支气管动脉CTA融合气道三维重建对咯血介入治疗的价值

目的探讨支气管动脉CTA融合气道三维重建对咯血介入治疗的价值。方法收集2015年10月~2018年1月73例咯血患者,A组42例,每例患者在DSA术前行支气管动脉CTA融合气道三维重建,观察支气管动脉(BA)的有关参数(支气管动脉开口、起源、类型以及BA与气管隆突的位置关系)并进行统计与分析;B组31例,DSA术前未行CTA检查;对比两组患者DSA手术时间及对比剂用量。结果A组42例咯血患者中,CTA发现BA97支,左侧44支,右侧52支,异位BA1支;咯血责任血管55支,其中正常起源咯血责任BA54支,异位起源责任BA1支;发现的BA分支类型有4型,以R1L1型最多,占71.4%;以气管隆突水平上下为界分类,比例分别为60.5%及39.5%;咯血责任BA平均管径(3.46±1.31)mm,非咯血责任BA平均管径(1.57±0.38)mm;A组患者DSA手术时间及术中对比剂用量明显低于B组(P<0.05)。结论支气管动脉CTA与气道三维重建融合技术能很好的发现并显示可疑咯血责任BA的起源,走行,形态以及其与支气管分叉的位置关系,同时可以大大缩短DSA手术时间和减少术后对比剂用量,可作为咯血介入治疗术前首选的常规检查方法。     

双源CT支气管动脉成像的应用

目的探讨双源CT支气管动脉成像的应用价值。方法收集28例因肺部病变而行CT支气管动脉成像的患者资料,应用多平面重组、最大密度投影、容积再现等多种后处理重建技术处理图像,分析、研究支气管动脉的特点。结果全部患者共检出73支支气管供血动脉,其中支气管动脉正常起源者24例,共64支血管,左侧30支、右侧支34支。另有4例由肺外体循环动脉参与供血,共9支血管,为左侧3支、右侧6支。正常起源的支气管动脉类型以R1L1(15/24)多见。支气管动脉起源于胸主动脉者中开口在胸主动脉T4~T7范围水平,以T5、T6水平最多,其中左右共干者6例。8例支气管动脉增粗。结论双源CT支气管动脉成像技术可便捷、无创、直观的显示支气管动脉的开口位置、走行、形态,评价管腔直径,并能观察异常起源的支气管供血动脉的开口位置及形态特征。     

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.     

16层CT支气管动脉成像的临床应用价值

目的:通过16层CT血管成像了解支气管动脉(BA)的三维影像解剖特点,以期为经BA开展的介入治疗提供有价值的参考。方法:对66例BA显示良好的CTA原始图像进行MPR、MIP及VR三维后处理,观察BA的走行情况、分支数目、开口位置,并测量BA开口处的管径。66例均经病理或临床随访证实,分成3组:肺癌组(n=36)、肺转移组(n=15)和非肿瘤组(n=15),并将肺癌组按中央型及周围型分为2组,分别对不同组别的BA管径进行统计学分析。结果:66例共显示BA 83支,其中右侧74支、左侧9支。BA的类型以右一型为多见(49/66),且常与右侧肋间动脉共干(28/74)。BA开口多位于Th_5～Th_6椎体水平(63/83),以气管隆突区域定位则以0区为多见(66/83);右侧BA或肋间支气管动脉干多开口于胸主动脉右侧壁(52/74),左侧BA多开口于胸主动脉前壁(5/9)。肺癌组右侧BA内径与转移组比较差异无统计学意义,与非肿瘤组比较差异有统计学意义(P<0.05)。中央型肺癌与周围型肺癌比较,BA内径差异有统计学意义(P<0.01)。结论:16层CT血管成像能很好地显示BA的解剖特点,并能立体、直观地发现异位起源的BA,可为经BA介入治疗提供有价值的参考;并且进一步证明BA参与肺癌(尤其是中央型肺癌)的供血。     

