MSCT在异常体动脉供血正常左肺下叶基底段诊断中的应用

目的 探讨多层螺旋CT在异常体动脉供血正常左肺下叶基底段诊断中的应用价值。方法 选取我院6例异常体动脉供血正常左肺下叶基底段的临床及影像资料,回顾性分析异常供血动脉、肺动静脉、肺实质及支气管MSCT表现。结果 6例均可见胸降主动脉左前方发出单支异常动脉走行于左肺下叶基底段,其中3例左下肺静脉呈受压改变,远端相比近心端较膨大; 2例左肺下叶基底段肺实质内见磨玻璃密度影,其内血管增粗、迂曲。结论 异常体动脉供血正常左肺下叶基底段MSCT表现典型,增强扫描及三维重建、重组可以明确诊断。     

异常体动脉供应正常左下肺基底段的胸部X线片和螺旋CT表现

目的 总结异常体动脉供应正常左下肺基底段在胸部X线片和螺旋CT上的特征性表现。方法 回顾分析5例异常体动脉供应正常左下肺基底段的胸部X线片和螺旋CT资料。结果 5例异常体动脉供应正常左下肺基底段在胸部X线片上均表现为心后区肿块，左下肺动脉纹理细小，受累左下肺区域无正常肺动脉分支影分布，但有异常增粗纹理。CT上5例均表现为受累肺组织体积轻度缩小，支气管通畅，2例肺实质呈磨玻璃状改变。5例均可见左下肺动脉在背段动脉起始远侧缺如，增粗扭曲的异常体动脉起自降主动脉，其扩张的分支分布于受累肺段。1例血管造影表现与CT相仿。结论 该病在胸部X线片上的表现有一定特征性。增强螺旋CT扫描可明确诊断，以避免创伤性的血管造影和致命的穿刺活检。     

经动脉弹簧圈栓塞治疗异常体动脉供应正常下肺基底段一例

患者女,33岁.因心悸3年,咳嗽伴痰中带血10 d,于2007年8月6日入院.体检:心、肺、腹未见异常.气管镜检查正常.胸部螺旋CT增强扣描显示:左肺下叶基底段支气管通畅,管径正常;基底段体积有缩小,纵隔稍左移,左侧斜裂后移;整个基底段肺实质透亮度降低,伴磨玻璃样密度增高和增粗血管影,合并少许条索影(图1,2);左下肺动脉管径缩小,基底段肺动脉缺如;1支起始于胸主动脉的异常血管分布于左肺下叶基底段,左下肺静脉扩张(图3～5).患者拒绝外科手术,经内科保守治疗后痰中带血症状消失出院.     

肺隔离症合并异位肺静脉引流一例

病例资料患者,男,60岁.无临床症状,因体检胸片发现左下肺肿块析行CT平扫加增强扫描检查.CT表现:多层螺旋CT(multislice spiral computed tomography,MSCT)平扫见左下肺后基底段脊柱旁类圆形肿块,密度均匀,CT值35 HU,边界较清晰,周围血管纹理明显增粗、增多,可见一蒂与胸主动脉相连,在其后方可见血管影伸过胸主动脉后方与奇静脉相连;增强扫描及血管重组成像清晰显示与肿块相连蒂为肿块供血动脉来自胸主动脉,并见分支血管附于肿块边缘,左肺下叶一粗大引流静脉接受肿块周围及一部分F叶正常肺组织回流跨过肿块边缘,从胸主动脉后方回流入奇静脉,奇静脉轻度增粗,肿块本身无明显强化.CT诊断:肺隔离症(叶内型)合并异位肺静脉引流(图I).     

食管固有动脉参与咯血及其解剖学基础

目的 观察咯血患者的食管固有动脉(PEA)血管造影表现,分析出现异常PEA参与供血的高危因素及解剖学基础.资料与方法 58例大咯血患者接受螺旋CT及血管造影检查,基础病变包括支气管扩张33例,肺结核20例,肿瘤3例,其他2例.观察选择性PEA插管的结果,分析PEA的血管造影表现及存在异常PEA与病变部位、性质的关系.结果 PEA选择性插管成功17例,共发现18支PEA,PEA表现异常7例,血管8支,主要表现为主干增粗、迂曲,分支增多、紊乱并进入相邻下肺组织,PEA与肺动脉分流2例,PEA与正常起源支气管动脉异常交通1例.PEA表现异常者基础病变均为支气管扩张,病灶均累及肺下叶后基底段,病变邻近处纵隔胸膜均无明显 增厚粘连.结论 当肺内病变累及下叶后基底段时,PEA可通过肺韧带动脉参与咯血的侧支供血.     

