多层螺旋CT增强扫描联合CTA血管重建技术在肺叶内型肺隔离症诊断中的应用价值

Use of multislice contrast-enhanced scanning combined with CTA revascularization for diagnosis of intralobar lung sequestration

目的探讨多层螺旋CT增强扫描联合CTA血管重建技术在肺叶内型肺隔离症诊断中的应用价值。方法选取河南科技大学附属许昌市中心医院收治的20例肺隔离症患者作为研究对象,使用多层螺旋CT增强动静脉的双期扫描,并结合CTA血管重建,对病变特征、供血动脉、异常引流静脉全貌进行分析,评价多层螺旋CT增强扫描联合CTA血管重建技术在肺叶内型肺隔离症诊断价值。结果隔离肺组织位置:左肺下叶后基底段有10例,左肺下叶前内基底段5例、右肺下叶内基底段3例、右肺下叶后基底段2例;特征:囊实性混合病变9例,囊性5例,实性肿块4例,局部肺血管纹路变粗紊乱、无肺实质病变2例;有12例边界清楚;4例有胸腔积液;2例有支气管扩张和肺气肿改变;增强扫描病灶实性部分表现为不均匀延迟强化,17例有粗大迂曲血管穿行,3例对异常血管起源、行程、分支情况显示不清。经CTA血管重建能直观显示出异常供血体动脉,长度3~14cm,单支动脉13例,多支动脉7例,管径不一,单支为0.6~1.5cm,多支为0.3cm;起源胸主动脉直接入隔离肺组织11例,起源腹主动脉6例,起源腹腔干3例,穿横膈入下肺基底段病灶再分支;经数字减影血管造影显示的异常供血动脉同CTA重建显示的大致一致,仅有1例不同。10例异常引流静脉汇进左肺下叶静脉,经变粗的下肺静脉引流进入左心房。结论多层螺旋CT增强扫描联合CTA血管重建技术在肺叶内型肺隔离症诊断中的应用价值良好,能清晰显示出隔离肺位置、大小、形态、供血动脉、异常引流静脉全貌,提高确诊率,为手术治疗和术中出血预防提供可靠的影像依据。

【Objective】To investigate the use of multislice contrast-enhanced CT scanning combined with CTA revascularization technology in the diagnosis of lobar intralobar pulmonary sequestration.【Methods】Twenty patients with pulmonary sequestration treated in our hospital were selected for the study,and the complete picture of the lesion characteristics,feeding arteries,and abnormal draining veins were analyzed using dual phase scan of arterial and venous enhancement with multislice CT in combination with CTA revascularization.The diagnostic value of multislice CT enhanced scan combined with CTA revascularization technique for intralobar pulmonary sequestration was evaluated.【Results】The locations of the isolated lung tissues were as follows:there were 10 cases in the posterior basal segment of the lower lobe of the left lung,5 cases in the anterior inner basal segment of the lower lobe of the left lung,3 cases in the basal segment of the inner basal segment of the lower lobe of the right lung,and 2 cases in the posterior basal segment of the lower lobe of the right lung.Characteristics:mixed cystic solid lesions(9 patients),cystic solid masses(5 patients),solid masses(4 patients),coarsening disorder of local pulmonary vascular striae and no pulmonary parenchymal lesions(2 patients);in 12 cases,the borders were clear;4 patients had pleural effusion;2 cases had bronchiectasis and emphysematous changes;the solid portion of the lesion on contrast-enhanced scans showed heterogeneous delayed enhancement,17 had coarse and tortuous vessel traversals,and 3 showed unclear information about the origin,course,and branching of abnormal vessels.Revascularization by CTA visualized the anomalous donor artery,which measured 3 to 14 cm in length,13 in single and 7 in multiple arteries,with variable caliber,ranging from 0.6 to 1.5 cm in single and 0.3 cm in multiple vessels.The thoracic aorta of origin was directly into the isolated lung tissue in 11 cases,the abdominal aorta of origin in 6 cases,the celiac trunk of origin in 3 cases,and the lesion rebranched by penetrating the diaphragm into the basal segment of the lower lung.The abnormal feeding artery visualized by digital subtraction angiography with same CTA reconstruction was grossly concordant,differing in only 1 case.Ten patients with abnormal drainage veins into the left lower lobe veins,through coarsening of the lower lobe veins drainage into the left atrium.【Conclusion】The use of multislice contrast-enhanced CT scanning combined with CTA revascularization in the diagnosis of lobar intralobar pulmonary sequestration is excellent,which clearly shows the complete picture of the isolated lung location,size,morphology,feeding arteries,abnormal draining veins,and improves the diagnosis rate,thus providing a reliable imaging basis for surgical treatment and intraoperative hemorrhage prevention.