肺癌支气管动脉与肺动脉CT血管造影分析

Impact of multi-layer spiral CT angiography of bronchial artery and pulmonary artery in assessment of the main blood supply to the primary lung cancer

目的利用CT血管造影(CTA)显示支气管动脉(BA)和肺动脉(PA)三维影像学特征,进一步探讨肺癌血供。方法收集原发性肺癌147例及正常对照46例,采用多层螺旋CT胸部增强扫描获得原始图像,用容积显示(VR)、多平面重建(MPR)、最大强度投影(MIP)进行CTA重建,观察和分析BA、PA形态学特征及其与肺癌关系。结果肺癌组BA在VR中清晰显示136例,显示率为92.5%,平均2.3支/例;对照组BA清晰显示32例,显示率为69.6%,平均2.0支/例。肺癌组同侧BA管径较肺癌对侧和正常对照组BA明显增粗(P<0.05);肺癌同侧总截面积显著大于正常对照组(P<0.05),且较肺癌对侧明显增加(P<0.05);肺癌侧BA扩张扭曲呈蚓状走向肿瘤或进入肿瘤内,多分支网状吻合。肺癌组PA均清晰显示,54例PA穿过肿瘤或从瘤旁经过,未见异常变化;25例PA显影完整,受肿块推挤并从周围包绕肿块,形成手握球征;40例PA基本完整,肿块从外对PA环状包埋,PA管腔呈扁平状、偏心性或向心性缩窄或枯树枝征;28例PA受肿块包绕并残缺截断形成残根征。结论原发性肺癌BA明显扩张,总供血量明显增加;PA穿过肿瘤或狭窄截断。多重螺旋CTA同样证明肺癌主要为BA供血,未见PA供血证据。

Objective To investigate the blood supply of primary lung cancer （PLC） using CT angiography for bronchial artery （BA） and pulmonary artery （PA）. Methods Thin-section enhanced multi-layer spiral CT （MSCT） were carried out in 147 primary lung cancer patients and 46 healthy subjects as control. Three-dimensional images of bronchial artery and pulmonary artery were obtained using volume render（VR） and multi-planar reconstruction （MPR） or maxmum intensity projection （MIP） at the workstation, and their morphological findings and relationship with the mass were assessed. Results 136 primary lung cancer patients and 32 healthy controls were evaluated for at least one bronchial artery displayed clearly in VR. The detective rate of the bronchial artery was 92. 5% and 69.6%, respectively. The bronchial artery caliber and the total section area of lesion side in lung cancer patients were significantly larger than that on the contralateral side and that of the control （ P 〈 0.05 ）. Bronchial artery on the lesion side in lung cancer was dilated and tortuous, directly penetrating into the mass with reticularly anastomosed branches. In the PLC patients, all PA were shown clearly with normal morphological image though crossing over the masses in 54 patients ; In 25 PLC patients, the PA being essentially intact, was pushed around and surrounded the mass, giving the ＂hold ball＂ sign; In 40 other PLC patients, PA being also intact, the mass surrounded and buried the PA from the outside, crushing the PA flat resulting in an eccentric or centrifugal shrinkage, forming the ＂dead branch＂ sign; In the rest 28 patients, the PA was surrounded and even compressed, forming the ＂residual root＂ sign. Conclusion Primary lung cancer patient shows dilated bronchial arteries and increased bronchial artery blood flow, whereas pulmonary arteries just pass through the mass or are compressed by the mass. It is further demonstrated that the bronchial artery, instead of the pulmonary artery, is the main vessel of blood supply to the primary lung cancer as shown by MSCT angiography of bronchial artery and pulmonary artery.