64层螺旋CT血管成像在咯血诊疗中的临床价值

Clinical value of 64-slice spiral CT angiography in the diagnosis and treatment of hemoptysis

目的利用64层螺旋CT血管成像(CT angiography,CTA)研究咯血相关血管的影像学特征及其临床价值。方法回顾性分析41例因反复或大量咯血行胸部增强扫描的病例,包括原发性支气管肺癌13例,支气管扩张(以下简称支扩)或慢性炎症21例,支气管肺癌合并支扩2例,肺内血管畸形2例,肺隔离症3例,采用容积显示(volume rendering,VR)、多平面重建(multi-planar reformat,MPR)及最大密度投影(maximum intensity projection,MIP)等后处理技术对咯血相关血管进行观察和分析。结果肺癌、支扩及慢性炎症36例中,供应病灶的支气管动脉均显示异常,15例伴有肺外体循环动脉供血;供应病灶的动脉共117支,其中支气管动脉占71.8%(84/117),10支存在异位起源,肺外体循环动脉占28.2%(33/117),其来源和数目与病灶所处位置、累及范围及胸膜病变密切相关;肺动静脉瘘1例,表现为瘤样扩张的血管囊及与其相连的供血动脉及引流静脉;支气管动脉畸形1例,表现为丰富的支气管动脉血管网伴多个动脉瘤形成;肺隔离症3例,表现为肺外体循环动脉异常分支供血病灶。结论64层螺旋CTA能够提供咯血供血动脉的来源、数目等详细数据,有效评价咯血相关血管的三维影像特征,在咯血的诊断及治疗中具有重要价值。

Objective To investigate the vessel imaging features of the patients with hemoptysis by 64- slice CT angiography （CTA） and its clinical value. Methods Forty-one patients with repeated or massive hemoptysis underwent enhanced 64-slice CT scan, including thirteen cases of primary lung cancer, twenty-one eases of bronehieetasis or chronic inflammation, two cases of primary lung cancer with bronchiectasis, two cases of vascular malformation and three cases of pulmonary sequestration. Their image data were processed at the workstation and the three-dimensional images of the vessels associated with hemoptysis were reconstructed using the reconstructional techniques, like multi-planar reformat （MPR）, maximum intensity projection （MIP）, and volume rendering （VR）. Results Abnormal bronchial arteries were found in 36 patients with lung cancer, bronchiectasis or ehronic inflammation. In addition, one or more non-bronchial systemic arteries supplying the lesions were found in some patients. Totally 117 arteries supplied the lesions, including 84 （71.8%） bronehial arteries （ten were anomalous bronehial arteries） and 33 （28.2%） non-bronchial systemie arteries. The origin and number of the non-bronchial systemic arteries supplying the lesions had a close correlation with lesion site, lesion extent, and pleural thickening and adhesion. In the cases of vascular malformation or congenital diseases, one ease of pulmonary arteriovenous fistula displayed the tumor-like dilatation of the vascular sac cavity eonnected with the feeding artery and draining vein, one case of bronchial arterial malformation showed anastomosis with several aneurysms and three eases of pulmonary sequestration showed the anomalous systemic arteries supplying the abnormal portion of the lung. Conclusion 64-slice CTA not only can supply detailed data of the feeding vessels to the lesions in origin and number, but also can display these vessels clearly.