体动脉侧支血管参与咯血供血的影像学研究

Imaging study of non-bronchial systemic collateral supply in hemoptysis

目的探讨非支气管性体动脉侧支(NBSC)在支气管咯血病变中的意义,及其对支气管动脉(BA)的影响。方法回顾分析124例支气管咯血患者的多层螺旋CT(MSCT)血管造影。采用实时螺旋薄层CT增强扫描,在独立工作站行胸部体动脉三维重建,统计NBSC和BA数目,测量其内径及病变区域邻近胸膜厚度。根据NBSC发现情况,资料分别归入NBSC组和无NBSC组作统计学分析。结果NBSC参与供血36例,BA内径平均值为(1.850±0.631)mm,其中病灶附近胸膜增厚22例(61%),厚度为2.7～16.0mm,平均(7.71±4.12)mm;无NBSC供血88例,BA内径的平均值为(2.200±0.528)mm,病灶附近胸膜增厚7例(8%),厚度为1.1～2.4mm,平均(1.7±0.53)mm,两组间BA平均值和伴有胸膜增厚差异均有统计学意义(P值均<0.05)。结论NBSC能分流支气管动脉向咯血病变的供血,成为咯血的主要供血来源。显著的胸膜增厚是产生NBSC供血的重要原因。

Objective To investigate the significance of non-bronchial systemic collaterals （NBSCs） in supplying bronchial hemoptysic lesions, and to study the morphological features of bronchial artery （BA） when NBSCs beenme the predominant supplying vessels. Methods Multi-slice helical CT angiographic findings in 124 patients with bronchial hemoptysis were retrospectively analyzed. 3D reconstruction of thoracic systemic arteries, including BAs and NBSCs, was performed at the console work station with the help of real- time thin-slice enhanced helical CT scanning. The number of NBSCs and BAs was calculated, and the internal diameter of the arteries and the thickness of pleura in the vicinity of the pulmonary lesion were measured. According to the presence or absence of NBSCs, the patients were divided into NBSCs group and non- NBSCs group. The relevant data was statistically analyzed. Results NBSCs group included 36 cases, the mean internal diameter of BA was （1.850 ± 0.631 ）mm and the pleura adjacent to the pulmonary lesion was obviously thickened in 22 cases （61%） with a thickness of 2.7-16.0 mm [mean（7.71 ± 4.12） mm]. In the non- NBSCs group in = 88）, the mean internal diameter of BA was （2.200 ± 0.528） mm and the pleura adjacent to the pulmonary lesion was obviously thickened in 7 cases （8%） with a thickness of 1.1-2.4 mm [mean（l.7±0.53） mm]. The differences in both internal diameter of BA and the thickness of lesion＇s adjacent pleura between two groups were statistically significant （P 〈 0.05）. Conclusion NBSCs can become the predominant arteries to supply the hemoptysic lesions, with the decreasing of BA blood flow. The development of NBSCs is the main cause of noticeable pleural thickening.