Preoperative diagnosis and operative effect of intracranial aneurysm with three-dimensional computed tomography angiography

BACKGROUND ： Digital subtraction angiography （DSA） is always regarded as the golden standard for diagnosis of intracranial aneurysm; however, the procedure is complex, traumatic, expensive and easy to induce vascular complication. Three-dimensional computed tomography angiography （3D-CTA） can make up deficiencies of DSA; therefore, it is used in clinical therapy wider and wider. OBJECTIVE ： To evaluate the clinical effect of 3D-CTA on disruption and hemorrhage of intracranial aneurysm pre- and post-operation and compare with the effect of DSA. DESIGN ： Auto-control contrast observation SETTING ： Department of Neurosurgery, Shengjing Hospital of China Medical University PARTICIPANTS ： A number of 106 patients with disruption and hemorrhage of intracranial aneurysm were selected from the Department of Neurosurgery, Shengjing Hospital of China Medical University from January 2003 to April 2006. All patients were diagnosed with cranial operation and consent. There were 47 males and 59 females aged from 3-76 years with the mean age of （47±13） years. Among them, 82 patients had extensive subarachnoid hemorrhage （SAH）, 7 had hemorrhage at longitudinal fissure, and 17 had hemorrhage at ambiens cistema and lateral fissure. Moreover, intraventricular hematocele was accompanied on 13 patients and hematom on 9 patients. METHODS： （1） 3D-CTA examination： Siemens SOMATOM Sensation 64 CT was used in this study. The thickness was 1 mm and interval of reconstruction was 0.8 mm. Localizing section was plainly scanned as the standard of canthus line. Scan ranged from 30 mm below sella to 50 mm above sella. Non-ion contrast medium of Omnipaque 350 （concentration of iodine was 350 g/L） was inserted into anterior vein of elbow with 18G trochar retained with high-pressured injectoc pum. The speed was 4.5 mL/s and the total volume was 80-100 mL with the means of 90 mL. Scan started at 10-20 s after injection of contrast medium. Original image was dealt with Leonardo workstation and retreated with Syngo software. Volume rendering and maximum intensity projection were used to reconstructed images, （2） All 106 patients suffered from occlusion of aneurysm clamp. Before operation, 3D-CTA was undertaken and DSA was followed. After operation, patients were rechecked with 3D-CTA. MAIN OUTCOME MEASURES： Comparisons between 3D-CTA and DSA. RESULTS ： All 106 patients were involved in the final analysis. （1） Examination of 3D-CTA and DSA： Among 118 patients with aneurysm, 110 were checked with 3D-CTA and the detected rate was 93.2% （110/118）. Among other 8 cases, 3 were negative and checked again with DSA; 1 had pericallosal aneurysm, 1 ophthalmic aneurysm, and 1 anterior choroidal artery of aneurysm. 3D-CTA results of other 5 cases were suspicious, and then, they were regarded as having aneurysm with DSA. Before operation, correlation among site, body, neck of aneurysm and peripheral anatomic structure were shown sufficiently. After operation, 82 patients were rechecked with 3D-CTA, which was complete occlusion, precise, unobvious constriction, emphraxis or remains as compared with 3D-CTA those pre-operation. （2） Characteristics of 3D-CTA： With multiple vessels and angles, 3D-CTA observed the relationship between aneurysm neck and carried artery and showed thrombosis in cavity of aneurysm, calcification of aneurysm wall and peripheral structure of vessel at the same time. However, DSA could not detect the reactions mentioned above. It could delete image of cranium, simulate image of operative route, eliminate artifact induced by metal, but not distinguish blood stream direction. Meanwhile, posterior communicating artery was always poor during circle of Willis artery showing. CONCLUSION： （1） 3D-CTA is characterized by simple operation and non-invasive showing vascular stereo structure and correlation. Therefore, it is significant for diagnosis and designing plan of operative approach and focal location pre-operation and evaluating effect post-operation. （2） 3D-CTA does not completely replace DSA on the diagnosis of intracranial aneurysm.

