多排CT血管造影对肺癌支气管动脉灌注化疗的指导意义初探

The role of multislice CT angiography in bronchial arterial chemo-infusion for lung cancer:preliminary result

目的探讨术前胸部CT血管造影对经支气管动脉治疗肺癌的指导意义。方法回顾性分析20例原发性肺癌患者,术前均行胸部16排螺旋CT血管造影(CTA),在轴位图(Ax)基础上行多平面重建(MPR)、容积再现(VR)及最大密度投影(MIP),重建供应肺癌的支气管动脉及其他体循环动脉,并以此为参照,在DSA下对患者行支气管动脉化疗灌注栓塞,术中记录寻找到的支气管动脉及非支气管动脉体循环动脉数目。结果胸部CTA共发现34支动脉参与肺癌供血,包括支气管动脉27支(其中异位于右锁骨下动脉的支气管动脉1支)、肋间动脉3支、内乳动脉和膈下动脉各2支。34支动脉均在介入治疗中顺利插管并证实为肺癌供血动脉,DSA造影还发现在CTA上未发现的患侧3支支气管动脉不参与肿瘤供血。结论多排螺旋CT血管造影可显示肺癌的供养血管(包括支气管动脉和非支气管体循环供血动脉)及其走行情况,有助于经支气管动脉介入治疗。

Objective To evaluate the role of pre-procedural thoracic CT angiography in assisting bronchial arterial chemo-infusion for lung cancer.Methods 20 cases of primary lung cancer were retrospectively reviewed.All underwent axial plain and contrast enhanced 16-slice CT of the chest before intervention,and CT angiography（CTA）was performed using multiplanar reconstruction（MPR）,volume rendering（VR）and maximum intensity projection（MIP）.Percutaneous arterial angiography and chemo-infusion were then performed according to the distribution of tumor-feeding arteries revealed on CTA.The number of bronchial and other systemic arteries found on DSA was recorded.Results Totally 34 arteries supplying lung cancer were revealed on CTA,including 27 bronchial arteries（one was aberrant from right subclavian artery）,three intercostal arteries,two internal mammary arteries and two infra-phrenic arteries.All arteries were successfully catheterized and confirmed to supply lung cancer.Three additional bronchial arteries,which were not revealed on CTA,were also found,but did not supply the lung cancer.Conclusions Multi-slice CTA provides depiction and traceability of arteries supplying lung cancer（including bronchial and non-bronchial systemic arteries）,and simultaneously assists trans-bronchial arterial intervention.