肺部疾病的支气管动脉与肺外体循环动脉CTA分析

MDCT Angiography of Bronchial and Nonbronchial Arteries in Pulmonary Diseases

目的:利用CT血管造影对支气管动脉与肺外体循环动脉进行肺供血研究。材料和方法:回顾性分析16层CT胸部增强发现肺外体循环动脉参与供血的不同肺疾病患者39例(男性24例,女性15例,平均年龄63.4岁;范围,20-82岁),采用容积显示(VR)、多平面重建(MPR)、最大强度投影(MIP)进行支气管动脉与肺外体循环动脉进行重建,分析其供血特征。结果:39例病人中共显示支气管动脉128支,肺外体循环动脉42支,其中内乳动脉19支,锁骨下动脉8支,膈下动脉8支,肋间动脉5支,甲状颈干与腹腔干各1支。35支肺外体循环动脉扩张迂曲进入肺内。5例支气管扩张和1例肺癌中扩张迂曲的支气管动脉与肺外体循环动脉形成明显的交通吻合成网状,7例支气管扩张中支气管动脉、肺外体循环动脉与肺动脉间形成吻合。除1例肺隔离症没有伴明显胸膜增厚外,其余肺外体循环动脉穿过胸壁进入肺内均伴有明显的胸膜增厚。结论:CTA并三维重建技术能清晰显示支气管动脉肺外体循环动脉的起源、分布等解剖特征,为介入术提供明确路径,有利于疾病的诊断与治疗。

Purpose： To retrospectively evaluate bronchial and nonbronchial systemic arteries at multi - detector row helical computed tomography （MDCT） angiography in patients with different pulmonary disorders. Materials and Methods： 39 patients （24 men, 15 women; mean age, 63.4 years; range, 20 - 82years. 28 of the patients had at least an episode of hemoptysis） with congenital or acquired pulmonary disorders of bronchial and nonbronchial systemic arteries supplying underwent multi - detector row helical CT angiography of the thorax with use of a 16 - detector row scanner. Findings on CT angiograms, including maximum intensity projections（MIP）, MPR, and three - dimensional volume - rendered images （VR）, were used to retrospectively analyze the characteristics of bronchial and nonbronchial systemic arteries on CT angiogram. Results： In 39 patients, a total of 128 bronchial arteries were identified. 42 branches of nonbronchial systemic arteries were detected： 19 branches of the internal mammary artery, 8 branches of the subclavian artery, 8 branches of inferior phrenic artery, 5 branches of intercostal artery, i branch of thyrocervical trunk, I branch of celiac trunk. 35 arteries entered into the lung parenchyma and extended down to the lesions dilatedly and tortuously. Each case except one with sequestration was associated with pleural thickening when the vascular structures passed through the extrapleural fat. Conculsion： Multi - detector row helical CT angiography provides precise depiction of bronchial and nonbronchial systemic arteries, which may be useful in the diagnosis and assessment of the pulmonary diseases. A concerted search for a nonbronchial systemic arterial supply should be performed to increase the safety and effect of interventional therapy.