Thoracoscopic segmentectomy assisted by three-dimensional computed tomography bronchography and angiography for lung cancer in a patient living with situs inversus totalis: A case report

BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera.Performing thoracoscopic segmentectomy for a patient with lung cancer and SIT is an extremely skilled and challenging surgical procedure.CASE SUMMARY A 41-year old woman with a medical history of dextrocardia since childhood was admitted to our hospital with a mixed ground-glass opacity(mGGO)in her left lung field,discovered by computed tomography during her health checkup.In order to facilitate surgical orientation,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was preoperatively carried out.The result of 3D-CTBA was consistent with the diagnosis of SIT and an mGGO in the posterior segment of the left upper lobe(LS2).Surgery was conducted in accordance with preoperative 3D-CTBA and designed surgical procedure,combined with intraoperative navigation.Final pathological examination revealed in situ adenocarcinoma.The patient’s postoperative condition was uneventful and no complications were observed.CONCLUSION We present the first case of lung cancer in a patient with SIT who successfully underwent thoracoscopic segmentectomy assisted by 3D-CTBA.This is a new technique that covers precise confirmation and dissection of targeted structures and intersegmental demarcation,and can help achieve a meticulous anatomical segmentectomy.

Three-dimensional time-of-flight magnetic resonance angiography combined with high resolution T2-weighted imaging in preoperative evaluation of microvascular decompression

BACKGROUND Neurovascular compression(NVC) is the main cause of primary trigeminal neuralgia(TN) and hemifacial spasm(HFS). Microvascular decompression(MVD) is an effective surgical method for the treatment of TN and HFS caused by NVC. The judgement of NVC is a critical step in the preoperative evaluation of MVD, which is related to the effect of MVD treatment. Magnetic resonance imaging(MRI) technology has been used to detect NVC prior to MVD for several years. Among many MRI sequences, three-dimensional time-of-flight magnetic resonance angiography(3D TOF MRA) is the most widely used. However, 3D TOF MRA has some shortcomings in detecting NVC. Therefore, 3D TOF MRA combined with high resolution T2-weighted imaging(HR T2WI) is considered to be a more effective method to detect NVC.AIM To determine the value of 3D TOF MRA combined with HR T2WI in the judgment of NVC, and thus to assess its value in the preoperative evaluation of MVD.METHODS Related studies published from inception to September 2022 based on PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Studies that investigated 3D TOF MRA combined with HR T2WI to judge NVC in patients with TN or HFS were included according to the inclusion criteria. Studies without complete data or not relevant to the research topics were excluded. The Quality Assessment of Diagnostic Accuracy Studies checklist was used to assess the quality of included studies. The publication bias of the included literature was examined by Deeks’ test. An exact binomial rendition of the bivariate mixed-effects regression model was used to synthesize data. Data analysis was performed using the MIDAS module of statistical software Stata 16.0. Two independent investigators extracted patient and study characteristics, and discrepancies were resolved by consensus. Individual and pooled sensitivities and specificities were calculated. The I_(2) statistic and Q test were used to test heterogeneity. The study was registered on the website of PROSERO(registration No. CRD42022357158).RESULTS Our search identified 595 articles, of which 12(including 855 patients) fulfilled the inclusion criteria. Bivariate analysis showed that the pooled sensitivity and specificity of 3D TOF MRA combined with HR T2WI for detecting NVC were 0.96 [95% confidence interval(CI): 0.92-0.98] and 0.92(95%CI: 0.74-0.98), respectively. The pooled positive likelihood ratio was 12.4(95%CI: 3.2-47.8), pooled negative likelihood ratio was 0.04(95%CI: 0.02-0.09), and pooled diagnostic odds ratio was 283(95%CI: 50-1620). The area under the receiver operating characteristic curve was 0.98(95%CI: 0.97-0.99). The studies showed no substantial heterogeneity(I2 = 0, Q = 0.001 P = 0.50).CONCLUSION Our results suggest that 3D TOF MRA combined with HR T2WI has excellent sensitivity and specificity for judging NVC in patients with TN or HFS. This method can be used as an effective tool for preoperative evaluation of MVD.

