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目的:探讨双源64排螺旋CT诊断冠状动脉瘘(CAFs)的临床价值。方法:选择在14 124例冠心病筛查中检出CAFs30例,分析双源CT机行冠状动脉CT血管造影(CTA)检查情况,应用对比剂示踪法,在主动脉根部层面选择CT值,当升主动脉根CT值达到100Hu时,延迟5s自动触发扫描;图像数据采用单扇区重建,在后处理工作站采用曲面重组(CPR)、最大密度投影(MIP)、容积再现(VR)等技术进行图像分析。结果:(1)发出瘘管的冠状动脉血管分布情况:前降支、右冠状动脉均有分布8例(26.7%),前降支9例(30.0%),右冠状动脉8例(26.7%),回旋支2例(6.7%),钝缘支1例(3.3%),前降支、右冠状动脉窦均有分布1例(3.3%),右冠状动脉窦1例(3.3%)。(2)流入瘘口分布情况:冠状动脉肺动脉瘘23例(76.7%),冠状动脉左心房瘘1例(3.3%),冠状动脉左心室瘘3例(10.0%),冠状动脉右心室瘘1例(3.3%),冠状动脉静脉瘘2例(6.7%)。瘘管明显迂曲粗大5例。行冠状动脉造影检查4例,证实瘘管类型与冠状动脉CTA检查一致,其中,右冠状动脉-左心室瘘1例,左心室明显扩大,有心力衰竭表现。结论:双源64排螺旋CT可清晰显示冠状动脉瘘的起始、走行、交通支、终点,瘘口大小及与邻近心脏、大血管的空间关系等特征,可为诊断及治疗提供参考依据。
Objective: To investigate the clinical value of dual-source 64-slice spiral CT in the diagnosis of coronary artery fistula (CAFs). Methods: Totally 30 cases of CAFs were detected in 14 124 cases of coronary heart disease screening. The coronary CT angiography (CTA) was performed in dual-source CT scanner. Contrast-enhanced tracer method was used to select the CT value of the aortic root. When the ascending aortic root CT value reached 100Hu, delayed 5s automatic trigger scanning; image data using single-sector reconstruction, post-processing workstation using surface reconstruction (CPR), maximum density projection (MIP), volume reproduction Perform image analysis. Results: (1) Distribution of coronary vessels in fistula: There were 8 cases (26.7%) in anterior descending branch and 9 cases in right coronary artery, 9 cases (30.0%) in anterior descending artery and 8 cases (26.7% , 1 case (3.3%) of the anterior circumflex branch and 1 case of the right coronary artery (3.3%), 1 case (3.3%) of the right coronary artery. (2) The distribution of inflow fistula: 23 cases (76.7%) of coronary artery fistula, 1 case of left atrial fistula of coronary artery (3.3%), 3 cases of left ventricular fistula of coronary artery (10.0%), Cases (3.3%), 2 cases of coronary venous fistula (6.7%). Fistula obvious tortuous 5 cases. Coronary angiography in 4 cases confirmed that the fistula type and coronary CTA examination consistent, of which, right coronary artery - left ventricular fistula in 1 case, the left ventricle was significantly enlarged, with heart failure performance. Conclusion: Dual-source 64-slice spiral CT can clearly show the characteristics of coronary artery fistula, such as the starting, walking, traffic branch, end point, the size of fistula, and the spatial relationship with the adjacent heart and large blood vessels, which can provide reference for diagnosis and treatment.