The Anatomical Study Of Pulmonary Vein's Type, Standard Ostium Measurement And Relative Variations By Multi-detector Spiral Computed Tomography

Objective Pulmonary vein(PV) is functional vessel of lung.The ectopic exciting of its muscular sleeve is associated intimately with occurrence and maintenance of atrial fibrillation(AR).By multi-detector spiral CT angiography(MSCTA) of PV,its ostium will be measured exactly,its type and relative variations will be observed in multiple modes and directions in order to provide help for cardiovascular and thoracic surgery,radiofrequency ablation for AR.Materials and methods 120 patients(without serious disease of heart,lung,liver and kidney,without AR) who were performed MSCTA of PV were analyzed.The reconstructed images of PV and left atrium(LA) were acquired using post-processing technology.PV number and ostia number were observed on volume rendering(VR), multi-planner reconstruction(MPR) and original transversal images.PV type was put forward on basis of its variations,for example additional pulmonary vein(APV) and common ostia(CO).The 'standard'.PV ostia was identified on high definition maximum intensity projection(HD MIP),combined with oblique image by using chest vessel analysis (VA) software.Then the area was measured on lumen images,the long diameter and short diameter was measured on oblique images(reconstructed ostium axial image perpendicular to PV's long axis).The long diameter,short diameter,venous ostium index(VOI) and area of PV were analyzed by SPSS 15.0 on age and gender.The location,draining lung lobe and segments of APV were analyzed on VR,MPR and original transversal images.For left atrium diverticulum(LAD),combined with oblique image,its cervix width and body height were measured on MPR or original transversal images.The relationship between its presence probability and gender was analyzed.Results①There are 4 types about PV type.The most common one is type 'standard'(62.5%).The probability of type 'CO','APV','mixed variation' is 21.7%, 15.0%,0.8%,respectively.②In four PVs,the largest in long diameter,short diameter and area is right superior pulmonary vein(RSPV),the smallest is left inferior pulmonary vein(LIPV).There is no difference on long diameter,short diameter and area of RSPV,left superior pulmonary vein(LSPV) and LIPV among different age group.However,there is different on right inferior(RIPV) among different age group.Above ostium data of >75y group is smaller than other age groups'.There is no gender difference about them in statistics.③In VOI of four PVs,the largest is RIPV,the smallest is LSPV.There is different in statistics between middle aged and elderly aged on LSPV.There is no statistic difference on gender for VOI.④Between our study and Yin's,there is statistics difference on ostium average diameter of RIPV and LIPV,area of RIPV.Our results are larger than Yin's.⑤The presence probability of CO is 22.5%,18.8%for male,27.5%for female, respectively.There is no statistics difference on gender.CO mostly was appeared on left side of LA.⑥The presence probability of APV is 15.8%,17.4%for male, 13.7%for female,respectively.There is no statistics difference on gender.APV mostly was appeared on right side of LA.APV may appears between RSPV and RIPV, on superior wall of LA(between RSPV and RIPV),nearer to the root of RSPV or RIPV,between LSPV and LIPV.It may drainage from medial and lateral segment of right middle lobe,posterior segment of right upper lobe,back segment of right lower lobe,inferior lingular segment of left upper lobe.⑦The presence probability of LAD is 16.7%,male of it is 13.0%,female is 17.6%.The cervix width of diverticulum is 4.9mm±3.2mm,the body height of them is 5.4mm±2.0mm.The ratio of body height to cervix width is from 0.47 to 4.08(median 1.16).The left atrium diverticulums are probably acquired or congenital.It can be proved by reexamination after therapy or autopsy at last.Conclusion①There are 4 types about PV style named 'standard','CO','APV' and 'mixed variation'.The most common one is 'standard'.The rarest is 'mixed variation'.②In four PVs of 'standard',the largest in long diameter,short diameter and area is RSPV,the smallest is LIPV.In VOI,the largest is RIPV,the smallest is LSPV.There is different on age group about above data in statistics.Oppositely there is no gender difference about them.③APV appears mostly between RSPV and RIPV,draining medial and lateral segment of right middle lobe.There is no statistics difference on gender.④LAD diverticulum appears mostly anterior wall of left atrium.It's usually single and cystiform.There is no statistics difference on gender.⑤MSCTA of PV can provide anatomy information to succeed the cardiovascular and thoracic surgery,radiofrequency ablation for AR.Innovation①PV type was put forward through observation the connection between PV and LA.②After it's variations were rejected,the average of PV ostia's long diameter,short diameter,VOI and area were obtained on the basis of 'standard'. The data were analyzed on age group and gender in statistics.③Analyze detailedly anatomy of APV,such as presence probability,position,draining lung lobe and segments.④Devote detailedly anatomy of LAD,such as position,number, shape and size.