MSCTA VR融合图像冠状坐标定位在支气管动脉介入插管中的价值

The Value of MSCTA VR Merging images as coronal localization for the Interventional therapy of Lung Cancer Using the Bronchial Arteries Intubation

目的探讨多层螺旋CT容积重组(VR)融合图像对支气管动脉开口冠状坐标定位在肺癌介入插管中的临床价值。资料与方法实验组选择26例肺癌经导管化疗的患者,术前行支气管动脉CTA检查,采用冠状坐标定位VR融合技术分别重组VR像,将动脉(含支气管动脉和主动脉)、肺癌肿块、气管、胸廓图像融合,获得一个三维的融合像,以气管分叉下缘为圆点建立坐标系,对支气管动脉开口进行冠状三维坐标定位,在介入术中根据开口定位结果进行插管;对照组选择19例未行支气管动脉开口定位的病例。两组病例从插管时间、对比剂用量、支气管动脉插管成功率进行对比分析。结果实验组通过VR融合图像进行支气管动脉开口定位,术中插管迅速,插管成功率100%,插管平均时间为(2.15±1.05)min,对比剂平均用量为(31.54±15.15)ml,多支供血者均分别进行灌注治疗;对照组插管平均时间为(20.74±8.09)min,对比剂平均用量为(80.00±13.33)ml,其插管平均时间明显延长,对比剂平均用量明显加大,插管成功率96%。将两组数据进行比较,差异有统计学意义(t值分别为9.95、11.36,P值均<0.01)。结论VR融合图像及其冠状坐标定位能直观显示支气管动脉的解剖特征,准确定位其开口位置,明显提高介入术中支气管动脉插管成功率,缩短照射时间,减少对比剂用量,提高治疗效果。

Objective To explore the clinical value of MSCT VR merging images as coronary localization coordinates for lung cancer interventional trearnent. Materials and Methods 26 cases selected as lung cancer group performed chemotherapy through bronchial artery catheters. Pre-operative CTA examination was performed. Reconstructed three dimensional VR images included bronchial artery, aorta,lung tumor, trachea and thorax. Coronary localization coordinate was established at the lower edge of tracheal bifurcation, which guided the bronchial arteries intubation. 19 cases selected as control group performed bronchial arteries intubation without guided by localization coordinate. Intubation time, the amount of contrast agents, the successful rate of bronchial artery intubation were compared in these two groups. Results In lung cancer group guided by VR merging images, the intubation successful rate was 100%, the average time for intubation was （ 2.15 ± 1.05 ） min, the average amount of contrast agent was （31.54 ± 15.15 ） ml. In the control group, the intubation successful rate was 96% , the average intubation time was （ 20.74 ± 8.09 ） rain, the average amount of contrast agent was （ 80.00 ± 13.33 ） ml. There were significant differences （ t = 9.95,11.36 ,P value 〈 0. 01 ） of these parameters between two groups. Conclusion VR images and the location coordinates are usful to disply the anatomical features of bronchial artery, to localize the intubation position, to improved the successful rate of bronchial artery intubation, to shorten the exposure time, to reduce the amount of contrast media, and to improve the effectiveness of treatment.