多层螺旋CT支气管动脉成像与肺癌的相关研究

Multi-slice Spiral CT Imaging of Bronchial Arteries in Patients with Lung Cancer

目的通过多排螺旋CT扫描检测支气管动脉(BA)的走形、特征及变异,观察分析BA与肺良、恶性病变的关系及肺癌的供血特点。方法将119例患者按疾病的不同分为4组:正常组(16例)、慢性感染组(21例)、肺结核组(20例)和肺癌组(62例)。肺癌组根据病理及其在肺内的位置又分为4个亚组(1例肝癌肺转移除外):左侧中央型肺癌组(16例)、右侧中央型肺癌组(28例)、左侧周围型肺癌组(7例)及右侧周围型肺癌组(10例)。均使用GE Bright speed 16层CT增强扫描,通过GE Avantage Workstation 4.4后处理工作站对薄层图像进行观察和后处理。对各组BA直径进行组内和组间的统计学分析,对患侧BA直径与肺部肿块的直径进行Personl和Spearmen相关性分析。结果 119例患者中BA为左1支右1支101例(84.9%),左1支右2支8例(6.7%),左2支右1支9例(7.5%),左3支右1支1例(0.8%)。左侧共检出支气管动脉130支,右侧共检出支气管动脉127支。正常组、慢性感染组及肺结核组两侧BA直径比较差异均无统计学意义(均P>0.05);左、右侧中央型肺癌组及右侧周围型肺癌组患侧BA直径大于对侧BA直径,差异均有统计学意义(均P<0.05);左侧周围型肺癌组两侧BA直径比较差异无统计学意义(P>0.05)。左侧中央型肺癌组、左侧周围型肺癌组肺癌侧BA直径均大于正常组左侧BA直径(均P<0.01)。右侧中央型肺癌组、右侧周围型肺癌组肺癌侧BA直径均大于正常组右侧BA直径(均P<0.01)。Personl和Spearman相关性分析结果示:中央型肺癌组患侧BA直径与肿块直径呈正相关(r=0.342,P<0.05),周围型肺癌患侧BA直径与肿块直径无相关性(r=-0.026,P>0.05)。结论 MSCT支气管动脉成像安全、无创、快速,通过后处理技术可较好地显示BA,能较好地观察肺内疾病的血供来源,为肺癌的临床及影像诊断提供依据。BA参与了中央型肺癌的血供,周围型肺癌血供存在多重性。

Objective To observe the morphology, characteristics and variability of bronchial arteries with multi-slice spiral CT, and to analyze the relationships of bronchial arteries to benign and malignant lung lesions and the blood supply of lung cancer： Methods A total of 119 patients were divided into four groups ： normal group （n = 16）,chronic infection group （n =21）, pulmonary tuberculosis group（n=20） and lung cancer group（n=62）. Patients in lung cancer group were further divided into four subgroups （except 1 patient with pulmonary metastasis from liver cancer） ：left central-type lung cancer group（n=16）,right central-type lung cancer group （n=28）, left peripheral-type lung cancer group （n=7） and right peripheral-type lung cancer group（n=10）.All patients underwent GE Bright speed 16-slice CT scan. The images were observed and post-processed with GE Avantage Workstation 4.4 image processing workstation. Pearson and Spearman pulmonary mass diameter were analyzed. Results right bronchial artery were found in 101（84.9%）, correlations between bronchial artery diameter and Among the 119 patients, 1 left bronchial artery and 1 1 left bronchial artery and 2 right bronchial arteries in 8 （6.7%）,2 left bronchial arteries and 1 right bronchial artery in 9 （7.5%）, and 3 left bronchial arteries and 1 right bronchial artery in 1（0.8%）.A total of 130 bronchial arteries were found on the left and 127 on the right~ There were no significant differences in bronchial artery diameter between the left and right sides in normal group,chronic infection group,pulmonary tuberculosis group and left peripheral- type lung cancer group（P〉O.05）.The bronchial artery diameter on the ipsilateral side was significantly greater than that on the contralateral side in left central-type lung cancer group, right central-type lung cancer group and right peripheral-type lung cancer group （P〈0.05）. The ipsilateral bronchial artery diameter in left central-type lung cancer group or left peripheral-type lung cancer group was significantly greater than the left bronchial artery diameter in normal group（P〈0.01）. The ipsilateral bronchial artery diameter in right central-type lung cancer group or left peripheral-type lung cancer group was significantly greater than the fight bronchial artery diameter in normal group（P〈0.01）. Pearson and Spearman correlations showed that the ipsilate correlated with the primary tumor diameter in patients with ral bronchial artery diameter was positively central-type lung cancer （r=0.342,P〈0.05）, but was not correlated with the primary tumor diameter in patients with peripheral-type lung cancer （r=-0.026,P〉0.05）.Conchmion Multi-slice spiral CT imaging and post-processing techniques allow safe, non-invasive and fast assessment of bronchial arteries and the source of blood supply,and provide the evidence for the clinical and imaging diagnosis of lung cancer. Bronchial arteries are involved in the blood supply of central-type lung cancer. Peripheral-type lung cancer has multiple blood supply.