Evaluation Of64-slice Spiral CT With Multiple Reconstruction Technique In Assessing Characteristics Of The Pulmonary Vein And Left Atrium

Objective To explore the value and method of64-slice Spiral CT with multiplereconstruction technique in assessing characteristics of the pulmonary vein and left atriumof patients with or without atria fibrillation（AF）.Methods We retrospectively analyzed the anatomies of the pulmonary vein and leftatrium in50patients without atria fibrillation and11patients with atria fibrillation whocame to CT room in Tongji hospital from April to December2011undergone ECG-gated64-slice CT angiography. Patients without AF group by age and sex. The workstation andpostprocessor with multi-planar reformatting(MPR), volume rendering(VR) andintravascular endoscopy (VIE) was used to analyze the data so as to observe themorphologic characteristics of the pulmonary vein and left atrium. During the operation,this data was integrated with the eletroanatomic data. We got the result of the operation.Results①VR can reconstruct properly the morphology of the pulmonary veins(PVs).44of50cases without AF (88%) had typical pattern of four PVs,6with variation (12%). Thecalibers of the superior PVs were bigger than the inferior PVs (p<0.05), and the calibers ofmale’s left superior PVs and right PVs were bigger than female’s (p<0.05), but that of theleft inferior PVs between male and female were similar (p>0.05).The calibers of PVs weresimilar between middle aged group and older aged group (p>0.05); The superior PVs weremuch more precipitous than the inferior PVs (p<0.05).8of11cases with AF（72.7%） hadtypical pattern of four PVs，3with variation（27.3%）。②VIE properly showed the ostia ofthe PVs and the relationship of the ostias among the PVs and left atria appendage (LAA)and the4types of the crista between LAA and left PVs.③3types of left atria top wererevealed in50without AF cases, including convex type(38%) in19cases, concavetype(4%) in2cases and plateau type(58%) in29cases; The average volume of left atrium was84.5cm3. The average volume of the older aged group was bigger than the middleaged(p<0.05), and that of male was bigger than female(p<0.05).3of11cases with AF wereconvex type，4cases concave type and4plateau type. The average volume of left atriumwas108.3cm3.④The average angle of the coronary sinus entered the righter atrium of50cases without AF was78.9°which ranged from9.5°to130.9°， and the average angleof11cases with AF was85.9°which ranged from67.8°to97.1°. With the help ofimage integration of CT and3D electroanatomic mapping system，11cases with AFundergo catheter ablation without post-procedure complication.Conclusion64-slice Spiral CT with multiple reconstruction technique can demonstratepulmonary vein and left atrium clearly and make sure the ostia of PVs and LAA andvariation before the procedure and integrate with electroanatomic mapping system, which isof important value to guide radiofrequency catheter ablation and increase the successfulrate and decrease the complications.