Empirical description of bronchial and nonbronchial arteries with MDCT

Purpose

We aimed to retrospectively evaluate bronchial and nonbronchial systemic arteries using multi-detector row helical computed tomographic (MDCT) angiography in patients with pulmonary disorders.

Materials and Methods

Thirty-nine patients (24 men, 15 women; mean age, 63.4 years; range, 20-82 years) with congenital and acquired pulmonary disorders of the bronchial and nonbronchial systemic arteries underwent multi-detector row helical computed tomographic angiography of the thorax using a 16-detector row scanner. Each of these patients had experienced an episode of hemoptysis. Computed tomographic angiogram data, which included maximum intensity projections, multiplanar reconstruction, and three-dimensional volume-rendered images, were used to retrospectively analyse the characteristics of the bronchial and nonbronchial systemic arteries.

Results

We identified a total of 128 bronchial arteries (76 on the right side and 52 on the left) in 39 patients. We detected 42 nonbronchial systemic artery branches, including 19 internal mammary artery branches, 8 subclavian artery branches, 8 inferior phrenic artery branches, 5 intercostal artery branches, 1 thyrocervical trunk branch, and 1 celiac trunk branch. Thirty-five dilated and tortuous nonbronchial systemic arteries entered into the lung parenchyma and extended down to the lesions. Every case, except the one case of sequestration, was associated with pleural thickening where the vascular structures passed through the extrapleural fat.

Conclusions

The variations in both the bronchial artery anatomy and the location and type of the nonbronchial arteries were great. Nonbronchial arteries may be a significant source of hemoptysis. MDCT angiography can be used to detect detailed anatomical information about the origins and courses of bronchial and nonbronchial systemic arteries and their pathophysiologic features.     

Cryptogenic Hemoptysis: Effectiveness of Bronchial Artery Embolization Using N-Butyl Cyanoacrylate

Purpose

To describe angiographic findings and assess safety and effectiveness of bronchial artery embolization (BAE) with N-butyl cyanoacrylate (NBCA) in patients with cryptogenic hemoptysis (CH).

Multidetector CT chest with bronchial and pulmonary angiography determining causes,site and vascular origin of bleeding in patients with hemoptysis

Objective

To assess the role of MDCT chest with bronchial and pulmonary angiography in determining the cause, site of bleeding, and its vascular origin in patients presenting with hemoptysis.

Materials and methods

Fifty patients suffering from hemoptysis were evaluated by MDCT with bronchial and pulmonary angiographic techniques.

Results

MDCT chest with angiography revealed the cause in 84% of cases, the site and vascular origin in 76% of cases presenting with hemoptysis.

Conclusion

MDCT of the chest with bronchial and pulmonary angiography is considered a primary noninvasive imaging modality in the evaluation of patients with hemoptysis. It also serves as a guide for other diagnostic or therapeutic procedures.     

Bronchial and nonbronchial systemic arteries in patients with hemoptysis: depiction on MDCT angiography

OBJECTIVE: In this pictorial essay, we show the usefulness of MDCT angiography for visualization of the bronchial and nonbronchial systemic feeder vessels responsible for hemoptysis. CONCLUSION: By providing thin-section transaxial, multiplanar reconstruction, and 3D images, CT angiography using MDCT allows comparable or better images than conventional angiography with respect to the depiction of bronchial or nonbronchial systemic arteries. CT angiography is particularly useful for visualizing the ectopic origin of bronchial arteries and nonbronchial systemic collateral arteries.     

The Value of 320-Row Multidetector CT Bronchial Arteriography in Recurrent Hemoptysis after Failed Transcatheter Arterial Embolization

Purpose

To retrospectively assess the value of computed tomographic (CT) bronchial arteriography (BA) with 320-row multidetector CT in the management of patients with recurrent hemoptysis immediately after bronchial artery embolization (BAE).

