目的探讨64层CT血管造影在 先天性冠状动脉瘘诊断中的价值。方 法 对12例CAF患者行64-MDCTA扫描， 获得满意图像后，行容积再现(volume rending,VR)、多平面重组（multiplanar reconstruction,MPR)及最大密度 投影(maximum intensity projection, MIP)后处理，并与冠状动脉血管造影 (coronary angiography，CAG)检查结果 进行比较。结果 64-MDCTA检查显示，12 例CAF患者共有22支瘘血管，其中单一 瘘道者占41.7%(5/12)，多发瘘道者占 58.3%(7/12)；合并瘘动脉瘤形成者占 25.0%(3/12)。64-MDCTA比CAG多检测出1 支起源于左锁骨下动脉(left subclavian artery,LSCA)的瘘血管，64-MDCTA与 CAG诊断其余21例瘘血管的结果完全一 致。VR诊断CAF瘘血管入口的未确诊率 为9.1%(2/22)，MPR为18.2%(4/22)， MIP为54.5%(12/22)；VR和MPR未确诊 率显著低于MIP(χ2 =10.476、6.286， P=0.001、0.012)，VR和MPR未确诊率比 较无统计学差异(χ2 =0.772，P=0.380)。 VR诊断CAF瘘血管出口的未确诊率为 13.6%(3/22)，MPR为18.2%(4/22)，MIP 为59.1%(13/22)；VR和MPR未确诊率显著 低于MIP(χ2 =9.821、7.765，P=0.002、 0.005)，VR和MPR未确诊率比较无统计学 差异(χ2 =0.170，P=0.680)。结论 64- MDCTA在CAF诊断方面具有良好的价值。

Objective To evaluate the imaging features and diagnosis of 64-Multidetector coronary CT angiography(64-MDCTA) on congenital coronary artery fistula(CAF). Methods A total of 12 patients with CAF were given 64-MDCTA scan, acquired satisfactory image, did the post-processing for volume rending(VR), multiplanar reconstruction(MPR) and maximum intensity projection(MIP), and compared with the results of coronary angiography(CAG). Results 64-MDCTA results showed that, a total of 22 fistulas were found in 12 patients with CAF, single fistula was 41.7%(5/12), multiple fistulas was 58.3%(7/12), combined with fistula aneurysm was 25.0%(3/12). 64- MDCTA detected 1 fistula origin of the left subclavian artery(LSCA), and 64-MDCTA and CAG were identical in the diagnosis of the remaining 21 fistulas. The missed diagnosis rate of VR diagnosis fistula entrance was 9.1%(2/22), MPR was 18.2%(4/22) and MIP was 54.5%(12/22). The missed diagnosis rate of VR and MPR significantly less than MIP(χ2 =10.476, 6.286, P=0.001, 0.012). The missed diagnosis rate of VR and MPR were no statistic difference(χ2 =0.772, P=0.380). The missed diagnosis rate of VR diagnosis fistula exit was 13.6%（3/22), MPR was 18.2%(4/22) and MIP was 59.1%(13/22). The missed diagnosis rate of VR and MPR significantly less than MIP(χ2 =9.821, 7.765, P=0.002, 0.005). The missed diagnosis rate of VR and MPR had no statistic difference(χ2 =0.170, P=0.680). Conclusion 64-MDCTA has good value in the diagnosis of CAF.