The value of three-dimensional computed tomographic angiography in the early diagnosis and treatment of spontaneous subarachnoid hemorrhage (616 cases report)

Objective To evaluate the clinical value of three dimensional computerized tomography angiography in the diagnosis and treatment of spontaneous subarachnoid hemorrhage. Methods 616 cases were diagnosed as suspected intracranial aneurysms in 3D CTA system. Computed tomographic scans and CTA studies were

Multidetector CT angiography with volumetric three-dimentional rendering to evaluate bronchial arteries in primary lung cancer

Objective:To evaluate the imageologic characteristics of the bronchial arteries (BAs) in primary lung cancer (PLC) with multidetector CT (MDCT) angiography. Methods: Thin-section enhanced CT scanning (with an Toshiba Aquilion 16 scanner) was performed in 164 PLC patients, of whom 123 were confirmed by pathology and the remaining 41 were confirmed by typical radiological and clinical findings. Another 46 patients with normal thoracic CT presentations were served as control. Three-dimensional (3D) images of the BAs were processed at workstation (Vitrea 2, Vital Corp, USA). Spatial anatomical characters of the BAs were observed using volume rendering (VR) and muhiplanar reconstruction (MPR) or maximum intensity projection (MIP). Results: At least one bronchial artery was displayed clearly on VR in 152 (92. 7%) of the 164 PLC patients and 32 (69. 6%) of the 46 controls. There were 48. 92% of the right BAs originating from the descending aorta and 46. 24% from the right intercostal artery. 97. 53% of the left BAs originated from the descending aorta, and 94. 87% of the common trunk from the descending aorta. There were 10 distribution patterns of the BAs, with one on the right and one on the left predominating (48. 68%). More BA branches were found to reach far from the segmental bronchi or enter into the lesions in the PLC group than those in the control group (25. 8% vs 1. 7% ). and also the ipsilateral side of the PLC than the contralateral side (40% vs 8. 8%). The diameter and the total transaxial areas of the BAs on the ipsilateral side of the PLC lesions were significantly larger than those on the contralateral side or those of the control group (P<0. 05). Conclusion:The anatomic characters and pathologic changes can be depicted in vivo stereographically and clearly by CTA with volumetric 3D rendering. Dilation of the BAs and increase of total blood flow in patients with PLC can be evaluated quantitatively, which may be useful in the diagnosis and assessment of PLC, and have the potential to increase the-safety and effect of interventional therapy.

Thoracoscopic segmentectomy and lobectomy assisted by threedimensional computed-tomography bronchography and angiography for the treatment of primary lung cancer

BACKGROUND Anatomical segmentectomy has been proposed as a substitution for lobectomy for early-stage lung cancer.However,it requires technical meticulousness due to the complex anatomical variations of segmental vessels and bronchi.AIM To assess the safety and feasibility of three-dimensional computed-tomography bronchography and angiography(3D-CTBA)in performing video-assisted thoracoscopic surgery(VATS)for lung cancers.METHODS In this study,we enrolled 123 patients who consented to undergo thoracoscopic segmentectomy and lobectomy assisted by 3D-CTBA between May 2017 and June 2019.The image data of enhanced computed tomography(CT)scans was reconstructed three-dimensionally by the Mimics software.The results of preoperative 3D-CTBA,in combination with intraoperative navigation,guided the surgery.RESULTS A total of 59 women and 64 men were enrolled,of whom 57(46.3%)underwent segmentectomy and 66(53.7%)underwent lobectomy.The majority of tumor appearance on CT was part-solid ground-glass nodule(pGGN;55.3%).The mean duration of chest tube placement was 3.5±1.6 d,and the average length of postoperative hospital stay was 6.8±1.8 d.Surgical complications included one case of pneumonia and four cases of prolonged air leak lasting>5 d.Notably,there was no intraoperative massive hemorrhage,postoperative intensive-care unit stay,or 30-d mortality.Preoperative 3D-CTBA images can display clearly and vividly the targeted structure and the variations of vessels and bronchi.To reduce the risk of locoregional recurrence,the application of 3D-CTBA with a virtual 3D surgical margin help the VATS surgeon determine accurate distances and positional relations among the tumor,bronchial trees,and the intersegmental vessels.Three-dimensional navigation was performed to confirm the segmental structure,precisely cut off the targeted segment,and avoid intersegmental veins injury.CONCLUSION VATS and 3D-CTBA worked in harmony in our study.This combination also provided a new pattern of transition from lesion-directed location of tumors to computer-aided surgery for the management of early lung cancer.