Hemoptysis: bronchial and nonbronchial systemic arteries at 16-detector row CT

PURPOSE: To retrospectively evaluate 16-detector row computed tomography (CT) compared with conventional angiography in depiction of bronchial and nonbronchial systemic arteries in patients with hemoptysis. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was not required. Sixteen-detector row helical CT and conventional angiography of the thorax were performed in 22 patients (16 men, six women; age range, 18-75 years; mean age, 50 years) with hemoptysis. Three observers in consensus analyzed retrospectively transverse, multiplanar reconstruction, or three-dimensional CT images for visibility, traceability of bronchial arteries from their origin at the aorta or aortic branches to the hilum, and presence of nonbronchial systemic arteries. CT and angiographic findings of bronchial and nonbronchial systemic arteries causing hemoptysis were compared by two radiologists in consensus. Differences in visibility, traceability, and diameter of bronchial arteries causing and those not causing hemoptysis were tested by using generalized estimating equation method or the mixed model. RESULTS: Fifty-two (30 right and 22 left) bronchial arteries and 33 nonbronchial systemic arteries were visible at CT. Thirty-four (20 right and 14 left) of 52 bronchial arteries were traceable from their origins to the hilum. Thirty-one (16 right and 15 left) of 46 (27 right and 19 left) bronchial arteries and 26 of 64 nonbronchial systemic arteries evaluated at angiography were causing hemoptysis. Forty (87%, 23 right and 17 left) of 46 bronchial arteries seen at angiography were also detected at CT. All 31 bronchial arteries and sixteen (62%) of 26 nonbronchial systemic arteries causing hemoptysis were detected at CT. Twenty-three (74%) of 31 bronchial arteries causing hemoptysis were traceable from their origins to the hilum, and one (11%) of nine bronchial arteries not causing hemoptysis was traceable (P = .002). CONCLUSION: Sixteen-detector row CT provides depiction and traceability of the bronchial arteries in patients with hemoptysis, and in most patients it enables detection of the bronchial and nonbronchial arteries causing hemoptysis.     

咯血的多层螺旋CT血管成像诊断

目的 评价64层MSCT血管成像对咯血的诊断及指导治疗作用.方法 22例因反复大量咯血的患者行胸部64层MSCT血管成像.结果 咯血相关血管表现为无支气管动脉供血型3例、单支或多支支气管动脉供血型15例、支气管动脉与非支气管动脉共同供血型3例以及直接异常体循环动脉供血型1例.结论 64层MSCT血管成像对支气管动脉DSA插管及栓塞治疗大咯血有明显的指导作用.

Abstract：

Objective To evaluate the nse of CT angiography in the diagnosis of hemoptysis and guiding the treatment of it with 64-slice spiral CT.Methods Twenty-two patients with repeated and massive hemoptysis underwent chest CT angiography.Results The blood supply of hemoptysis was nonbronchial systemic arteries in 3 patients,single or multiple bronchial arteries in 15 patients,mixed arteries of nonbronchial systemic and bronchial arteries in 3 patients and abnormal systemic arteries in 1 patient.Conclusion With 64-slice spiral CT,CT angiography provided useful information for the treatment of hemoptysis by guiding bronchial arterial embolization.     

La tomografía computarizada multidetector en la hemoptisis amenazante

Life-threatening hemoptysis is a severe condition that requires rapid diagnosis and treatment. One of the treatments of choice is embolization. The initial assessment aims to locate the origin and cause of bleeding. The technological advance of the development of multidetector computed tomography (MDCT) has changed the management of patients with life-threatening hemoptysis. MDCT angiography makes it possible to evaluate the cause of bleeding and locate the vessels involved both rapidly and noninvasively; it is particularly useful for detecting ectopic bronchial arteries, nonbronchial systemic arteries, and pulmonary pseudoaneurysms. Performing MDCT angiography systematically before embolization enables better treatment planning. In this article, we review the pathophysiology and causes of life-threatening hemoptysis (including cryptogenic hemoptysis) and the MDCT angiography technique, and we review how to systematically evaluate the images (lung parenchyma, airways, and vascular structures).     