MSCTA VR融合技术在支气管动脉成像中的应用价值

目的：探讨MSCTAVR融合技术显示支气管动脉（BA）的应用价值。方法：选择125例胸部增强CT扫描患者对动脉（含支气管动脉和主动脉）、气管、胸廓均采用AOS-VR技术分别重组VR像,然后进行图像融合,获得三维融合图像,观察支气管动脉的起源、走行及与相邻组织之间的解剖关系。结果：125例胸部增强CT扫描患者中117例支气管动脉显示清晰,共显示BA267支。右侧BA145支主要起源于右肋间动脉（68／145,46．9％）及降主动脉（65／145,44．8％）;左侧BA122支主要起源于降主动脉（119／122,97．5％）。267支中有153支发自降主动脉前壁,77支发自降主动脉右侧壁,9支发自降主动脉后壁,22支发自降主动脉左侧壁,3支发自右侧锁骨下动脉,1支发自左侧颈总动脉,1支发自右侧甲状颈干,1支头臂干。起源于降主动脉的右BA以右壁最多（69／145,47．6％）,其次是前壁（63／145,43．4％）;起源于降主动脉的左BA以前壁最多（98／122,80．3％）。结论：VR融合技术能清晰、直观地显示支气管动脉的起源、形态、走行及与相邻组织结构的关系,对胸部手术或介入治疗术前评估有重要的临床应用价值。     

MSCTA对肺癌供血支气管动脉开口定位价值的研究

目的:探讨多层螺旋CT血管成像(MSCTA)对肺癌供血支气管动脉(BA)开口的定位价值.方法:对86例原发性肺癌患者行支气管动脉CT血管成像(BA-CTA),利用容积显示(VR)融合技术,将动脉像(含肺癌供血支气管动脉、主动脉及肺癌原发肿块)、支气管像及胸廓像三者融合在一起,以气管分叉下缘为圆点建立坐标系,对肺癌供血支气管动脉开口位置进行冠状三维立体定位;再以BA开口所在横断图像逆时针倾斜45°角建立坐标系,明确开口所在血管壁位置.结果:86例中有78例106支BA能显示清晰,通过VR融合像能直观显示出开口所在冠状位的坐标位置以及横断面所处血管壁的位置.其中72支BA开口于第一象限,3支开口于第二象限,31支开口于第四象限;25支发自降主动脉前壁,58支发自降主动脉右侧壁,7支发自降主动脉后壁,12支发自降主动脉左侧壁,2支发自右侧锁骨下动脉,1支发自左侧颈总动脉,1支发自右侧甲状颈干.结论:MSCTA能清楚显示肺癌供血支气管动脉及其分支,明确了支气管动脉开口的位置,为支气管动脉插管介入治疗肺癌提供准确而有价值的定位信息.     

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.     

支气管动脉64排螺旋CT血管成像对咯血型肺部疾病的诊断价值

目的 探讨支气管和非支气管动脉64排螺旋CT血管成像(CTA)对咯血型肺部疾病的诊断价值。方法 选取我院治疗的44例患者,行64排螺旋CTA检查,对咯血支气管和非支气管系统的动脉进行观察和分析。结果 44例患者经CTA支气管动脉血管成像检查共发现78支咯血动脉,其中支气管动脉63支,非支气管动脉15支,其中有11支为下肢肺动脉,占73. 3%(11/15),4支上肺动脉,占26. 7%(4/15); 63支支气管动脉中右侧33支,占52. 4%(33/63),左侧18支,占28. 6%(18/63),另有5支为左右共干,7支为异位起源的支气管动脉; 44例患者中21例(47. 7%)供血支气管动脉走形迂曲,供血支气管动脉内径范围在1. 3～4. 1 mm,平均内径为(2. 1±0. 6) mm;肺癌合并咯血患者CT多平面重组可见支气管动脉增粗,行走至病灶内参与供血,CTA瘤体内可见点或网状肿瘤血管,其内肺动脉被包绕,变窄,甚至闭塞,支气管扩张患者、炎性病变者及肺结核患者可见部分支气管动脉起源位置异常,明显增粗。结论 64排螺旋CT支气管动脉成像能较好地显示支气管动脉及非支气管动脉的形态解剖学特征,为临床治疗提供依据。     

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Aquilion 16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.     

