Evaluation Of64Multislice Spiral CT With Multiple Reconstruction Technique In Assessing Characteristics Of The Pulmonary Vein And Left Atrium

Objective To explore the value and method of64multislice spiral CT withmultiple reconstruction technique in assessing characteristics of the pulmonary veinand left atrium of patients with or without atrial fibrillation（AF）.Methods We retrospectively analyzed the anatomies of the pulmonary vein andleft atrium in90patients(54male and36female) with atrial fibrillation and116patients (65male and51female) with atrial fibrillation who came to CT room inJiangxi provinces people’s hospital from April to December2012undergoneECG-gated64-slice CT angiography. According to the atrial volume， patientswithout atrial fibrillation were divided into the normal atrial volume group (group A)and the increase atrial volume group (group B); patients with atrial fibrillation weredivided into the normal atrial volume group (group C) and the increase atrial volumegroup (group D); patients with atrial fibrillation were divided into the paroxysmalatrial fibrillation group and the persistent atrial fibrillation group. The workstationand postprocessor with volume rendering(VR),multi-planar reformatting(MPR) andintravascular endoscopy (VIE) was used to analyze the data so as to observethemorphologic characteristics of the pulmonary vein and left atrium.Results①VR can reconstruct properly the morphology of the pulmonaryveins(PVs).79of90patients without AF (87.7%) had typical pattern of four PVs,11with variation (12.3%) including7patients with left common pulmonary vein and3patients with an additional right pulmonary vein;112of116patients with AF (96.6%)had typical pattern of four PVs,4with variation (3.4%) including3patients with leftcommon pulmonary vein and1patient with an additional right pulmonary vein.②Inpatients without atrial fibrillation,the perimeter of left superior pulmonary vein(LSPV) in the increase left atrial volume group is longer than the one in the normalleft atrial volume group (P <0.05);In patients with normal left atrial volume,theperimeter of right superior pulmonary vein(RSPV) in the atrial fibrillation group islonger than the one in the non-atrial fibrillation group (P<0.05);In patients with increase left atrial volume,the left atrial volume in atrial fibrillation group is lagerthan the one in non-atrial fibrillation group (P<0.05),and the perimeters of leftinferior pulmonary vein (LIPV)、RSPV、right inferior pulmonary vein (RIPV) in atrialfibrillation group are longer than the ones in non-atrial fibrillation group (P<0.05).③The age of patients with atrial fibrillation is older than the age of ones without atrialfibrillation (P<0.05),the left atrial volume of patients with atrial fibrillation is lagerthan the left atrial volume of ones without atrial fibrillation (P<0.05),the perimeter ofLIPV、RSPV and RIPV in patients with atrial fibrillation is longer than the one inpatients without atrial fibrillation (P<0.05).④The left atrial volume of patients withpersistent atrial fibrillation is lager than the one of patients with paroxysmal atrialfibrillation (P<0.05).⑤The perimeter of RIPV in patients with persistent atrialfibrillation is longer than the one of RIPV in patients with paroxysmal atrialfibrillation(P<0.05).Conclusion①64multislice Spiral CT with multiple reconstruction technique candemonstrate pulmonary vein and left atrium clearly and make sure the ostia of PVsand the perimeter of PVs and variation before the procedure, which is important valueto guide radiofrequency catheter ablation and increase the successful rate anddecrease the complications.②The left atrial volume and perimeters of PVs ofpatients with AF are larger than the ones of patients without AF.③The pulmonaryveins probably take part in the form of turn-back ring which cause atrialfibrillation.The longer the diameter of PVs is,the more likely to form the turn-backring.④The target organs of paroxysmal atrial fibrillation and persistent atrialfibrillation may be different,and RIPV may be the key link between the both above.