成人冠状动脉-肺动脉瘘的MSCT和超声影像诊断

目的：探讨多层螺旋 CT（MSCT）和超声心动图（USG）在诊断成人单纯冠状动脉-肺动脉瘘（CPF）中的价值。方法：回顾性分析临床怀疑冠状动脉病变的218例成人患者的病例资料，所有患者同时接受64层螺旋 CT、USG 和传统冠状动脉造影（CAG）检查。以 CAG 为金标准，比较 MSCT 和 USG 诊断 CPF 的效能。结果：218例患者 CAG 发现冠状动脉异常血管网21例，诊断为 CPF 患者19例，未发现明确瘘口2例；MSCT 诊断为 CPF 患者20例，诊断为冠状动脉分支畸形患者1例；CPF 的 MSCT 影像征象包括：纡曲扩张血管网匍匐于肺动脉壁，瘘口表现为开窗征、射血征、烟雾征、飘带征、等密度征。以 CAG 为金标准，MSCT 诊断成人 CPF 的符合率、敏感度、特异度、阳性预测值、阴性预测值分别为98．6％、94．7％、99．0％、90．0％、99．5％。USG 诊断为 CPF 患者5例，漏诊14例，敏感度为26．3％，漏诊率为73．7％。所有患者未发现其他先天性心脏畸形。结论：USG 诊断成人 CPF 的漏诊率高，而 MSCT 重组技术对成人 CPF 的诊断符合率较高，对诊疗有较大指导意义，可作为诊断的首选方法。

Value of MSCT angiography and echocardiography in the diagnosis of coronary artery-pulmonary artery fistula in adults

Objective:To assess the value of MSCT angiography (MSCTA)and ultrasonic cardiography (UCG)in the diagnosis of coronary artery-pulmonary artery fistula (CPF)in adults.Methods:The clinical materials of 218 adult patients with clinically suspected coronary artery disease were analyzed retrospectively.All patients underwent MSCTA,UCG and coronary angiography (CAG).Taking CAG as gold standard,the efficacy of MSCTA and UCG were compared and ana-lyzed.Results:Of the 218 patients,abnormal vascular network were revealed in 21 patients on CAG,19 patients were diag-nosed as CPF,while the fistula orifice didn't display in 2 patients.20 patients were diagnosed by MSCT as CPF and one pa-tient was diagnosed as coronary artery branching anomaly.Features of CPF on MSCT included tortuous and enlarged vascu-lar network creep on pulmonary artery wall;fistula orifice showing as window sign,spray sign,smog sign,ribbon sign and iso-density sign.With the results of CAG as golden standard,the accuracy,sensitivity,specificity,positive and negative pre-dictive value of CPF diagnosis using MSCT was 98.6%,94.7%,99.0%,90.0% and 99.5%,respectively.Five patients were diagnosed as CPF and 14 patients were missed by USG.The sensitivity,misdiagnosis rate of USG for CPF was 26.3%and 73.7%,respectively.Conclusion:For the diagnosis of CPF in adults,high misdiagnosis rate was assessed with USG.The accuracy for the diagnosis of CPF using MSCT with reformation technique was high,which could be a significant guide for the diagnosis and treatment of CPF,and could be considered as the first choice modality.