MSCT血管成像对肺隔离症的诊断价值

目的：探讨MSCT血管成像（MSCTA）对肺隔离症的诊断价值。方法：回顾性分析12例经手术及病理证实的肺隔离症的MSCT增强扫描及后处理资料,记录病变特征与供血动脉的来源。结果：12例（13个病变）中,叶内型12个,叶外型1个,均位于下叶后基底段;位于左肺下叶8个,右肺下叶5个;病灶表现为实性4个,囊实性5个,囊性3个;仅见增粗血管结构1个。肺隔离症供血动脉均来源于体循环动脉,10个病灶起源于胸降主动脉,2个源于腹主动脉,1个源于腹腔干（叶外型,左下肺）;9个为1支供血动脉,3个2支供血动脉,1个3支供血动脉。13个病变均引流至肺静脉。结论：MSCTA结合后处理技术可清晰显示肺隔离症的病变特征及供血动脉来源,对该病的诊断及术前评估有重要价值,值得推广。     

肺癌血管造影表现及临床意义

目的：研究肺癌的肿瘤血管形态，指导肺癌的诊断和介入治疗。材料和方法：对１００例肺癌病人在治疗前行支气管动脉ＤＳＡ，其中２０例同时作了肺动脉ＤＳＡ。结果：①肺癌的血供来自支气管动脉；②供血的支气管动脉增粗；③出现肿瘤血管和肿瘤染色；④少数病例可见支气管动脉与肺动脉或肺静脉直接交通；⑤纵膈或肺门淋巴结显影。表现与原发癌相似。结论：肺癌的介入治疗应选择支气管动脉为靶血管，不但要进行灌注化疗，而且要栓塞支气管动脉以阻断肿瘤的血供和异常交通，不但要栓塞原发瘤的供血动脉也要栓塞转移淋巴结的供血动脉。     

左肺动脉吊带的MSCT诊断

目的：评价MSCT在左肺动脉吊带（LPAS）诊断中的应用价值。方法：回顾性分析7例经手术证实的LPAS的临床表现及MSCT特征。结果：7例LPAS术前MSCT均正确诊断,7例均合并心内、外畸形。MSCI、及后处理（MPR、MIP、MinIP、VR）示：7例中完全性LPAS6例,表现为左肺动脉自右主肺动脉发出,从右主支气管上方绕行并向后走行至气管和食管间达左肺门;部分性LPAS1例,表现为左上肺动脉起自右主肺动脉,从右主支气管上方穿过。向后走行于气管和食管之间并供血左肺上叶,而左下肺动脉起源和走行正常;7例均伴不同程度的气管和／或支气管狭窄。结论：MSCT不仅能显示LPAS及其合并心血管畸形,还能显示LPAS伴随气管、支气管狭窄,对制定外科手术方案具有重要临床价值。     

多层螺旋CT血管成像诊断肺动脉栓塞的价值

目的探讨多层螺旋CT(multi-slice spiral CT,MSCT)血管成像诊断肺动脉栓塞的价值.材料和方法回顾性分析17例急性肺动脉栓塞的MSCT肺血管造影表现.结果确诊为肺动脉栓塞17例,209处肺动脉及分支受累.其中第2级肺动脉受累9例11支,第3级肺叶动脉受累13例31支,第4级肺段动脉受累116支和亚段肺动脉受累51支.MSCTA显示肺动脉栓塞的直接征象为肺动脉内的不规则充盈缺损及完全阻塞,其中栓塞表现为中央型充盈缺损4例、偏心性充盈缺损12例、附壁血栓4例及完全阻塞5例;间接征象有肺门动脉增宽、肺梗死、局限性肺纹理稀疏、胸腔积液、右心室肥大等.结论MSCT肺血管造影诊断肺动脉栓塞,无创、快捷、有效、敏感性高,可作为肺栓塞的首选检查方法.     

叶内型肺隔离症多层螺旋CT影像表现特征

目的观察叶内型肺隔离症的CT影像特征,分析疾病发病机理,提高影像诊断的准确率。资料与方法对16例叶内型肺隔离症患者发病部位、形态、病变周围情况、病变与血供关系等影像学表现进行回顾性分析,全部病例均采用多层螺旋CT(MSCT)平扫及增强扫描,应用多平面重组(MPR)、曲面重组(CPR)及最大密度投影(MIP)等方法进行观察。结果 16例中病变位于右下肺5例,左下肺11例。表现为大片状不均实变其间囊状透亮区8例,表现为软组织肿块影或囊实性肿块影4例,表现为单纯囊性肿块3例,仅见到异常供血动脉而肺组织未见明确异常1例。除以上表现外,异常供血区内肺组织见到肺气肿8例,支气管扩张4例。所有病例均经MPR、MIP及CPR等重组方法发现异常体动脉供血,所有体循环供血动脉均来自主动脉,供血动脉1支15例,2支1例,只有异常供血动脉及引流静脉无隔离肺肿块1例,引流静脉为肺静脉14例,引流入奇静脉2例。供血动脉分支范围在病变范围内10例,供血动脉分支范围大于病变范围6例。结论叶内型肺隔离症实质是局部肺血供的异常,体循环异常供血动脉既供应影像学表现异常的肺组织,同时也可供应其周边的影像学表现正常的肺组织;异常供血区内可见到正常、支...     

