64层螺旋CT胸腹联合增强扫描显示肺动脉相关病变及肺癌支气管动脉的应用价值

目的通过肝动脉期CT胸腹联合增强扫描胸部各级肺动脉管内外显示，肺癌支气管动脉成像的技术分析，探讨胸部恶性肿瘤伴发病变、中晚期恶性肿瘤行胸腹联合CT增强扫描的应用价值。方法恶性肿瘤资料48例，初诊34例（肺癌19例、食管鳞癌12例、恶性胸腺瘤3例）、肿瘤治疗后随访或疗效监测14例（其中有肺部手术史3例）。观察无肺部手术史45侧肺动脉的分级，癌症合并肺栓塞，肺动脉及其分支周围的淋巴结分布；19例肺癌观察肿瘤供血血管，肺癌病灶内肺动脉分支的表现；测量48例肺动脉干分叉层面升主动脉、肺动脉、降主动脉及上腔静脉的CT值。结朵45例显示肺动脉7级以上，6级以内肺动脉均能清晰显示，发现癌症合并4—6级肺动脉栓塞l例，显示5级以内肺动脉旁淋巴结。19例肺癌肿块直径≥3cm12例均见病灶供血血管，病灶直径〈3cm7例，4例见供血血管。供血血管主要是支气管动脉，部分为外周肿瘤附近的肋间动脉或膈动脉供血。显示肺癌内肺动脉受侵表现。48例胸腹联合CT增强扫描注射延迟时间分别位于22S-33fi之间，平均29．17±0．45S。升主动脉、肺动脉、降主动脉及上腔静脉的CT值分别为250．51±4．82Hu、27O．OO±8．26Hu、24O．41±4．44Hu、452．21±29．45Hu，四者动脉cT增强净强化值均大于200Hu。结论cT胸腹联合增强扫描，扫描时相控制在对比剂处于肺循环中后期、体循环早期的胸部“动脉血管期”，腹部肝动脉期，胸部可以发现肿瘤合并6级肺动脉以内的肺栓塞，显示5级肺动脉旁淋巴结，肺癌病灶内肺动脉的受侵情况，肺癌的供血血管，同时发现腹部肝动脉期的病变特性，有利于更大范围疾病的诊断和鉴别诊断，肺癌的介入治疗指导。

Application Showing the Pulmonary Artery Related Lesions and Lung Cancer Bronchial Artery by Thoracoabdominal Enhanced Scan of 64-Slice CT

Objective To show of chest pulmonary arterial pipe inside and outside at all levels and the lung cancer bronchial artery by way of CT thoraco-abdominal enhanced hepatic arterial phase scan, it is explored the application value in the thoracic malignancies associated with other lesions and advanced malignancies. Methods 48 cases of tumor data, first diagnosed in 34 patients, including 19 cases of lung cancer, esophageal squamous cell carcinoma in 12 cases, 3 cases of malignant thvmoma ; tumor treaunent follow-up or curative effect observation of 14 cases（3 cases of which have a history of lung surgery）, observed no history of lung surgery in 45 cases of pulmonary artery grading, cancer combined with puhnonary embolism, distribution of lymph nodes around the pulmonary artery and its branches; 1.9 cases of lung cancer is observed tumor blood vessels supplying and the pulmonary artery branch ; to measure CT value of 48 cases in pulmonary artery bifurcation level include the ascending aorta, puhnonary artery, descending aorta and vena cava. Results In 45 cases, it showed more than 7 grades pulmonary arteries, the 6 grades can be showed clearly, it found that cancer complicating pulmonary embolism of the 4 - 6 levels pulmonary arteries in 1 cause, the lymph nodes are showed around S grades pulmonary arteries. In 19 cases of lung cancer, with diameter 1〉 3cm in all 12 cases were seen supply blood vessels, with 7cases which diameter 〈 3cm, supply blood vessels were seen in 4 cases. The main Blood vessel is bronchial artery, part of the intercostal arteries or phrenic artery in the vicinity of peripheral tuumrs. It revealed a tumor within the pulmonary artery been invaded. Injection delay time of thoracoabdominal combined enhancement scan were located between 22s± 33s, mean 29.17 ± 0.45s .The CT values of ascending aorta, pulmonary artery, descending aorta and the superior vena cava were 250.51 ±4.82 Hu, 270.00 ± 8.26 Hu, 240.41± 4.44 Hu, 452.21 ± 29.45 Hu. The CT reinforcement values of them were greater than 200Hu. Conclusion in CT thoracoabdominal combined enhancement scan, the scanning phase is controlled in the chest ＂arteries period＂ of contrast agent for the puhnonarv circulation in the late and circulation early, and in its abdomen hepatic arterial phase, the chest can be found the pulmonary tmnor complicating pulmonary embolism within 6 grades pulmonary arteries, showing the lymph nodes around 5 grades pulmonary arteries, the invasion of the pulmonary artery within the lung cancer ,showing the supply blood vessels of the lung tumor, also found that the abdomen hepatic arterial phase lesions characteristic, it is conducive to diagnosis and differential diagno- sis disease with the wider, and guidance of interventional treannent of lung cancer.