤颈直径4倍。（2）IVMSA大小：瘤颈直径为1.95~18.95（8.36±3.84）mm,瘤体长径范围为2.39~20.70（9.67±3.77）mm。（3）IVMSA膨出方向：49例患者IVMSA膨向右室流入道,1例膨向右室流出道。（4）IVMSA瘤壁：1例室间隔缺损修补患者术后合并之IVMSA瘤壁破裂,其余49例未见瘤壁破裂迹象。（5）IVMSA瘤腔：50例患者均未见IVMSA瘤腔内血栓形成。结论 IVMSA形态上以多叶状最多见,大小不一,多数膨向右室流入道,极少数可出现瘤壁破裂,瘤腔内血栓形成较为罕见。冠状动脉CTA结合三维重建技术,可以对IVMSA的影像形态进行综合观察,为临床诊疗提供可靠的依据。

The imaging features of interventricular membranous septal aneurysm based on coronary artery CT angiography and three-dimensional reconstruction technology

Objective To explore the imaging features and clinical importance of interventricular membranous septal aneurysm (IVMSA) based on coronary artery computed tomography angiography (CTA) and 3D reconstruction technique. Methods This study is a cross-sectional study. Fifty patients with IVMSA who were diagnosed by coronary CTA in the radiology department of Dezhou Hospital, Qilu Hospital of Shandong University from January 2013 to May 2022 were included. The patients comprised 15 males and 35 females aged 35-80 (59±11) years. First, the position of the ventricular septal membrane was found on the 2D axial CTA image of the coronary artery. Then, the CT imaging features of IVMSA in terms of morphology, size, bulging direction, aneurysm wall, and aneurysm cavity thrombosis were analyzed using volume rendering (VR), multiplanar reconstruction (MPR), maximum density projection (MIP), and other post-processing techniques. Results (1) Morphology of IVMSA: The 50 IVMSA cases were divided into three types in terms of morphology. Forty-seven cases were multi-lobed and had uneven leaf size. Two cases were hemispherical, in which the surface was smooth, and the diameter of the aneurysm neck was larger than that of the aneurysm body. One case had a tunnel-like morphology with a long curved aneurysm cavity, which was free in the right ventricle. The aneurysm length and diameter exceeded the aneurysm neck diameter by four times. (2) Size of IVMSA: The diameter of the aneurysm neck was 1.95-18.95 (8.36±3.84) mm, and the length and diameter of the aneurysm body were 2.39-20.70 (9.67±3.77) mm. (3) Bulging direction of IVMSA: IVMSA bulged to the right ventricular inflow tract in 49 patients, and one case bulged to the right ventricular outflow tract. (4) Wall of IVMSA: One patient with ventricular septal defect repair had IVMSA wall rupture, and the other 49 patients showed no signs of aneurysm wall rupture. (5) Cavity of IVMSA: All patients had no thrombosis in the IVMSA cavity. Conclusion IVMSA is multi-lobed with different sizes. Most IVMSA cases bulged into the right ventricular inflow tract, and few IVMSA cases can rupture the aneurysm wall. Thrombosis in the aneurysm cavity is rare. Coronary CTA combined with 3D reconstruction technology can comprehensively observe IVMSA and provide a reliable basis for clinical diagnosis and treatment.