肺癌供血动脉的MSCTA与DSA对照研究

MSCTA and DSA Control Study on Feeding Artery of Lung Cancer

目的通过MSCTA与DSA比较,评价MSCTA对肺癌供血动脉显示的真实性和可靠性。方法对23例临床确诊肺癌患者进行介入治疗前,先行供血动脉MSCTA三维重组,CT检查后0～3天内行DSA检查,并接受介入治疗。MSCT后处理技术采用VR、MIP、MPR等。所有CT横断图像及MSCTA重组图像和DSA造影图像由2位从事肺癌诊断和介入治疗多年经验的影像科医生进行分析评价,意见一致为准。重点评价两种检查方法对肺癌供血动脉的显示能力。结果全组23例肺癌患者中,22例顺利完成MSCTA三维重组及DSA造影检查,DSA造影证实肿瘤供血动脉共46支;MSCTA三维重组显示肿瘤供血动脉共45支。以DSA显示作为参考标准,MSCTA显示肿瘤供血动脉的灵敏度为97.8%(45/46)、特异度为100%(1/1)、准确率为97.9%(46/47)。MSCTA对肿瘤供血动脉的显示结果与DSA比较差异无统计学意义(P>0.05),且二者对肺癌供血动脉显示的吻合度差异有统计学意义,并且吻合度较强(kappa值=0.657,P=0.000)。MSCTA与DSA对供血动脉的直径测量分别为(2.54±0.31)mm、(2.66±0.32)mm,两者差异无统计学意义(P>0.05)。结论与DSA相比,MSCTA能够准确、直观地显示肺癌供血动脉的解剖特点,且真实性和可靠性好;MSCTA相对无创,是术前肺癌供血动脉筛选的较好影像学检查方法。

Objective To assess the validity and reliability of the tumor feeding artery imaging of MSCT angiography with the comparison of DSA. Methods Twenty-three patients with lung cancer underwent MSCT angiography of tumor feeding artery and also were performed by selective digital subtraction angiography （DSA）. First, MSCTA was performed in these patients with lung cancer, with real time helical thin slice CT scanning. Three-dimensional images of tumor feeding artery were processed at the console workstation, Spatial anatomical characters of tumor feeding artery using different rotations of view were observed. DSA and interventional therapy were followed up after 0-3 days in these patients. MSCT angiography findings were compared with those of DSA for every equivalent segment; taking the outcomes of DSA as gold standard and analyzing the sensitivity and specificity etc. Resuits All tumor feeding arteries in 22 of 23 patients with lung cancer were observed using VR,MPR,MIP,which could exactly be shown about their origin, course and diameter. Diameter of tumor feeding artery became thicker evidently. Among them, some tumor feeding arteries （bronchial arteries） could reach far from the segment bronchi or entered into the lesion. Volume rendering images were the best among these images. DSA had a high consistency with MSCTA in displaying the tumor vascular, tumor stain, and origin of tumor feeding artery in the patients who received MSCTA and the interventional therapy. Comparing with DSA, the sensitivity, specificity and accuracy of MSCTA to display feeding artery was 97.8%, 100% and 97.9% respectively; the difference was not statistically significant between the both examinations （P〉0.05）, and Symmetric Measures k=0.657, P=0.000, both goodness of fit was better. Diameter of tumor feeding artery became thicker evidently on the image of MSCTA and DSA, and the difference was not statistically significant between MSCTA and DSA （P〉0.05）. Conclusion The anatomical characters of feeding arteries in patients with lung cancer can be displayed stereographically and clearly by MSCT angiography, which has higher validity and reliability.