Cerebral blood flow volume measurements of the carotid artery and ipsilateral branches using two-dimensional phase-contrast magnetic resonance angiography

The optimal velocity encoding of phase-contrast magnetic resonance angiography （PC MRA） in measuring cerebral blood flow volume （BFV） ranges from 60 to 80 cm/s. To verify the accuracy of two-dimensional （2D） PC MRA, the present study localized the region of interest at blood vessels of the neck using PC MRA based on three-dimensional time-of-flight sequences, and the velocity encoding was set to 80 cm/s. Results of the measurements showed that the error rate was 7.0±6.0% in the estimation of BFV in the internal carotid artery, the external carotid artery and the ipsilateral common carotid artery. There was no significant difference, and a significant correlation in BFV between internal carotid artery ＋ external carotid artery and ipsilateral common carotid artery. In addition, the BFV of the common carotid artery was correlated with that of the ipsilateral internal carotid artery. The main error was attributed to the external carotid artery and its branches. Therefore, after selecting the appropriate scanning parameters and protocols, 2D PC MRA is more accurate in the determination of BFV in the carotid arteries.

Multislice spiral CT angiography in evaluation of liver transplantation candidates

BACKGROUND: Orthotopic liver transplantation has be- come the treatment of choice for patients with end-stage liver disease. This study was designed to study whether multislice spiral CT angiography (MSCTA) could be used for preoperative evaluation for orthotopic liver transplanta- tion candidates. METHODS: Eighty consecutive potential candidates for liver transplantation were evaluated with dual-phase three-di- mensional CT angiography (3DCTA). The arterial-phase was used to create vascular maps of the celiac axis (inclu- ding the origin of the hepatic common artery, left gastric artery and splenic artery) and origin of the superior mesen- teric artery. The portal venous-phase was used to analyze portal vein thrombosis and collateral vascularization of the portal vein. Statistical analyses were made using the chi- square test for differences between hepatic arterial anatomy of 80 patients and Michel's anatomy of 200 patients. Appearance of MSCTA and operative results of 16 patients were analyzed. RESULTS; Sixty-two patients (77.5%) showed conven- tional and 18 (22.5%) nonconventional hepatic arterial anatomy. A significant difference was found between the two groups in anatomy of the hepatic artery (P <0.05). Celiac axis stenosis was observed in 6 patients, SA aneu- rysm in 2, small-caliber hepatic arterial vessels in 2, and portal vein thrombosis in 15. Vascular structures of 16 ope- rative patients were well defined. CONCLUSION: As a noninvasive examination, MSCTA can provide a comprehensive preoperative vascular evalua- tion for liver transplantation candidates.

3D-CTBA联合3D打印技术在肺癌胸腔镜肺段切除术中的应用价值

目的:探究三维计算机断层扫描支气管血管成像(3D-CTBA)联合3D打印技术在肺癌胸腔镜肺段切除术中的临床应用效果。方法:选取接受胸腔镜肺段切除术的肺癌患者90例,采用随机双色球法分为试验组(45例)和对照组(45例)。对照组患者在术前接受薄层CT增强扫描,试验组在对照组的基础上加用3D-CTBA联合3D打印技术。比较两组患者手术中转率、肺叶转换率、围手术期指标(手术时间、术中出血量、术后引流量),以及术前和术后第15天肺功能指标[用力肺活量(FVC)、肺一氧化碳弥散因子(TLCO)、每分钟最大通气量(MVV)];统计两组患者术后1个月并发症发生情况。结果:试验组手术中转率、肺叶转换率显著低于对照组(均P<0.05);试验组手术时间、术中出血量、术后引流量显著低于对照组(均P<0.05)。术后第15天,两组患者FVC、TLCO、MVV水平低于术前,且试验组高于对照组(均P<0.05)。术后1个月内,试验组并发症总发生率低于对照组(P<0.05)。结论:在肺癌胸腔镜肺段切除术前应用3D-CTBA联合3D打印技术可对病灶位置进行定位,有效提升临床手术精准度和安全性,降低手术对患者的不良影响,有利于患者术后恢复。