Anomalous systemic arterialization to normal basal segments of the left lower lobe: helical CT and CTA findings

PURPOSE: The purpose of this work was to evaluate the helical CT and CT angiography (CTA) findings of anomalous systemic artery (ASA) to the basal segments of the left lower lobe (LLL). METHOD: Three patients (two had hemoptysis, one was asymptomatic) with blotchy nodular density in the LLL revealed on chest radiographs underwent helical CT and CTA. Bronchoscopy was performed in two of these patients. Angiography and surgery were performed in one patient. RESULTS: All three patients demonstrated characteristic helical CT and CTA findings including 1) a sigmoid-shaped ASA originating from the lower descending thoracic aorta, with a distal bulbous configuration and four arterial branches supplying the basal segments of the LLL; 2) absence of an interlobar pulmonary artery or presence of a small artery lateral to the truncus basalis; 3) engorged vascular markings in the basal segments of the LLL; and 4) normal tracheobronchial tree and lung parenchyma. CONCLUSION: The findings in the present three cases suggest that the use of invasive studies such as angiography or bronchoscopy may be obviated in the diagnosis of ASA to the LLL because diagnosis can be provided through a clear set of criteria on helical CT and CTA.     

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。     

16层螺旋CT血管成像在肺癌诊治中的价值

目的:探讨16层螺旋CT(16 MSCT)血管成像(CTA)在肺癌诊断和治疗上的价值。方法:对28例经手术病理证实的肺癌病例作回顾性分析。其中中央型肺癌18例,周围型肺癌10例。采用层厚1 mm、螺距0.9375进行连续螺旋CT扫描,用CT自带软件Vitrea 2三维重组软件,重组方法包括CTA及多平面重组(MPR)、最大密度投影(MIP)、遮盖表面显示(SSD)、容积再现(VR)。结果:18例中央型肺癌中,全部肿块均可见由肿瘤性支气管动脉供血,其中1 例见肿瘤性支气管动脉和肿瘤性肋间动脉同时供血。10例周围型肺癌中有5例由肿瘤性支气管动脉供血,其中2例同时由肿瘤性支气管动脉和肿瘤性肋间动脉供血,5例找不到明确的供血血管。28 例肺癌病例中,肺血管有形态改变者23 例,中央型肺癌15例,周围型肺癌8例。其中鼠尾征10例,血管受压及狭窄者12例。上腔静脉狭窄或阻塞3例。结论:MSCT血管成像对肺癌特别是中央型肺癌的诊断及肿块区肺血管的侵犯情况有极重要的临床价值。     

Diagnosis of arterial sequestration using multidetector CT angiography

Background

Arterial sequestration is a rare congenital disorder. The diagnostic evaluation of this condition using multidetector computerized tomography (MDCT) has not been described previously. The purpose of this study was to describe the characteristic features of this disorder and to assess the use of MDCT in visualizing the characteristic anatomic features.

Methods

We retrospectively reviewed the records of seven patients with anomalous systemic blood supply to left lower lobe of the lung. All the patients had undergone MDCT angiography. To evaluate the lung parenchyma, bronchial branching pattern, and vascular anatomy, four series of images were systematically reconstructed as follows: contiguous transverse CT scans viewed at mediastinal and pulmonary window settings, oblique coronal and sagittal maximum intensity projections (MIP), multiplanar reconstruction (MPR), and three-dimensional volume-rendered images (VR) of airway and thoracic vascular structures.

Results

All 7 cases had isolated and tortuous arterial anatomy from the descending thoracic aorta to the basal segment of the left lower lobe; however, variable distribution of branches was observed. Characteristic findings of anomalous systemic arterial (ASA) supply were distinct from those seen in other pulmonary sequestration syndromes and were well visualized by the use of noninvasive MDCT.

Conclusion

Complex CT findings allow clear imaging of arterial sequestration and the ASA blood supply; MDCT angiography has demonstrated its value and accuracy in diagnosing this condition, obviating the use of digital subtraction angiography and magnetic resonance angiography for the diagnosis of arterial sequestration.     