咯血患者胃左动脉起源迷走支气管动脉的解剖学分析和栓塞治疗

观察咯血患者胃左动脉(LGA)起源的支气管动脉(BA)的解剖学特点,评价栓塞治疗的有效性和安全性。在3625例咯血患者中术前CTA发现7例(0.2%,7/3625)BA起源于LGA,并经LGA造影明确诊断。6例呈BA优势,1例呈LGA优势。BA经食管裂孔,沿着食管前方向上走行至左主支气管后方进入肺门和肺。所有BA均表现为左下BA,供应左肺下叶,其中2例沿途发出异常的非支气管性体动脉供应部分左肺下叶病灶。所有BA均应用微导管成功行超选择性插管栓塞,其他病理性BA和非支气管性体动脉行完整栓塞,患者均无严重并发症,临床疗效满意。     

支气管动脉CT血管成像三维解剖学研究

目的评价CT血管成像（CTA）对支气管动脉（BA）的显示能力及三维影像解剖特征。方法对443例患者采用16层螺旋CT增强扫描获得胸部原始图像，用容积显示（VR）、多平面重组（MPR）、最大强度投影（MIP）进行三维重组，观察BA特征。结果有359例在VR中至少1支BA肺外段能清晰显示。右侧BA主要起源于右肋间动脉（213／436支，48．85％）及降主动脉（207／436支，47．48％），左BA主要起源于降主动脉（363／371支，97．84％）。起源于降主动脉的右BA以右壁最多（95／207支，45．89％），其次是前壁（88／207支，42．51％），起源于降主动脉的左BA以前壁最多（272／363支，74．93％）。起源于降主动脉的共干动脉以前壁最多（57／77支，74．03％）。60．11％（223／371支）的左BA走行于左主支气管上缘，少数在下缘（95／371支，25．61％）和后缘（53／371支，14．28％）。49．31％（215／436支）的右BA走行于右主支气管后缘，35．55％（155／436支）走行于下缘。BA分布类型共11种，左右各1支（R1L1）者最多见（192／359例，53．48％），右2支左1支（R2L1）其次（63／359例，17．55％）。结论BA解剖学特征复杂，CTA三维成像能予以较好的评价。     

多层螺旋CT在支气管内膜结核诊断及治疗评价中的应用价值

目的探讨多层螺旋CT(MSCT)在支气管内膜结核诊断及治疗评价中的应用价值。方法回顾性分析32例经纤维支气管镜证实的支气管内膜结核的CT轴位图像表现,并对在工作站获取的薄层图像分别进行多平面重建(MPR),CT仿真内窥镜(CTVE),表面遮盖(SSD)3种方法后重建。结果共有49处气管受累,主支气管2例,右主支气管4例,左主支气管3例,右肺上叶支气管15例,左肺上叶支气管12例,右中叶支气管4例,右肺下叶支气管5例,左肺下叶支气管4例。CT表现为支气管阻塞12例,支气管腔狭窄18例,支气管壁增厚13例,支气管壁钙化6例,伴肺门及纵隔淋巴结钙化27例。结论多层螺旋CT多种重建方法的结合应用,可以明确显示病变的发生部位及支气管腔狭窄或阻塞,有利于支气管内膜结核的诊断及治疗评价。     

Can sufficient preoperative information of intracranial aneurysms be obtained by using 320-row detector CT angiography alone?

Purpose

To determine whether sufficient pre-surgical treatment information of unruptured intracranial aneurysms can be obtained by using 320-row detector CT angiography (CTA) alone.