3D-CTBA联合3D打印在老年早期NSCLC胸腔镜肺段切除术中的应用效果及安全性

目的探究三维计算机断层扫描支气管血管成像(3D-CTBA)联合3D打印在老年早期非小细胞肺癌(NSCLC)胸腔镜肺段切除术中的应用效果及安全性。方法选取2020年6月至2023年1月期间本院收治的70例老年早期NSCLC患者,对患者均行胸腔镜肺段切除术,按照随机数字表法将其分为3D-CTBA组(35例)及联合组(35例)。3D-CTBA组术前进行胸部CT增强扫描,并进行3D-CTBA,联合组在3D-CTBA组的基础上进行3D打印。检测并比较两组患者肺功能指标,统计并比较两组术中及术后相关指标,包括切缘距离、术中出血量及手术时间,术后引流量、术后置管时间及住院时间,观察两组患者术后并发症情况。结果与术前相比,两组患者术后肺活量(FVC)、第一秒用力呼气容积(FEV1)及每分钟最大通气量(MVV)水平均降低(P<0.05);与3D-CTBA组相比,联合组患者术后FVC、FEV1及MVV水平升高(P<0.05);与3D-CTBA组相比,联合组患者术切缘距离更大,术中出血量减少,手术时间缩短(P<0.05);与3D-CTBA组相比,联合组患者术后引流量减少,术后置管时间及住院时间缩短(P<0.05);3D-CTBA组、联合组并发症发生率分别为11.43%、8.57%,二者比较差异无统计学意义(P>0.05)。结论3D-CTBA联合3D打印用于老年早期NSCLC胸腔镜肺段切除术,能够降低手术操作对肺功能的影响,缩短手术时间,减少术中出血,同时能够有效控制切缘距离,减少术后并发症的发生,有利于患者康复。

基于非线性融合技术肺支气管血管成像在肺结节术前定位的应用

目的 评价双能量CT非线性融合技术在肺支气管血管成像中的运用,并探讨该技术在肺结节患者术前定位的临床应用。方法 选择2020年4月至2022年3月在扬州大学附属医院行双能量肺静脉成像并拟行肺结节切除的患者115例,其中男性55例,女性60例;年龄24~81岁,平均年龄61.3岁;病灶直径0.4~2.4 cm,平均直径1.19 cm;病程1天~2年,平均病程2.5个月。所有患者双能量扫描获得80 kV(A组)、(Sn)150 kV(B组)、线性融合M-0.6(C组)和非线性融合(D组)4组图像。计算肺静脉干信噪比(SNR)、对比噪声比(CNR)、右肺上叶静脉与右肺中叶动脉平均CT值差值。将最佳组数据导入Mimics软件进行三维肺支气管血管成像,进行图像等级评分。结果 经一致性分析,4组图像肺静脉干的组内相关系数(ICC)分别为0.991、0.987、0.985、0.994,竖脊肌的ICC分别为0.877、0.885、0.887、0.895。D组图像的SNR和CNR最高,SNR为167.1±22.9、CNR为150.1±21.2。D组与其他3组SNR和CNR比较,差异有统计学意义(P <0.05)。D组图像肺静脉与动脉差值(328.5±98.9)最高,A组与D组图像差异无统计学意义(P> 0.05),B组、C组与D组图像差异有统计学意义(P <0.05)。用最佳组D组进行三维肺支气管血管成像,111例图像评为优,3例为良,1例为差。结论 用非线性融合技术进行肺静脉图像重建,图像SNR和CNR更高,且肺静脉与动脉差值最大,更容易重建出高质量的肺支气管血管图像,更利于观察肺支气管血管是否存在变异及血管与病灶的三维关系,为胸外科医生手术方案的制定提供重要的理论依据。

