Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, PR China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, PR China.
J Cardiovasc Comput Tomogr. 2019 Jan-Feb;13(1):75-80. doi: 10.1016/j.jcct.2018.10.013. Epub 2018 Oct 19.
To review the imaging features of coronary artery-to-pulmonary artery fistula (CPAF) on CT coronary angiography (CTCA) and evaluate its diagnostic performance compared with coronary catheter angiography (CCA) and transthoracic echocardiography (TTE).
We retrospectively reviewed with a diagnosis of CPAF from among 19855 consecutive CCTA performed with 256-slice MDCT scanner for suspected coronary artery disease. CT images were evaluated for - origin, number, size and course (tubular/worm-like dilation/significant aneurysm formation/wall attachment sign) of fistula vessels, drainage site, drainage site imaging features (pierced sign, isodensity sign, smoke sign, jet sign), and main pulmonary artery (MPA) enlargement. 25 patients of CPAF also underwent CCA and 47 patients underwent TTE.
There were 72 patients with CPAF (0.36%) in our study, of which 44 were men and 28 were women, with mean age of 55.8 ± 13.2 years (range 22-85 years). CPAF originated from conus artery, left anterior descending artery (LAD), combined conus artery and LAD in 55, 67, 50 cases, respectively. Tubular dilation, worm-like dilation and aneurysm was seen in 14, 58 and 35 cases, respectively. Wall attachment sign was noted in 69 cases. All the cases demonstrated only a single drainage site, with left lateral wall, left anterolateral, anterior, right lateral and right anterolateral walls of MPA in 44, 21, 5, 1 and 1 cases, respectively. The mean diameter of the fistula drainage site was 2.6 ± 1.3 mm. Pierced sign, jet sign, smoke sign, isodensity sign was seen in 72, 46, 41 and 24 cases, respectively. MPA enlargement was seen in 20 patients. CCA showed CPAF in only 20 cases among 25 patients; while TTE showed CPAF in only 9 patients among 47 patients.
CTCA is competent in detecting and characterizing CPAF with an excellent diagnostic performance as the first imaging modality of choice, which is valuable for giving a distinct and intuitive explanation to patients and physicians and making an objective and exact assessment for further management.
回顾 CT 冠状动脉造影（CTCA）中冠状动脉-肺动脉瘘（CPAF）的影像学特征，并评估其与冠状动脉造影（CCA）和经胸超声心动图（TTE）的诊断性能。
我们回顾性分析了在 19855 例连续行 256 层 MDCT 扫描仪 CTCA 检查以怀疑冠心病的患者中，经诊断患有 CPAF 的患者。评估 CT 图像的瘘管血管的起源、数量、大小和走行（管状/虫样扩张/明显动脉瘤形成/壁附着征）、引流部位、引流部位的影像学特征（穿孔征、等密度征、烟雾征、射流征）和主肺动脉（MPA）扩张。25 例 CPAF 患者行 CCA 检查，47 例行 TTE 检查。
本研究共发现 72 例 CPAF（0.36%）患者，其中男 44 例，女 28 例，平均年龄 55.8±13.2 岁（22-85 岁）。CPAF 起源于圆锥动脉、左前降支（LAD）和圆锥动脉与 LAD 联合，分别为 55、67、50 例。管状扩张、虫样扩张和动脉瘤分别为 14、58 和 35 例。69 例存在壁附着征。所有患者均仅显示单一引流部位，左外侧壁、左前外侧壁、前壁、右外侧壁和右前外侧壁分别为 44、21、5、1 和 1 例。瘘管引流部位的平均直径为 2.6±1.3mm。72 例可见穿孔征、射流征、烟雾征、等密度征，46、41、41 和 24 例分别可见 jet sign、smoke sign、isodensity sign。20 例患者 MPA 扩张。25 例患者中 CCA 仅显示 20 例 CPAF；而 TTE 仅显示 47 例患者中的 9 例 CPAF。
CTCA 能够很好地检测和描绘 CPAF，具有卓越的诊断性能，是首选的成像方式，可对患者和医生进行清晰直观的解释，并对进一步的治疗提供客观准确的评估。
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