Peripheral pulmonary artery pseudoaneurysms and massive hemoptysis

OBJECTIVE: The aim of this study was to determine the incidence and etiology of pulmonary artery pseudoaneurysms in patients undergoing bronchial angiography for massive hemoptysis and to assess patient outcome after the embolization of these pseudoaneurysms. CONCLUSION: Peripheral pulmonary artery pseudoaneurysms occur in up to 11% of patients undergoing bronchial angiography for hemoptysis. These are often most easily appreciated on bronchial and/or nonbronchial systemic arterial angiograms because of complete reversal of flow in pulmonary artery branches in the diseased lung. Embolization of bronchial and nonbronchial systemic arteries alone may not be sufficient therapy to control hemoptysis, and occlusion of the pseudoaneurysm itself via a pulmonary artery approach is recommended.     

肺部疾病的支气管动脉与肺外体循环动脉CTA分析

目的:利用CT血管造影对支气管动脉与肺外体循环动脉进行肺供血研究。材料和方法:回顾性分析16层CT胸部增强发现肺外体循环动脉参与供血的不同肺疾病患者39例(男性24例,女性15例,平均年龄63.4岁;范围,20-82岁),采用容积显示(VR)、多平面重建(MPR)、最大强度投影(MIP)进行支气管动脉与肺外体循环动脉进行重建,分析其供血特征。结果:39例病人中共显示支气管动脉128支,肺外体循环动脉42支,其中内乳动脉19支,锁骨下动脉8支,膈下动脉8支,肋间动脉5支,甲状颈干与腹腔干各1支。35支肺外体循环动脉扩张迂曲进入肺内。5例支气管扩张和1例肺癌中扩张迂曲的支气管动脉与肺外体循环动脉形成明显的交通吻合成网状,7例支气管扩张中支气管动脉、肺外体循环动脉与肺动脉间形成吻合。除1例肺隔离症没有伴明显胸膜增厚外,其余肺外体循环动脉穿过胸壁进入肺内均伴有明显的胸膜增厚。结论:CTA并三维重建技术能清晰显示支气管动脉肺外体循环动脉的起源、分布等解剖特征,为介入术提供明确路径,有利于疾病的诊断与治疗。     

Radiological Management of Hemoptysis: A Comprehensive Review of Diagnostic Imaging and Bronchial Arterial Embolization

Hemoptysis can be a life-threatening respiratory emergency and indicates potentially serious underlying intrathoracic disease. Large-volume hemoptysis carries significant mortality and warrants urgent investigation and intervention. Initial assessment by chest radiography, bronchoscopy, and computed tomography (CT) is useful in localizing the bleeding site and identifying the underlying cause. Multidetector CT angiography is a relatively new imaging technique that allows delineation of abnormal bronchial and nonbronchial arteries using reformatted images in multiple projections, which can be used to guide therapeutic arterial embolization procedures. Bronchial artery embolization (BAE) is now considered to be the most effective procedure for the management of massive and recurrent hemoptysis, either as a first-line therapy or as an adjunct to elective surgery. It is a safe technique in the hands of an experienced operator with knowledge of bronchial artery anatomy and the potential pitfalls of the procedure. Recurrent bleeding is not uncommon, especially if there is progression of the underlying disease process. Prompt repeat embolization is advised in patients with recurrent hemoptysis in order to identify nonbronchial systemic and pulmonary arterial sources of bleeding. This article reviews the pathophysiology and causes of hemoptysis, diagnostic imaging and therapeutic options, and technique and outcomes of BAE.     

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

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。     

Prediction of recurrent hemoptysis with MDCT angiography

OBJECTIVE: To identify the computed tomography (CT) findings to predict recurrent bleeding in patients with massive hemoptysis. METHODS: Fifty-eight patients with massive hemoptysis underwent both CT and conventional bronchial angiography for bronchial artery embolization. Retrospective analysis was done to analyze the statistical differences in the initial CT findings between the nonrecurrent and recurrent hemoptysis groups using the Mann-Whitney U test and the chi or Fisher exact test. Stepwise logistic regression analysis was used to find predictive variables for the recurrence of hemoptysis. RESULTS: After embolization, recurrence of hemoptysis was observed in 15 of 58 patients (26%). The diameter of bronchial (P = 0.001) and nonbronchial systemic arteries (P < 0.05), total number of dilated bronchial and nonbronchial systemic arteries (P = 0.001), pleural thickening (P = 0.01), extrapleural fat thickening (P = 0.004), and enhancing vascular structures within the extrapleural fat layer (P = 0.04) were significantly different in the nonrecurrent and recurrent hemoptysis groups. Stepwise logistic regression analysis showed that the total number of dilated bronchial and nonbronchial systemic arteries (odds ratio, 3.540; 95% confidence interval: 1.175, 10.662; P = 0.025) was a significant CT variable associated with the recurrence of hemoptysis. CONCLUSIONS: CT bronchial angiography may help in the prediction of recurrent bleeding in patients with massive hemoptysis.     

