原发性肺癌供血动脉的CT血管成像表现及临床价值

Features of feeding arteries in primary lung cancer by 64-slice spiral CT angiography

目的利用64层螺旋CT血管成像(CTangiography,CTA)研究原发性肺癌供血动脉的三维影像特征及其临床价值。方法对63例行64层螺旋CT胸部增强扫描至少1支支气管动脉(bronchial artery,BA)清晰显示的病例,包括原发性支气管肺癌43例(其中明确病理学证实37例,临床综合诊断6例)及正常对照20例,采用容积显示(volume ren-dering,VR)、多平面重建(multi-planar reformat,MPR)及最大密度投影(maximum intensity projection,MIP)等后处理技术进行三维重建,分析肺癌供血动脉的影像学特征。结果43例原发性肺癌中,全部肿块均可见BA供血,其中8例合并肺外体循环动脉供血。所有供血BA的起源、数目、内径等三维形态学特征均得到清晰显示,其中单支供血型22例(51.2%),8例表现为供血BA主干不同程度扩张迂曲,14例表现为供血BA主干及分支均扩张迂曲,走向或走行至病灶内;多支供血型13例(30.2%),表现为2支或多支BA供血病灶,相互交通吻合形成血管网;多种动脉供血型8例(18.6%),表现为BA和肺外体循环动脉向同一病灶供血。结论原发性肺癌以BA供血为主,可合并肺外体循环动脉供血,64层螺旋CTA能安全、清晰地评价肺癌供血动脉的三维影像特征。

Objective To investigate the three-dimensional imaging features of feeding arteries to primary lung cancer and the clinical value by 64-slice spiral CT angiography （CTA）. Methods The image data of 63 patients who received enhanced chest 64-slice spiral CT scan with at least one bronchial artery clearly displayed were processed at the workstation. Among the 63 cases, there were 43 cases of primary lung cancer （37 cases confirmed by pathology and 6 cases confirmed by the synthesized clinical methods） and 20 cases without any chest lesion confirmed by CT as normal control group. The spatial imaging features of the arteries supplying to lesion were observed and analyzed using multi-planar reformat （MPR）, maximum intensity projection （MIP） and volume rendering （VR）. Results All 43 cases with lung cancer were supplied by the bronchial arteries and 8 of them were supplied by the bronchial arteries and other arteries of systemic circulation. Three-dimensional imaging features of these feeding bronchial arteries such as origin, number and diameter can be showed clearly. That only one bronchial artery supplying lesion was found in 22 cases （51.2%） , of which the main trunk of bronchial arteries were dilated in 8 cases and both the main trunk and branches were dilated and tortuous in 14 cases. These feeding vessels all extended down to or entered into lesions. That 2 or 3 bronchial arteries supplying lesion was seen in 13 cases （30.2%） and the anastomosis usually occurred. That bronchial arteries and other arteries of systemic circulation supplying the same lesion was observed in 8 cases （ 18.6% ）. Conclusion Bronchial arteries are the main feeding arteries of primary lung cancer and sometimes other arteries of systemic circulation also supply the lesion. The 64-slice spiral CTA can show the three-dimensional imaging features of bronchial arteries feeding primary lung cancer safely and clearly, which can be used as the roadmap for the intervention therapy of lung cancer.