The Evaluation In 256-Slice MSCT Of Right Atrial Appendage Structure And Function

Part 1 Consistency study of the quantitative measurements of the right atrial appendage using 256-slice Spiral CTObjective : To assess the consistency of the quantitative measurement of right atrial appendage(RAA) using 256-slice spiral CT.Methods : 40 individuals suspected coronary heart disease underwent 256 slice CT coronary CT angiography(CTA)with P3 T software of stel-lant double barrel syringe injection, the second phase injection sel-ected 3:7 contrast-saline mixture.The CT data sent to the workstation and measured the RAA volume,height,the longitudinal and transverse diameters and the area and perimeter of RAA basilar part using 75%phase imaging of the cardiac cycle by different observers.The consi-stency of interobserver and intraobserver were evaluated by paired t-test suggested ? pearson correlation analysis and Bland—Altman stati-stic method.Results : There was no significant differences in RAA related parameters of CT between inter-observers and intra-observer(P>0.05, r= 0.76 ~ 0.98). There also showed a high consistencies between inter-observer and intra-observer's in RAA related parameters of CT using Bland-Altman figure,and the absolute value can be acceptted in clinic.Conclusion : 256 Slice CT coronary angiography shows high reproducibility and consistency in measuring the RAA parameters,which can provide further important reference for quantitative measurement RAA parameters.Part 2 Quantitative Study of Right Atrial Appendage and Adjacent Anatomic Structure By 256 iCTObjective : To quantitate the Right atrial appendage(RAA) morphological structure by 256 iCT in order to provide the imaging reference for the clinical interventional or surgical therapy of RAA.Methods:200 cases without cardiovascular disease individuals were randomly selected underwent 256 MSCT coronary CT angiography( CTA).The CT RAA data was sent to the workstation and re-constructed by the software,and then measured the longitudinal and transverse diameters and the area and perimeter of RAA basilar part,RAA volume,et a1.Results:(1)There were greater in men with the volume and diameters and area of RAA basilar part than those in women. When the CT parameters of RAA standardization by surface area,there was greater in women with diameters and area of RAA basilar part than those in men.(2)The CT parameters of RAA was bigger in under forty group than those in other age groups(P<0.05).(3)The 95% normal medical reference ranges of RAA :the volume,height,longitudinal and transverse diameters,the area and perimeter of RAA basilar part,the distance and angle from the furthest point of RAA to superior vena cava were 4.83~19.97 ml, 21.46 ~ 41.80 mm, 25.89 ~ 41.65 mm, 19.34 ~ 36.24 mm,459.30 ~ 1093.28 mm 2, 86.16 ~ 147.04 mm, 1.67 ~ 31.23 °, 8.07 ~34.37 mm, respectively.Conclusion:This study provide important reference for clinical treatment of RAA,and primarily establish normal reference range of the p-arameters. Part 3 Anatomical morphology research of right atrial appendage on 256-slice spiral computed tomographyObjective:To observe and classify anatomical morphology of right atrial appendage(RAA) by 256-slice spiral computed tomography coronary angiography(CTA) and provide anatomical information for the diagnosis and treatment of RAA-related diseases.Methods : 500 individuals suspected coronary heart disease underwent 256 slice CT coronary CT angiography( CTA) were reconstructed by RAA 3D reconstruction.Anatomical morphology of RAA was observed and classified according to genders.Each type of angle from the furthest point of RAA to superior vena cava was measured.Results:On the basis of past classification,according to its apex of RAA,the shape of RAA were classified into 5 types and nine subtypes:Triangle-shaped Type Ia(10.4%),Type Ib(8.0%),M-shaped Type IIa(22.6%),Type IIb(1.4%),L-shaped Type IIIa(1.6%)?Type IIIb(16.6%),inversed L-shaped Type IVa(4.4%),Type IVb(24.0%)and balanced-shaped(11.0%).Type Ia was more frequently found in women than men and Type IIa was on the contrary(P<0.05),there were no difference among other types between genders. The angle from the furthest point of RAA to superior vena cava in Type Ia was less than that in Type Ib(P<0.05).Conclusion:MSCT can measure objectively the morphological structure of RAA, understanding those variations before interventional therapy has the potential to increase the success rate and to avoid post-procedure's complications for patients with RAA-related diseases.Part 4 Study on right atrial appendage of atrial fibrillation in patients By 256 iCTObjective : To quantitate the Right atrial appendage( RAA) morphological changes in patients with atrial fibrillation(AF) by 256 iCT in order to improve the diagnosis and treatment of the right atrial appendage related diseases.Methods:60 patients with atrial fibrillation and 200 patients with sinus rhythm as control group were selected underwent 256 MSCT coronary CT angiography(CTA).The CT RAA data ware sent to the workstation and reconstructed by the software,and then measured the RAA volume,hight,longitudinal and transverse diameters of RAA basilar part,et a1.Results:After excluded the relevant affecting causes, the volume of RAA and right atrial,the area of RAA basilar and distance from the furthest point of RAA to superior vena cava were greater in atrial fibrillation group than those in the control group(P<0.05).Conclusion:MSCT can be used to study the structure of the right atrial appendage morphology when patients with atrial fibrillation,and the volume of RAA and Right atrial were increased when AF.