Materials and methods

We enrolled 40 consecutive patients with unruptured intracranial aneurysms. All patients were prospectively conducted to perform 320-detector CTA as the only preoperative modality. Two blinded readers independently assessed CTA images. Interobserver agreement and the agreement between CTA and surgical findings were determined by calculating the κ coefficient. The referring neurosurgeons judged the usefulness of the information provided by CTA for treatment decisions.

Results

All patients had surgery without intraarterial digital subtraction angiography. Agreement between CTA and surgical findings was excellent for the aneurysm location (κ = 1.0) and good for the shape (κ = 0.71), neck (κ = 0.74) and its relationship with adjacent branches (κ = 0.71). Information obtained with 320-detector CTA was highly useful for surgical treatment in 37 of 40 (93 %) patients, although small perforators deriving from the aneurysm in 2 cases were not fully visualized on CTA images.

Conclusion

In most patients with unruptured intracranial aneurysms, sufficient pre-surgical treatment information can be obtained by using 320-detector CTA alone.     

肺动脉吊带的影像学诊断

目的 评价肺动脉吊带的影像学诊断价值。方法 7例肺动脉吊带中5例做了心血管造影（ACG）（5例均做了MR检查，4例同时做了CT检查），2例仅做MR检查。结果 7例肺动脉吊带病例中6例显示左肺动脉起始于右肺动脉远端分叉部，并绕过气管后方（4例有气管压迫征象，临床有气急、喘鸣的症状），另有1例为左下肺动脉起始于右肺动脉远端近分叉处，左上肺动脉起始正常。5例经手术证实。结论 ACG、造影增强磁共振血管造影（CE-MRA）、CT血管造影（CTA）为明确肺动脉吊带诊断的最佳方法，3种方法可互为补充。心血管造影选择性强，CE-MRA的三维成像显示肺动脉的走向较有优势；CTA可以同时显示气管和异常起源的左肺动脉之间的关系。     

Bronchial arteries: CT demonstration with arteriographic correlation

Dynamic computed tomography (CT) was performed in nine patients with enlarged bronchial arteries documented by arteriography. Plain and contrast-material-enhanced CT scans of two more patients with prominent bronchial arteries were retrospectively reviewed. The study was conducted to determine visibility of the bronchial artery with CT and to depict the anatomic relationship of its mediastinal portion to surrounding structures. The mediastinal portion of the bronchial artery was successfully outlined as nodular or linear densities on all dynamic CT scans. The right bronchial artery was confirmed to arise from the medial wall of the thoracic aorta, whereas the left arises from the anterior wall. Because of its retroesophageal location, the enlarged right bronchial artery can compress the posterior wall of the esophagus. It is postulated that the left bronchial artery occasionally traverses the aorticopulmonary window, recognized as nodular or linear densities below the aortic arch on CT scans.     

气管-主支气管覆膜分支状内支架的设计及初步应用

目的 设计治疗胸腔胃-主支气管瘘和主支气管狭窄的气管-主支气管覆膜分支状内支架。方法根据胸腔胃-主支气管瘘和主支气管狭窄的特殊解剖结构和病变特点，设计气管内主支架部分性覆膜、主支气管内分支支架全覆膜的分支状内支架。X线监视下，1例胸腔胃-隆突瘘、1例胸腔胃-左主支气管瘘、1例胸腔胃-右主支气管瘘、1例左主支气管结核性瘢痕狭窄共置入5枚支架。结果内支架一次性置入成功，3例胸腔胃-气道瘘完全封闭，即刻消除了呛咳症状，有效控制肺部感染，改善了呼吸状况。1例左主支气管狭窄支架植入24d后取出，狭窄段恢复正常。结论 气管-主支气管覆膜分支状内支架能有效封堵胸腔胃-气道瘘和治疗主支气管良恶性狭窄，操作简单、安全、近期疗效可靠。     

64-detector row CT evaluation of bronchial and non-bronchialsystemic arteries in life-threatening haemoptysis

