A Large Cohort Analysis Of Pulmonary Vein Anatomy And Its Drainage Types Using Three-Dimensional Multi-slice Spiral CT

Background:Pulmonary vein,as a functional blood vessel in the human body,originates from the alveolar capillary plexus and carries oxygenated blood through gas exchange to the left atrium.With the development and application of multi-slice spiral CT(MSCT),due to its advantages of high spatial resolution and image post-processing,the imaging anatomy of pulmonary vein and its surrounding tissues has gradually increased,and it has been found that pulmonary vein has significant variability,which is very important for clinical diagnosis and treatment involving pulmonary vein.But up to now,there is no recognized classification method which can take into account all the anatomic variations of pulmonary veins.The study of pulmonary vein anatomical structure and confluence types of its branches by MSCT can improve the understanding of pulmonary vein anatomical variation,so as to better serve clinical practice.Objective:To study the anatomical morphology of left atrial pulmonary vein in Chinese patients by MSCT,and to induce a classification system for describing the morphology of pulmonary vein entering left atrium,so as to provide anatomical basis for atrial fibrillation radiofrequency ablation and cardiothoracic surgery.Methods:The chest MSCT images of 1000 Chinese patients were retrospectively analyzed and postprocessed by Syngo.Via workstation.The connection mode of left atrial and pulmonary vein,drainage mode of left and right pulmonary veins and the number and course of branches of right middle pulmonary vein were observed.The types were classified and the frequency of occurrence of each type was counted,and the gender and lateral differences of anatomical structure of left atrial pulmonary vein were analyzed.Results:The incidence of common vein was 26.1%,and that of accessory pulmonary vein was 15.9%.There were four types of left atrio-pulmonary vein connection:standard 620 cases(62%),common dry 221 cases(22.1%),accessory vein 119 cases(11.9%),and mixed 40 cases(4.0%).The variation rate of bilateral pulmonary vein drainage mode was 47.5%,28.4%on the right side and 27.7%on the left side.The variation rate of bilateral pulmonary vein drainage mode was similar and there was no gender difference on the left side.On right side,there were 26 cases(2.6%)of one-branch type,820 cases(82.0%)of two-branches type,137 cases(13.7%)of three-branches type,and 17 cases(1.7%)of four-branches type.On left side,there were 241 cases(24.1%)of one-branch type,753 cases(75.3%)of two-branches type,and 6 cases(0.6%)of three-branches type.There was great variability in the right middle lobe vein,which can form 1～4 branches,of which one-branch type is the most,accounting for 53.1%,followed by two-branches type 40.9%,three-branches type 5.4%,four-branches type 0.6%.The right middle lobe vein mostly flowed into the right superior pulmonary vein(84.2%).Conclusion:The connection mode between pulmonary vein and left atrium has great variability.MSCT can display the anatomical structure of pulmonary vein in detail,which is an effective means to study its variation types and has important clinical significance for the diagnosis and treatment of cardiopulmonary diseases.