高流量对比剂注射速率下CTA对支气管动脉源性咯血栓塞治疗的价值

The value of multidetector CT bronchial arteriography at high contrast flow rate in assisting bronchial arteries embolization for patients with hemoptysis

目的评价高流量对比剂注射流速下320排CT血管成像(CTA)对支气管动脉栓塞(BAE)治疗咯血的术前指导价值。方法纳入95例咯血患者,通过分析支气管动脉开口位置和起源,以及血管形态学等特征来评估行栓塞治疗的可行性,并根据CTA提供的相关血管解剖路径图,行选择性血管造影,一旦证实为异常即行栓塞治疗,评估BAE术后临床成功率及技术成功率。结果在95例咯血患者中,320排CTA检测到297根支气管动脉,其中右侧155根,左侧142根,根据CTA提供的支气管动脉解剖学信息,228根支气管动脉成功进行了选择性支气管动脉造影,支气管动脉CTA与数字减影血管造影(DSA)表现为高度一致性,其中90例患者中的132根支气管动脉经DSA证实为责任血管,5例患者中因5根异常的支气管动脉未能成功插管,故未进行BAE,其余异常血管均成功栓塞。4例患者BAE术后仍有少量咯血。临床成功率为95.6%(86/90),技术成功率为96.2%(127/132)。结论高流量对比剂注射速率下,320排CTA可以清晰的显示咯血的支气管动脉的解剖学信息,可为介入治疗提供重要的参考信息,从而获得较高的成功率。

Objective To retrospectively evaluate the value of 320-row multidetector CT(MDCT)at high contrast flow rate in assisting bronchial arteries embolization(BAE)for patients with hemoptysis.Methods From April 2014 to March 2016,a total of 95 consecutive patients with hemoptysis underwent both preoperative 320-MDCT angiography at high contrast flow rate and digital subtraction angiography imaging were included in this study.Post processing with volume rendering and 3D fusion images technique were used for analyzing the anatomy of bronchial arteries,the ostium of the abnormal bronchial or and non-bronchial systemic artery arteries.BAE was then performed based on the CTA findings,technical success,clinical success recurrence of hemoptysis were accessed.Results A total of 297 BAs(155 right-sided and 142 left-sided arteries)were detected by CTA.228 of 297 BAs underwent selective angiography,with a high correlation between CTBA and conventional arteriographic findings,a total of 132 bronchial arteries in 90 patients were confirmed as abnormality and then successfully embolized.5 patients had no embolization performed subsequently,due to that no abnormal vessels was detected on bronchial artery angiography.Immediately,clinical success was achieved in 95.6%of patients(86/90).Technical success was achieved in 96.2%of patients(127/132).Conclusion 320-detector row CT angiography at high contrast flow rate is a very useful noninvasive imaging modality for initial assessment of any abnormal bronchial or and non-bronchial systemic artery arteries in patients with hemoptysis.It can precisely depict the sites of origin as well as mediastinal and hilar paths of feeding vessels that are responsible for hemoptysis,provide important anatomical information prior to therapeutic decision making.