Objective To retrospectively evaluate the depiction of bronchial and non-bronchial systemic arteries with 64-detector row CT in patients undergoing endovascular treatment for life-threatening haemoptysis. Methods 64-detector row helical CT and conventional angiography of the thorax were performed in 28 patients (25 males, 3 females; age range, 18-65 years; mean age, 40 years) with life-threatening haemoptysis. CT images were analysed to identify abnormal bronchial and non-bronchial systemic arteries and also to localise them in two planes. Results Using multidetector CT (MDCT), 43 bronchial arteries were identified on the right side and 46 on the left side. 89% of the right bronchial arteries originated from the right intercostobronchial arteries. A common trunk of origin of the right and left bronchial artery was noted in 46% of cases. 23 non-bronchial systemic arteries were noted on the right side and 41 on the left side. Pleural thickening >3 mm was confirmed to be a good predictor of non-bronchial systemic supply. An internal mammary artery diameter of >3 mm and an inferior phrenic artery diameter of >2 mm were sensitive indicators for non-bronchial systemic supply. Conclusion MDCT is a good investigation tool for evaluating life-threatening haemoptysis as it confirms the disease process, identifies the origin and ostial position of bronchial arteries, detects non-bronchial systemic arteries and acts as a roadmap for percutaneous transcatheter embolisation.     

A Case of Aorto-Bronchial Fistula After Insertion of Left Main Bronchial Self-Expanding Metallic Stent in a Patient with Recurrent Esophageal Cancer

We report a case of aorto-bronchial fistula (ABF) caused by a self-expanding metallic stent (EMS) 51 days after insertion into the left main bronchus. The patient presented with left main bronchial stenosis caused by post-operative local recurrence of esophageal cancer. Post-operative radio therapy totaling 40 Gy and post-recurrence radiotherapy totaling 34 Gy were administered, with daily fractions of 2 Gy. Stenosis of the left main bronchus improved slightly, and was followed with insertion of EMS to prevent re-stenosis. The patient experienced massive hemoptysis for 3 days before sudden death. Autopsy revealed the EMS edge perforating the descending aortic lumen. Tumor infiltration and bacterial infection were observed on the wall of the left bronchus, and atherosclerosis was present on the aortic wall around the fistula. It should be noted that the left main bronchus was at considerable risk of ABF after insertion of EMS for malignant stenosis, and prophylactic stent insertion into the bronchus without imperative need must be avoided.     

Profound xenon-133 trapping in left main bronchus. Obstruction by necrotic tumor

Squamous cell carcinoma of the esophagus eroded into the central airway with production of left main bronchus occlusion and aspiration pneumonia of the right lower lobe.     

Aortic ostia of the bronchial arteries and tracheal bifurcation: MDCT analysis

AIM:To explore the anatomical relationships between bronchial artery and tracheal bifurcation using computed tomography angiography (CTA).METHODS:One hundred consecutive patients (84 men,16 women;aged 46-85 years) who underwent CTA using multi-detector row CT (MDCT) were investigated retrospectively.The distance between sites of bronchial artery ostia and tracheal bifurcation,and dividing directions were explored.The directions of division from the descending aorta were described as on a clock face.RESULTS:We identified ostia of 198 bronchial arteries:95 right bronchial arteries,67 left bronchial arteries,36 common trunk arteries.Of these,172 (87%) divided from the descending aorta,25 (13%) from the aortic arch,and 1 (0.5%) from the left subclavian artery.The right,left,and common trunk bronchial arteries divided at-1 to 2 cm from tracheal bifurcation with frequencies of 77% (73/95),82% (54/66),and 70% (25/36),respectively.The dividing direction of right bronchial arteries from the descending aorta was 9 to 10 o’clock with a frequency of 81% (64/79);that of left and common tract bronchial arteries was 11 to 1 o’clock with frequencies of 70% (43/62) and 77% (24/31),respectively.CONCLUSION:CTA using MDCT provides details of the relation between bronchial artery ostia and tracheal bifurcation.