Role of MDCT in identification of the bleeding site and the vessels causing hemoptysis

OBJECTIVE: MDCT has improved the management of hemoptysis by providing more precise depiction of bronchial and nonbronchial systemic arteries than conventional CT. The purpose of this article is to review the role of MDCT in the identification of the bleeding site and the vessels causing hemoptysis. CONCLUSION: Identification of the origin of the involved systemic arteries (bronchial and nonbronchial) or involved pulmonary artery on MDCT enables the interventional radiologist to treat them, especially in elderly patients with a tortuous aorta and atheroma.     

Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography: comparison with conventional angiography

PURPOSE: To retrospectively evaluate bronchial and nonbronchial systemic arteries at multi-detector row helical computed tomography (CT) compared with conventional angiography in patients undergoing endovascular treatment of hemoptysis. MATERIALS AND METHODS: Neither institutional board approval nor informed consent was required. Forty-eight consecutive patients (39 men, nine women; mean age, 55.7 years; range, 20-82 years) with hemoptysis of bronchial and nonbronchial systemic artery origin underwent multi-detector row helical CT angiography of the thorax with use of a four-detector row (n = 31) or 16-detector row (n = 17) scanner prior to embolization. Findings on CT angiograms, including CT scans, maximum intensity projections, and three-dimensional volume-rendered images, were used to evaluate the depiction of bronchial and nonbronchial systemic arteries. Retrospective analysis of the ostium and the course of bronchial and/or nonbronchial systemic arteries on CT angiograms enabled evaluation of the accuracy of this technique in identification of the relevant vasculature. RESULTS: Among the 46 patients initially treated with bronchial artery embolization, 58 bronchial arteries were identified at CT and/or angiography. In 50 (86%) cases, concordant findings were observed with both modalities. In five (9%) cases, CT could not be used to identify the ostia of bronchial arteries. In three (5%) cases, CT depicted bronchial arteries that could not be selectively catheterized. Three-dimensional images were found to be superior to transverse CT scans in depicting the ectopic origin of the bronchial arteries, which enabled the interventional radiologists to perform successful embolization after direct catherization of the ectopic vessel in every case. In five (11%) patients, the nonbronchial systemic origin of bronchial bleeding was identified on CT angiograms. CONCLUSION: Multi-detector row helical CT angiography provides more precise depiction of bronchial and nonbronchial systemic arteries than does conventional angiography.     

Endovascular Embolization of Bronchial Artery Originating from the Upper Portion of Aortic Arch in Patients with Massive Hemoptysis

Purpose

Our experience with endovascular embolization (EVE) of the bronchial artery (BA) originating from the upper portion of the aortic arch (AA) in six patients is described.

Methods

Altogether, 818 patients with hemoptysis underwent multidetector row computed tomography angiography (MDCTA) before EVE or AA angiography during EVE. Aberrant BAs originating from the upper portion of the AA were the source of massive hemoptysis in six patients (0.73 %). MDCT angiograms and/or Digital subtraction angiograms were retrospectively reviewed. Selective catheterization and embolization were performed.

Results

The ostia of the BAs were located on the superior surface of the AA between the brachiocephalic trunk and left common carotid artery in three patients, the junction of the aorta and medial surface of the left subclavian artery in two, and the posterior wall of the upper portion of the AA in one. The six BAs comprised two common trunks, three single right sides, and one single left side. The targeted vessels were successfully catheterized and embolized by a coaxial microcatheter system using polyvinyl alcohol particles. Other pathologic BAs and nonbronchial systemic arteries also were embolized. Bleeding was immediately controlled in all patients with no recurrence of hemoptysis. No procedure-related complications occurred.

