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目的 探讨256层螺旋CT血管造影技术在成人冠状动脉肺动脉瘘(CPF)诊断中的价值.方法 回顾性分析CPF 21例,男13例,女8例,年龄57 ～ 85岁,平均72岁,心率61～ 97次/分,平均76次/分.256层螺旋CT回顾性心电门控扫描,图像后处理方法:容积再现(VR)、最大密度投影(MIP)、多平面重组(MPR)、曲面重组(CPR).结果 CPF单侧冠状动脉供血7例,双侧冠状动脉同时供血14例,占66.7％;供血动脉以左前降支近段居多,为13例(61.9％).21例均可直接观察到畸形血管团,表现为“毛线团”样或“筛网”样分布.12例可见供血动脉区动脉瘤形成.15例供血冠状动脉呈轻～中度狭窄,且均位于畸形血管开口处附近.21例均可观察到畸形血管向肺动脉内染色、供血,其中18例可见对比剂“喷射征”.结论 多排螺旋CTA技术重组方法多样,能够直观、准确地显示CPF的畸形血管形态以及“喷射征”等典型征象.“,”Objective To investigate the clinical value of 256-slice spiral CT angiography in diagnosing coronary-pulmonary artery fistula (CPF) in the adult patients.Methods A total of 21 patients with CPF were enrolled in this study.The patients included 13 males and 8 females,aged 57-85 years with a mean age of 72 years old.The heart rate ranged from 61 bpm to 97 bpm with a mean of 76 bpm.256-slice spiral CT retrospective ECG gated scanning was carried out in all patients.Image reconstruction techniques,including VR,MIP,MPR and CPR,were employed.The clinical data were retrospectively analyzed.Results Of the 21 cases,CPF with unilateral coronary blood supply was found in 7,bilateral coronary blood supply in 14 (66.7％).The feeding arteries mainly included proximal left anterior descending (n =13,61.9％).Vascular malformation,presenting as “wool ball” or “cribriform” distribution,was demonstrated in all 21 patients.Formation of aneurysm was seen in 12 cases.Mild to moderate stenosis of coronary artery was noted in 15 patients,all of them were located near the orifice of abnormal vessels.The blood flow from abnormal vessels to pulmonary arteries was demonstrated in all 21 patients,and “injection” sign was seen in 18 patients.Conclusion 256-slice spiral CT angiography together with multiple image reconstruction techniques can directly and precisely display the abnormal vessels as well as the typical CPF features such as “injection” sign.