16层螺旋CT血管造影及三维重建和CT仿真内镜技术在肺癌血供诊断中的价值

Role of 16 Slices Spiral CT Angiography with 3-Dimentional CT and CT Virtual Endoscopy in Detecting Blood Supply of Lung Carcinoma

背景与目的:以往主要靠主动脉或支气管动脉血管造影了解肺癌的供血血管及血供,但该方法具有较大的创伤性且操作复杂,部分病人不易接受,一次血管造影不能保证显示全部供血血管,且支气管动脉血管造影成功率较低。本研究探讨16层螺旋CT血管造影及三维重建和CT仿真内镜技术诊断与评价肺癌供血血管和血供的临床应用价值,为肺癌血供诊断提供一种无创伤性、安全、简便、全面有效的检查方法。方法:对72例经病理证实肺癌患者行16层螺旋CT血管造影及三维重建,血管三维重建方法包括容积再现技术(volumerendering,VR)、最大密度投影(maximumintensityprojection,MIP)和表面遮盖成像(surfaceshadeddisplay,SSD)。其中25例行支气管动脉CT仿真内镜(CTvirtualendoscopy,CTVE)成像。每个肺癌病灶同时行VR彩色三维成像,用肺癌病灶VR彩色图像红色色彩程度代表其血供状况。结果:68例肺癌血管三维重建显示供血血管,其中59例肺癌仅见支气管动脉;5例肺癌仅见肋间动脉;4例肺癌呈混合型,包括支气管动脉、肋间动脉和锁骨下动脉分支血管。4例肺癌纵隔转移淋巴结见支气管动脉进入其内。25例肺癌支气管动脉CTVE可较好显示其开口及血管内腔状况。72例肺癌VR彩色图像红色色彩程度分为4种类型:无色彩(11例),轻度(17例),中度(32例)和重度(12例),其增强后增加CT值分别为(6.16±2.23)Hu,(15.71±3.13)Hu,(25.47±2.71)Hu,(44.31±19.68)Hu。72例肺癌VR彩色成像红色色彩分布形态与其CT强化形态两者一致率为86.1%。结论:16层螺旋CT血管造影及三维重建和CT仿真内镜技术可较好显示肺癌供血血管及血供状况,是诊断与评价肺癌血供一种无创伤性、简便、有效方法。

BACKGROUND ＆ OBJECTIVE： Angiography, a common method in evaluating blood supply of lung carcinoma, is invasive and complicated, with low success rate for bronchial artery, and could not assure to show all supply blood vessels at a time. This study was to explore clinical value of 16 slices spiral CT angiography with 3-dimensional CT （3DCT） and CT virtual endoscopy （C-I-VE） in diagnosing and evaluating supply blood vessels and blood supply of lung carcinoma, so as to find a non-invasive, safe, simple and effective method in diagnosing blood supply of lung carcinoma. METHODS： A total of 72 patients with pathologically proved lung carcinoma underwent 16 slices spiral CT angiography with 3DCT. Volume rendering （VR）, maximum intensity projection （MIP）, and surface shaded display （SSD） of supply blood vessels of lung carcinoma were used as 3DCT models. CTVE of bronchial artery was performed in 25 patients. Color VR of tumor lesion was performed in all patients. RESULTS： Supply blood vessels were showed in 68 patients, 59 of them showed only bronchial artery, 5 showed intercostals arteries, and 4 showed mixed types, including bronchial artery, intercostals arteries, or branch arteries of subclavian artery. The bronchial artery entered into enlarged mediastinal lymph nodes in 4 patients. CTVE well displayed the orifice and lumen of bronchial arteries in the 25 patients. The extent of red color of tumor lesion on VR color image were divided into 4 types： no color （n=11）, light red （n= 17）, moderate red （n=32）, and heavy red （n=12）; the added CT values of tumor lesion after enhanced CT were （6.16±2.23） Hu, （15.71±3.13） Hu, （25.47±2.71） Hu, and （44.31±19.68） Hu, respectively. The corresponding rate between enhanced type and distributive type of red color on color VR was 86.1%. CONCLUSIONS：The 16 slices spiral CT angiography with 3DCT and CTVE could show clearly supply blood vessels and blood supply of lung carcinoma. It is a non-invasive, simple and effective method in evaluating and diagnosing blood supply of lung carcinoma.