三维CT支气管血管成像模拟对单孔胸腔镜肺癌根治术淋巴结清扫数量及患者肺功能的影响

目的观察三维CT支气管血管成像模拟对单孔胸腔镜肺癌根治术淋巴结清扫数量及患者肺功能的影响。方法回顾性分析150例非小细胞肺癌患者资料,所有患者均接受单孔胸腔镜肺癌根治术治疗,根据术前规划方法不同分为观察组(77例)和对照组(73例),其中对照组术前接受常规CT扫描,观察组在此基础上接受三维CT支气管血管成像模拟。比较两组患者手术情况(手术时间、术中出血量、切缘宽度、淋巴结清扫数量、引流量、胸腔引流管放置时间、首次下床活动时间、住院时间)、术后疼痛[视觉模拟评分法(VAS)]、肺功能[最大自主通气量(MVV)、1秒用力呼气容积(FEV1)/用力肺活量(FVC)]、免疫功能(CD3^(+)、CD4^(+)/CD8^(+))、围手术期并发症、术后6个月内复发率。结果观察组术中出血量、引流量、胸腔引流管放置时间、首次下床活动时间、住院时间均优于对照组,术后1、2、3 d的VAS得分、术后3 d的CD3^(+)、CD4^(+)/CD8^(+)水平、围手术期并发症总发生率低于对照组,淋巴结清扫数、切缘宽度、术后1个月的MVV、FEV1/FVC大于对照组,差异有统计学意义(P<0.05);两组手术时间比较差异无统计学意义(P>0.05);术后随访6个月,两组均无患者复发转移。结论应用三维CT支气管血管成像模拟有助于减少单孔胸腔镜肺癌根治术的手术创伤,降低术后并发症风险,对维持肺功能及免疫功能有利,可有效缩短肺癌患者康复时间。

支气管动脉CT血管成像在咯血患者介入治疗中的应用价值

目的分析支气管动脉(BA)CT血管成像(CTA)在咯血患者介入治疗中的应用价值。方法选取2021年1月至12月于九江学院附属医院治疗的84例咯血患者作为研究对象,依据术前是否行CTA检查分为两组,将术前行CTA检查的42例患者纳入观察组,将术前未行CTA检查的42例患者纳入对照组。两组均采用支气管动脉栓塞术(BAE)治疗,观察组于介入治疗前行CTA检查,对照组介入治疗前未行CTA检查。分析CTA咯血责任BA检出情况,比较两组手术及曝光时间、对比剂用量、止血效果、再发咯血、并发症及死亡情况。结果观察组42例患者中CTA共检出咯血责任BA有78支,数字减影血管造影(DSA)共检出咯血责任BA有81支,CTA咯血责任BA检出率为96.30%(78/81);观察组手术及曝光时间均短于对照组,对比剂用量少于对照组,差异有统计学意义(P<0.05);观察组再发咯血率低于对照组,差异有统计学意义(P<0.05);两组止血成功率、死亡率比较,差异无统计学意义(P>0.05);两组均未出现脊髓损伤、食管溃疡等并发症。结论BA CTA对咯血责任动脉检出率较高,BA CTA用于咯血患者介入治疗中有利于缩短手术时间及曝光时间,减少对比剂用量,降低术后再出血率。