Conclusions

Application of EVE of anomalous origin of BAs in patients with hemoptysis is important, as demonstrated in the six reported patients. MDCTA before EVE or AA angiography during EVE is critical to avoid missing a rare aberrant BA originating from the upper portion of the AA.     

甲状颈干栓塞术在外周血管介入中的临床意义

目的观察甲状颈干参与肿瘤及咯血供血的表现,评价栓塞甲状颈干的安全性和疗效。 方法2年间用介入技术治疗外周疾病（肿瘤及咯血）术中经血管造影证实甲状颈干参与病变咯血供血13例,其中纵隔肿瘤2例、肺部咯血性疾病11例,包括：肺部恶性肿瘤3例、支气管扩张6例、肺结核2例。年龄25～69岁,平均年龄44.5岁。对参与供血的甲状颈干进行了超选择性栓塞术,栓塞剂用聚乙烯醇微球（PVA,500～700μm）、明胶海绵颗粒和微型钢丝圈。观察甲状颈干参与病变供血的特点,评价栓塞甲状颈干的安全性和临床意义。 结果选择性造影均显示甲状颈干管径增粗、分支增多紊乱和不同程度的新生血管形成,伴有肿瘤血管和肿瘤染色者5例次、咯血患者中由甲状颈干供血区对比剂外溢4例次、非特异性片状对比剂染色4例。本组患者均行供血甲状颈干的栓塞术,同时栓塞胸廓内动脉9例、肋间动脉8例、膈下动脉3例、支气管动脉7例,术后咯血停止;随访2个月～2年,11例未再咯血。纵隔肿瘤患者介入治疗后行外科切除,术中出血仅100 ml。 结论甲状颈干可参与纵隔肿瘤及咯血的供血,如发现甲状颈干参与纵隔肿瘤及咯血供血,补充栓塞甲状颈干安全有效。     

The value of 16-slice multidetector computed tomographic angiography in preoperative appraisal of vascular anatomy in potential living renal donors

Background

Comprehensive preoperative appraisal of potential living renal donors is the key for selecting a proper donor and a suitable kidney.

Objective

To prospectively assess the diagnostic value of 16-slice multidetector computed tomography (MDCT) in preoperative appraisal of vascular anatomy in potential living renal donors.

Materials and methods

Preoperative angiography using a 16-slice MDCT scanner was performed in 68 consecutive potential living renal donors. The MDCT angiography included unenhanced and contrast-enhanced multiphasic scans. The MDCT images were reviewed for the number and branching pattern of the renal arteries and for the number and presence of major or minor variants of the renal veins. The results were compared with the actual anatomy at the open donor nephrectomy as the diagnostic standard of reference.

Results

The sensitivity and the specificity of MDCT angiography for the detection of various anatomic variants of renal arteries as well as renal venous anomalies were 100%. The anatomic variants of renal arteries included accessory arteries (n = 7) and early arterial branching (n = 10). Whereas, the detected venous anomalies were of major category of the circumaortic left renal vein anomaly (n = 2). No minor renal venous anomaly was identified in any subject.

Conclusion

16-Slice MDCT angiography is highly accurate for preoperative assessment of diverse anomalies of the renal vascular anatomy in potential living renal donors; in consequence, it markedly affects the surgical planning.     

Bronchial and nonbronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review.

Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. In 90% of cases, the source of massive hemoptysis is the bronchial circulation. Diagnostic studies for massive hemoptysis include radiography, bronchoscopy, and computed tomography (CT) of the chest. Bronchoscopy and chest radiography have been considered the primary methods for the diagnosis and localization of hemoptysis. Many researchers currently suggest that CT should be performed prior to bronchoscopy in all cases of massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. Knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, and possible complications of BAE and with the characteristics of the various embolic agents used in the procedure.     

Outcomes of Esophageal Arterial Embolization for Treatment of Hemoptysis

Purpose

To investigate safety and efficacy of esophageal arterial embolization (EAE) in addition to bronchial arterial embolization (BAE) for treatment of hemoptysis as well as the importance and characteristics of esophageal arteries in patients with hemoptysis.