Anomalous systemic arterial supply to normal basal segments of left lower lobe: characteristic imaging findings

PURPOSE: The purpose of this study was to describe the characteristic findings in each imaging modality of anomalous systemic arterial supply to normal basal segments of the left lower lobe of the lung. METHOD: Five patients with anomalous systemic arterial supply to normal basal segments of the left lower lobe were retrospectively reviewed. Chest radiography, contrast-enhanced CT scan, angiography, and other imaging modalities were analyzed. RESULTS: The imaging findings of this anomaly were characterized by three issues as follows: an anomalous systemic artery arising from the thoracic aorta, absence of pulmonary arterial supply, and normal bronchial system as well as normal pulmonary parenchyma in the affected segments. The anomalous systemic artery was demonstrated on chest radiography, contrast-enhanced CT scan, MRI, and thoracic aortography. Absence of pulmonary arterial supply was revealed by pulmonary angiography, radiolabeled perfusion scan, and CT scan. Normal bronchial system was confirmed by radiolabeled ventilation scan, bronchography, and CT scan. CONCLUSION: CT is useful in making the correct diagnosis of this anomaly because it is the only diagnostic method that can demonstrate the anomalous systemic artery, absence of pulmonary arterial supply, and normal bronchial system in the affected segments.     

肺隔离症的多层螺旋CT诊断

目的：探讨肺隔离症的多层螺旋CT（MSCT）征象,以提高对该疾病的认识及临床诊断。方法回顾性分析经手术及病理证实的肺隔离症患者13例,包括临床表现,多层螺旋CT扫描资料,并复习文献;所有患者均行胸部平扫及双期增强容积扫描。结果13例肺隔离症患者中,12例为叶内型,1例为叶外型。12例叶内型均位于肺下叶内后基底段,9例位于左下肺,3例位于右下肺;1例叶外型位于左膈与下叶之间。13例中1例为增多增粗的异常血管结构,4例为实质性肿块,5例为囊实性肿块,3例为囊性肿块。6例病灶周围可见局限性肺气肿,4例病灶周围见渗出性阴影。13例隔离肺的供血动脉均发自体动脉。结论肺隔离症CT征象典型,容积扫描能对其作出准确诊断,并能为外科手术治疗提供重要参考,多层螺旋CT可以作为诊断肺隔离症的首选方法。     

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.     

支气管动脉MSCT三维成像在肺癌介入治疗中的应用

目的:探讨支气管动脉多层螺旋CT(MSCT)三维成像在肺癌中的表现,评价支气管动脉的起源、走行及分支显示对肺癌介入治疗的价值。方法:26例行肺癌介入治疗的患者术前均行MSCT检查,其中9例行增强检查,行支气管动脉三维重建,使用不同的旋转轴观察支气管动脉的空间解剖细节。结果:9例肺癌支气管动脉三维重建的病例中,8例肺癌的支气管动脉三维图像能够清晰显示出支气管动脉的起源、走行、分支和血管直径等。三维成像中以容积再现(VR)技术显示最佳。结论:肺癌介入治疗术前行支气管动脉MSCT三维成像能准确、直观地显示支气管动脉的解剖特点,有利于降低操作难度和术中并发症的发生率,减少对比剂用量和曝光量,缩短选择性插管的时间。     

Pulmonary sequestration in the adult. Diagnostic contribution of angiography

PURPOSE: The diagnosis of pulmonary sequestration is based on demonstration of mal-developed lung tissue, feeding on abnormal systemic level. We investigate the role of angiography in the diagnosis of pulmonary sequestration in adult patients. MATERIAL AND METHODS: 1987 to 1998 we examined 9 patients with suspected pulmonary sequestration who were subsequently submitted to surgery. The patients were 3 women and men; 6 of them were symptomatic and 3 asymptomatic. Six patients were examined with CT of chest and upper abdomen, thoracoabdominal aortography and selective arteriography of the abnormal vessel; one patient also submitted to left angiopneumography. One patient underwent bronchography and another one MRI. RESULTS: An unquestionable diagnosis was made in 8 cases, namely 6 of intralobar and 2 of extralobar sequestration, and confirmed surgically. The only questionable case was diagnosed at histology as extralobar pulmonary sequestration atypically fed by thin branches from the left diaphragmatic artery. CONCLUSIONS: Angiography demonstrated the abnormal arterial feeding typical of pulmonary sequestration in all cases but one. The evidence of venous drainage was the key sign to diagnose extra-versus intralobar sequestration. Therefore we conclude that angiography remains an essential tool in the diagnosis of pulmonary sequestration, notwithstanding the great potentials of Helical CT of MR angiography.