支气管动脉栓塞术治疗支气管扩张大咯血失败原因之一:膈下动脉参与供血

目的观察膈下动脉(IPA)参与支气管扩张所致咯血供血的表现,评价经导管栓塞IPA的安全性和疗效。方法5年期间用经导管支气管动脉栓塞术(BAE)治疗支气管扩张所致大咯血62例,10例经选择性血管造影证实有IPA参与病变供血。对参与肺部病变供血的IPA进行选择性栓塞术,栓塞剂用明胶海绵颗粒8例、明胶海绵颗粒+微型钢丝圈2例。分析观察IPA参与肺部供血的表现、影响因素,评价栓塞IPA的安全性和临床意义。结果选择性IPA造影均显示IPA管径增粗、分支增多、紊乱和不同程度的新生血管,IPA供血区对比剂外溢4例、非特异性片状对比剂染色6例,IPA与肺动脉异常交通或分流者8例。10例患者病灶与胸膜关系密切:病变贴近膈胸膜和纵隔胸膜者6例、纵隔胸膜为主者4例。对10例患者均行供血IPA栓塞术,同时栓塞胸廓内动脉4例、肋间动脉2例,术后咯血停止。随访8个月～3年,2例分别于术后2、3个月复发少量咯血,经保守治疗后停止。8例未再咯血。结论IPA可参与支气管扩张症所致大咯血的供血,是造成BAE治疗咯血失败的原因之一。如发现IPA参与肺部病变供血,补充IPA栓塞术是安全和有价值的。

支气管动脉CTA在大咯血介入栓塞治疗中的应用

目的探讨支气管动脉CTA在大咯血介入栓塞治疗中应用的策略及临床效果。方法 80例大咯血的患者在介入栓塞治疗前行支气管动脉CT血管造影(CTA)检查,在介入手术中寻找所有的出血动脉,并逐一进行栓塞治疗。68例患者栓塞治疗1周后复查支气管动脉CTA检查。对支气管动脉CTA在大咯血介入栓塞治疗中的应用效果进行回顾性总结评价。结果 80例大咯血的患者在介入栓塞治疗前行支气管动脉CTA检查,共找到107支病变的出血动脉,介入手术中共找到118支出血动脉并成功栓塞治疗。术前支气管动脉CTA检查诊断的准确率为90.68%(107/118)。68例患者栓塞后治疗支气管动脉CTA检查显示所有已栓塞的支气管动脉栓塞效果良好。结论介入栓塞治疗前支气管动脉CTA检查可以为支气管动脉栓塞治疗中寻找出血动脉提供准确的定位作用。栓塞治疗后行支气管动脉CTA检查有利于对栓塞疗效的准确判定。

支气管动脉64层螺旋CT影像解剖学研究

目的利用64层螺旋CT血管造影研究评价支气管动脉(BA)的影像解剖特征及其临床应用价值。资料与方法对112例行胸部增强扫描,至少1支BA清晰显示的病例,采用容积再现(VR)、多平面重组(MPR)及最大密度投影(MIP)等后处理技术,观察和分析BA的相关解剖学特征。结果112例中,BA清晰显示280支,其中右侧158支,左侧122支;BA的分支类型共9种,较为常见的是左右各1支(41.07%,46/112)、右2支左1支(24.11%,27/112)两种类型;右BA主要起源于右肋间后动脉(52.53%,83/158)和降主动脉(38.61%,61/158),左BA主要起源于降主动脉(88.52%,108/122),异位起源的BA共20支(7.14%),同时还有相当数量的BA共干(24.29%,68/280)。源自降主动脉的右BA以右侧壁和前壁最多,源自降主动脉的左BA和共干均以前壁最多。BA开口主要平对T5～T6水平,以降主动脉血流方向为顺行方向,降主动脉段BA与降主动脉间平均逆行角度右侧为98.70°,左侧为105.12°。BA沿左右主支气管走行方式多样,右BA源自右肋间后动脉者,大多沿右主支气管后壁走行(45/83,54.22%)或同时行经右主支气管的后壁及下壁(25/83,30.12%);右BA源自降主动脉者,大多越过气管隆突下方沿右主支气管下壁走行(48/61,78.69%);左BA源自降主动脉者,大多沿左主支气管上壁走行(51/108,47.22%)或同时行经左主支气管的多个壁(36/108,33.33%)。结论64层螺旋CT血管造影可以有效评价BA的影像解剖特征,为临床BA栓塞治疗咯血、BA灌注化疗或灌注栓塞治疗中晚期肺癌提供重要解剖依据。

