64层螺旋CT多种三维重组对左心房肺静脉系统的形态学评价

发布时间：2018-11-18 19:12

【摘要】：目的探讨针对非房颤患者与房颤患者的左心房肺静脉系统，64层螺旋CT心血管成像及多种三维重组后处理技术的形态学评价方法与价值。方法回顾性分析2011年4月-12月期间来同济医院CT室行心血管成像的50例非房颤患者及11例房颤患者的左心房及肺静脉的结构，房颤患者不分组，非房颤患者按年龄和性别分组，利用工作站的容积再现（VR）、多平面重组（MPR）、仿真血管内窥镜（VIE）等多种三维重组技术进行后处理，以了解肺静脉及左心房的形态学结构；射频消融术中与电解剖图像融合，了解术后疗效。结果①利用VR可良好构建肺静脉的形态，50例非房颤患者中，44例双侧肺静脉均为2支（88%）；6例存在变异（12%）；双上肺静脉明显较双下肺静脉粗（P0.05），男性左上肺静脉、右上下肺静脉均较女性粗（P0.05），左下肺静脉男女无显著性差异（P0.05）；中年组和老年组肺静脉口径无显著性差异（P0.05）；双上肺静脉开口角度明显较双下肺静脉大（P0.05）。11例房颤患者中，8例双侧肺静脉均为2支（72.7%）；3例存在变异（27.3%）。②VIE技术良好显示左侧上下肺静脉开口之间、右侧上下肺静脉开口之间、左心耳开口与左上肺静脉开口之间的关系，良好显示左心耳与左上肺静脉之间界嵴的四种形态。③VR可良好显示左心房顶部4种形态。非房颤患者中，29例为平坦型（58%），，19例为突起型（38%），2例为凹陷型（4%）；测得50例患者左心房平均容积为84.5立方厘米；老年组左心房平均容积明显较中年组大（P0.05）。男性左心房平均容积较女性大（P0.05）。11例房颤患者中，4例左心房顶部为平坦型，3例为突起型，4例为凹陷型；左房容积平均为108.3立方厘米。④MPR图测量冠状窦汇入右房处与矢状面之间的角度，50例非房颤患者范围从9.5°到130.9°不等，平均为78.9°。11例房颤患者从67.8°到97.1°，平均为85.9°。在CT与三维电解剖标测系统图像融合的辅助下，11例房颤患者射频消融术后恢复窦性节律，无明显并发症。结论64层螺旋CT心血管成像多种三维重组后处理技术能够在术前直接对左心房肺静脉系统进行形态学观察，明确各种形态学变异等，术中与电解剖标测系统融合，可以为临床射频消融治疗房颤提供解剖信息。
[Abstract]:Objective to evaluate the morphologic evaluation of left atrial pulmonary vein system, 64-slice spiral CT cardiovascular imaging and three dimensional recombination post-processing techniques in patients with non-atrial fibrillation and atrial fibrillation. Methods the structures of left atrium and pulmonary vein in 50 patients with non-atrial fibrillation and 11 patients with atrial fibrillation were analyzed retrospectively from April to December 2011. The patients with atrial fibrillation were not divided into two groups. Patients with non-atrial fibrillation were divided into groups according to age and sex. (VR), multiplanar reconstituted (MPR), was reconstructed by workstation volume and (VIE) was simulated by vascular endoscope. To understand the morphological structure of pulmonary vein and left atrium. To understand the curative effect of radiofrequency ablation with electroanatomical image fusion. Results (1) the morphology of pulmonary veins could be well constructed by using VR. Of the 50 patients with non-atrial fibrillation, 44 (88%) had 2 pulmonary veins, 6 (12%) had variation. Double superior pulmonary vein was thicker than double inferior pulmonary vein (P0.05), male left superior pulmonary vein, right superior pulmonary vein were thicker than female (P0.05), left inferior pulmonary vein had no significant difference between male and female (P0.05). There was no significant difference in the diameter of pulmonary vein between middle age group and old group (P0.05), the angle of opening of double superior pulmonary vein was significantly larger than that of double inferior pulmonary vein (P0.05). In 11 patients with atrial fibrillation, two pulmonary veins were found in 8 cases (72.7%). There was variation in 3 cases (27.3%). The relationship between left superior and inferior pulmonary vein openings, right superior and inferior pulmonary vein openings, left atrial auricular openings and left superior pulmonary vein openings was well demonstrated by 2VIE technique. Four forms of the boundary ridge between the left atrial auricle and the left superior pulmonary vein were well displayed. 3VR showed the top of the left atrium well. Among the patients with non-atrial fibrillation, 29 cases were flat type (58%), 19 cases were protruding type (38%), 2 cases were concave type (4%), the mean volume of left atrium in 50 cases was 84.5 cubic centimeter. The mean volume of left atrium in the elderly group was significantly larger than that in the middle age group (P0.05). The mean volume of left atrium in male was larger than that in female (P0.05). In 11 patients with atrial fibrillation, 4 cases were flat at the top of left atrium, 3 cases were protruding type and 4 cases were concave type. The mean volume of left atrium was 108.3 cubic centimeters. The angle between the confluence of coronary sinus into the right atrium and sagittal plane was measured by 4MPR. The range of 50 patients with non-atrial fibrillation ranged from 9.5 掳to 130.9 掳. 11 patients with AF ranged from 67.8 掳to 97.1 掳, with an average of 85.9 掳. 11 patients with atrial fibrillation recovered sinus rhythm after radiofrequency ablation with the aid of fusion of CT and 3D electroanatomical mapping system without obvious complications. Conclusion 64-slice spiral CT can be used to observe the left atrial pulmonary vein system directly before operation, and to identify various morphologic variations, and to fuse with the electroanatomical mapping system during the operation. It can provide anatomic information for the treatment of atrial fibrillation by radiofrequency ablation.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R814.42

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