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目的探讨冠状动脉-肺动脉瘘(CPF)的多层螺旋CT(MSCT)诊断价值和征象分析。方法回顾性分析16例确诊为CPF患者的临床和CT影像资料,其中男性11例,女性5例,平均年龄56.4岁。观察瘘血管起源、走行和分布,瘘口位置、大小及征象(穿通征、射血征和浓染征),肺动脉增宽与否。结果 16例CPF中,右圆锥支1例,右冠状动脉供血9例(56.3%),左冠状动脉供血4例(25.0%),左右冠状动脉同时供血2例(12.5%);2例瘘口为2个,14例瘘口为1个;瘘口位于主肺动脉左侧壁12例、前壁4例;肺动脉瘘口大小约1.2~5.0 mm。MSCT直接征象:穿通征16例(100.0%);射血征7例(43.8%),均在75%期相显示;浓染征10例(62.5%),8例在45%期相显示,2例在75%期相显示。间接征象:表现为瘘血管增粗、迂曲,部分呈蚯蚓状改变,贴附于肺动脉表面,其中5例合并动脉瘤。肺动脉增粗4例,瘘口大小约3.8~6.9 mm,平均瘘口大小为4.8 mm。结论MSCT结合三维重组技术对诊断CPF具有极高的临床价值,可作为首选的检查方法。
Objective To investigate the diagnostic value and signs of multi-slice spiral CT (MSCT) of coronary artery-pulmonary arterial fistula (CPF). Methods Retrospective analysis of clinical and CT images of 16 cases diagnosed as CPF patients, including 11 males and 5 females, with an average age of 56.4 years. Observation of fistula vascular origin, walking and distribution, fistula location, size and signs (through signs, signs of edema and thick staining), pulmonary artery widening or not. Results In 16 cases of CPF, there were 1 case of right conus, 9 cases of right coronary artery supply (56.3%), 4 cases of left coronary artery supply (25.0%) and 2 cases of right and left coronary artery blood supply (12.5% 2, 14 fistula is 1; the fistula is located in the left pulmonary artery in 12 cases, anterior wall in 4 cases; pulmonary artery fistula size of about 1.2 ~ 5.0 mm. MSCT direct signs: 16 cases (100.0%) were puncture signs; 7 cases (43.8%) were signs of blood stasis, all showed in 75% phase; 10 cases (62.5% Two cases showed in 75% phase. Indirect signs: the performance of the fistula vascular thickening, tortuous, some were earthworm-like changes, attached to the pulmonary artery surface, including 5 cases with aneurysms. Pulmonary artery thickening in 4 cases, fistula size of about 3.8 ~ 6.9 mm, the average fistula size of 4.8 mm. Conclusion MSCT combined with three-dimensional reconstruction of the diagnosis of CPF has a very high clinical value, can be used as the preferred method of examination.