原发性肺癌的支气管动脉CT血管造影

目的利用CT血管造影研究原发性肺癌患者的支气管动脉(BA)影像特征。资料与方法搜集原发性肺癌164例,其中有明确病理学证实123例,临床综合诊断41例。CT检查未发现任何胸部疾病的正常对照者46例。采用Aquilion16层螺旋CT胸部增强扫描获得原始图像,用容积显示(VR)、多平面重建(MPR)、最大强度投影(MIP)进行CTA重建观察和分析。结果肺癌组至少1支BA在VR中能清晰显示的有152例,显示率92.7%,平均2.3支/例;对照组BA清晰显示32例,显示率69.6%,平均2.03支/例。肺癌组25.8%的支气管动脉走行至段以下或病灶内,明显多于对照组(1.7%),且肺癌同侧走行至段以下的BA(40%)明显多于对侧(8.8%)。所有研究对象BA走行至叶支气管最多,占31%。肺癌组同侧BA管径较正常对照组BA明显增粗(P<0.05);肺癌同侧BA管径较肺癌对侧亦明显增粗(P<0.05),肺癌同侧总截面积显著大于正常对照组(P<0.05),肺癌同侧总截面积较肺癌对侧明显增加(P<0.05)。结论CTA并三维重建技术活体无创性、立体化清晰显示原发性肺癌患者支气管动脉特征,能定量分析原发性肺癌支气管动脉扩张和支气管动脉总供血量增加等病理和病理生理学特征。

64层螺旋CT支气管动脉成像观察支气管动脉三维解剖结构

目的探讨64层CTA显示支气管动脉三维解剖结构的应用价值。方法对35例肺部疾病患者进行64层CT支气管动脉成像,以VR、MIP及MPR后处理技术显示支气管动脉解剖学特征。结果 35例患者中,共63支支气管动脉获得显示,右侧39支,左侧24支;支气管动脉正常起源34例,异常起源1例;4例有肺外体循环动脉参与供血,共10支血管,1例存在异常体循环动脉供血。最常见的支气管动脉类型为R1L1型（18/35）。27例支气管动脉增粗,直径2~5 mm。结论 64层CTA支气管动脉成像可无创、直观显示支气管动脉及肺外体循环动脉的形态解剖学特征。

体-肺循环分流与大咯血(附62例报告)

目的探讨体-肺循环分流(BPS)与大咯血的相关性及其介入干预。方法1999年4月～2006年7月咯血患者62例。其中,男39例,女23例;年龄26～84岁。咯血量300～2500mL/24h。回顾相关支气管体动脉造影,观察其形态学和血流动力学改变。综合影像学和临床资料,分析BPS与大咯血的关系;原发病、胸膜增厚与BPS的关系;BPS与咯血复发的关系;以及BPS的介入治疗。所有数据经χ2分析处理。结果BPS与大咯血关系密切;BPS与支气管扩张、显著的胸膜增厚等相关;BPS是不明原因咯血的主要因素;栓塞优势供血动脉后,BPS可诱使非优势动脉甚至隐匿侧支开放。结论BPS是大咯血的重要因素,也是栓塞后复发咯血的重要原因。BPS常伴随于各种原因引起的支气管扩张和严重胸膜增厚。彻底栓塞BPS及其供血动脉是预防咯血复发的关键。

右肋间支气管动脉CT血管造影解剖分析

目的:利用16层CT血管造影(CTA)研究评价肋间支气管动脉(ICBA)三维影像解剖学特征.材料和方法:CTA清晰显示右支气管动脉(BA)的399例胸部扫描病例,采用16层螺旋CT增强扫描获得原始图像,用容积显示(VR)、最大强度投影(MIP)进行三维重建,观察和分析右侧肋间后动脉与右支气管动脉、右侧支气管动脉开口位置与椎骨的对应关系.结果:254例(63.66%)右BA源自肋间后动脉,其中243例为最粗或唯一的右BA.ICBA主要起自第3及第4肋间后动脉(87.40%).全部的右肋间动脉-BA干均发自降主动脉右侧壁,绝大多数为降主动脉上第1支肋间后动脉.所有ICBA开口对应于T3～T6椎骨范围,向右未超过肋骨小头,63.0%的ICBA开口在椎体正前方.结论:右BA多数起源于右肋间后动脉,开口位置大多在椎体正前方,16层CT血管造影可较好评价ICBA影像解剖学特征.