支气管动脉CT血管成像对肺癌介入治疗的影像价值

Value of bronchial artery CT angiography in interventional therapy of lung cancer

①目的利用256层MSCT血管成像技术分步组合后处理方法评估支气管动脉(BA)的显示方法、起源以及肺癌时其内径改变,为介入治疗提供有效的影像依据。②方法回顾性分析行心电门控-支气管动脉CT成像的患者136例,选取最少1支左支气管动脉(BA)或右BA清晰显示的病例,将研究对象分为对照组(70例)和肿瘤组(66例),其中对照组分别用A组:多平面重组(MPR)+最大密度投影(MIP);B组:MPR+容积再现(VR);C组:MPR+曲面重组(CPR)3种不同后处理组合方式,选出优势组获得BA三维重建图像并将其分为6型,观察BA起源,同时比较对照组与肿瘤组的内径差异性,进行统计学分析。③结果就BA起源及大体形态的显示,A组明显高于B组及C组,差异有统计学意义(P<0.01);136例患者中,BA共显示314支,其中右侧164支,左侧150支;在BA的解剖分型及开口方位中,右BA常见于I型(80/164,48.8%),左BA多见于IV型(128/150,85.3%),I型(56/80,70%)、II型(16/40,40%)BA起源于胸主动脉右侧壁,III型(18/40,45%)BA起源于胸主动脉左前壁,IV型(50/128,39.1%)BA起源于胸主动脉前壁,V型(2/2,100%)BA起源于胸主动脉右前壁,VI型(24/314,7.6%)BA异位起源;在肺癌患者中,BA血管内径较对照组粗(P<0.01)。④结论采用MPR+MIP组合后处理的方法能较好的显示BA影像学解剖特征及大体走形;右BA常见于I型(48.8%),左BA多见于IV型(85.3%),I型(70%)、II型(40%)BA起源于胸主动脉右侧壁,III型(45%)BA起源于胸主动脉左前壁,IV型(39.1%)BA起源于胸主动脉前壁,V型(100%)BA起源于胸主动脉右前壁,VI型(7.6%)BA异位起源;就BA内径而言,肺癌患者的血管内径较对照组增粗。CTA对协助临床治疗肺癌提供重要的解剖依据。

Objective To evaluate the display method and origin of bronchial artery (BA) using the 256-slice MSCT angiography technique step-by-step combinatorial post-processing method,and to provide an effective imaging basis for interventional therapy.Methods One hundred and thirty-six patients undergoing ECG-bronchoscopic CT imaging were retrospectively analyzed.At least one patient with left or right BA was clearly selected.The subjects were divided into control group (70 cases) and tumor group (66 cases).The control group uses group A respectively:MPR + MIP;group B:MPR + volume reproduction (VR);group C:MPR + surface reorganization (CPR) 3 different post-processing combinations In the method,the dominant group was selected to obtain three-dimensional reconstruction images of BA and divided into six types.The origin of BA was observed,and the difference between the diameters of the normal group and the tumor group was compared and statistical analysis was performed.Results The results of BA origin and gross morphology were significantly higher in group A than in group B and C ( P < 0.01 ).Among 136 patients, BA showed 314 in total,of which 164 were on the right side.The left side of 150;in the BA anatomical type and opening orientation,right BA common in type I(80/164, 48.8%),left BA more common in type IV(128/150, 85.3%),type I (56 /80,70%),type II(16/40,40%) BA originated in the right side wall of the thoracic aorta,and type III(18/40,45%) BA originated in the left anterior wall of the thoracic aorta,type IV(50/128,39.1%) BA originated from the anterior wall of the thoracic aorta.Type V(2/2,100%) BA originated in the right anterior wall of the thoracic aorta,and type VI(24/314,7.6%) ectopic origin;In lung cancer patients,the diameter of BA blood vessels was larger than that of normal people( P < 0.01 ).Conclusion The combination of MPR+MIP post-processing method can better display the BA imaging anatomical features and general shape;right BA is common in type I(48.8%),left BA is more common in type IV( 85.3%),type I(70%),type II(40%)BA originate from the right side wall of the thoracic aorta,45% type III BA originate from the left anterior wall of the thoracic aorta,type IV(39.1%)type BA originate from the anterior wall of the thoracic aorta,and type V(100%) BA origin In the anterior wall of the thoracic aorta,the type VI(7.6%)ectopic origin of BA;in the case of BA internal diameter,the diameter of the blood vessel in patients with lung cancer was thicker than normal. CTA provides important anatomical basis for assisting clinical treatment of lung cancer.