支气管动脉CT血管成像三维解剖学研究

Three-dimensional anatomical evaluation of bronchial artery with CT angiography

目的评价CT血管成像(CTA)对支气管动脉(BA)的显示能力及三维影像解剖特征。方法对443例患者采用16层螺旋CT增强扫描获得胸部原始图像,用容积显示(VR)、多平面重组(MPR)、最大强度投影(M IP)进行三维重组,观察BA特征。结果有359例在VR中至少1支BA肺外段能清晰显示。右侧BA主要起源于右肋间动脉(213/436支,48.85%)及降主动脉(207/436支,47.48%),左BA主要起源于降主动脉(363/371支,97.84%)。起源于降主动脉的右BA以右壁最多(95/207支,45.89%),其次是前壁(88/207支,42.51%),起源于降主动脉的左BA以前壁最多(272/363支,74.93%)。起源于降主动脉的共干动脉以前壁最多(57/77支,74.03%)。60.11%(223/371支)的左BA走行于左主支气管上缘,少数在下缘(95/371支,25.61%)和后缘(53/371支,14.28%)。49.31%(215/436支)的右BA走行于右主支气管后缘,35.55%(155/436支)走行于下缘。BA分布类型共11种,左右各1支(R1L1)者最多见(192/359例,53.48%),右2支左1支(R2L1)其次(63/359例,17.55%)。结论BA解剖学特征复杂,CTA三维成像能予以较好的评价。

Objective To evaluate the ability of CT angiography in identifying and demonstrating the origins and courses of bronchial arteries by using the three-dimensional reformation technique. Methods Four hundred and forty-three cases were examined with thin-section enhanced MSCT. Three-dimensional images of bronchial arteries were processed at the workstation. Spatial anatomical characters of the bronchial arteries using volume rendering（ VR）, multiplanar reconstruction （MPR）, and maxium intensity projection （MIP） were observed. Results At least one bronchial artery was clearly displayed in VR in 359 cases. The right bronchial arteries mainly appeared to originate from the right intercostal artery （213/436, 48.85% ） and descending aorta （207/436, 47.48% ）, while the left bronchial arteries mainly from the descending aorta （363/371, 97.84% ）. The right bronchial arteries of the descending aorta were mainly arised from right wall （95/207, 45. 89% ）, and then the anterior wall （88/207, 42.51% ）, while the left bronchial arteries of the descending aorta mainly arised from anterior wall of the aorta （ 272/363, 74. 93% ）. The common trunk originated from the descending aorta mainly positioned in the anterior wall （57/77, 74. 03% ）. 49. 31% （215/436） of the right bronchial arteries were coursing across the posterior edge of the right main bronchi, 35.55% （155/436） coursing the inferior edge, while 60. 11% （ 223/371 ） of left bronchial arteries coursing forward across the superior edger of the left main bronchi, the others coursing the inferior or the posterior edge. There were eleven bronchial artery distribution patterns, with the right and left ones predominating （192/359, 53.48%）, and then two right and one left （63/359, 17.55% ）. Conclusion The bronchial artery anatomy was complicated, and CT angiography could clearly visualize the features.