肺部慢性炎症与原发性肺癌供血动脉CTA表现的影像比较

Comparative Imaging Study for Feeding Artery Changes in the Chronic Infla Mmation of the Lung and Primary Lung Cancer with 64-slice Spiral CT Angiography

目的探讨肺部慢性炎症与原发性肺癌供血动脉CT血管成像(CTA)表现差异及其鉴别诊断价值。资料与方法搜集81例行64层螺旋CT胸部增强扫描,支气管动脉清晰显示的病例,包括原发性支气管肺癌38例,慢性炎症(含支气管扩张)21例,肺癌合并支气管扩张2例及正常对照20例,全部病例均采用容积显示(VR)、多平面重组(MPR)及最大密度投影(M IP)对支气管动脉等供血动脉行三维重组,测量支气管动脉内径并计算肺癌组与慢性炎症组肺外体循环动脉供血率,比较3组支气管动脉内径及肺癌组与慢性炎症组肺外体循环动脉供血率有无差异(2例肺癌合并支气管扩张者不纳入统计)。结果肺癌组38例中,支气管动脉内径平均值为1.87 mm,18.42%(7例)伴有肺外体循环动脉供血;慢性炎症组21例中,支气管动脉内径平均值为2.54 mm,47.62%(10例)伴有肺外体循环动脉供血;正常对照组20例中,支气管动脉内径平均值为1.49 mm,3组支气管动脉内径、肺癌组与慢性炎症组肺外体循环动脉供血率差异均有统计学意义(P<0.05)。结论肺癌与慢性炎症时支气管动脉均有扩张,慢性炎症时支气管动脉扩张较原发性肺癌更为明显,更能刺激肺外体循环动脉参与供血,两者供血动脉的CTA表现在相关鉴别诊断中有一定价值。

Objective To explore the difference of feeding artery between the pulmonary chronic inflammation and primary lung lcancer with 64-slice spiral CT angiography and to evaluate its clinical value in the differential diagnosis. Materials and Methods The CT scan data of 81 patients, including 38 cases of primary lung cancer, 21 cases of chronic inflammation （including bronchiectasis） , 2 cases of primary lung cancer with bronchiectasis and 20 cases without any chest lesion as normal control group were collected. The patients and normal controls received enhanced chest CT scan. Three-dimensional imaging characters of the bronchial arteries were analyzed using volume rendering （ VR）, multi-planar reforma- tion （MPR） and maximum intensity projection （MIP） at workstation. The inner diameter of bronchial arteries and the rate of nonbranchial systemic arteries supplying to lesion were calculated. The inner diameter of bronchial arteries in three groups as well as the rate of nonbranchial systemic arteries supplying to lesion between the cancer group and the chronic inflammation group were compared respectively （ except 2 cases of primary lung cancer with bronchieetasis）. Results The inner diameter of bronchial arteries was 1.87 mm and the rate of nonbranchial systemic arteries supplying to lesion was 18.42% in 38 primary lung cancers, while the diameter of bronchial arteries was 2.54 mm and the rate of nonbranehial systemic arteries supplying to lesion was 47.62% in 21 chronic inflammations. There was a significant difference between the two groups （ P 〈 0. 05 ）. Conclusion Bronchial artery is dilated both in the cancer and chronic inflammation group. The dilation in the chronic inflammation group is more prominent than that in the cancer group. There are more nonbranchial systemic arteries supplying to lesion in the chronic inflammation group. The findings of feeding artery of the chronic inflammation and primary lung cancer are valuable in differential diagnosis.