MSCTA对咯血患者支气管动脉的检出及对介入治疗的价值

目的：探讨多层螺旋 CT 血管成像（MSCTA）对肺结核大咯血患者正常及异位起源支气管动脉（BA）的检出及其对介入治疗的临床价值。方法：搜集108例肺结核大咳血患者的病例资料，所有病例均行 MSCTA 检查，对其数据进行容积再现（VR）、最大密度投影（MIP）、多平面重组（MPR）、曲面重组（CPR）等后处理，获得起源正常及异位支气管动脉的开口位置、分支类型等解剖信息。MSCTA 检查后3天内所有病例均进行数字减影血管造影（DSA）检查及支气管动脉栓塞术，与 MSCTA 结果进行对照分析。结果：108例肺结核大咳血患者中，MSCTA 发现起源正常支气管动脉254支（254／273，93．0％），异位起源支气管动脉19支（19／273，7．0％）；发现咯血责任血管170支。以 DSA 为金标准，MSCTA对支气管动脉的检出率为97．5％，MSCTA 对咯血责任血管的检出率为95．0％。结论：支气管动脉 MSCTA 对发现正常及异位起源支气管动脉及辅助介入手术治疗大咯血具有肯定的临床价值，并能同时对肺部疾病进行评价，可作为支气管动脉栓塞术前首选的常规检查方法。

MSCTA for the detection of normal and ectopic bronchial arteries in patients having pulmonary tuberculosis accompanied with severe hemoptysis as well as its clinical value in interventional therapy

Objective:Using MSCTA to investigate the detection of normal and ectopic bronchial arteries (BA)in pa-tients having pulmonary tuberculosis accompanied with severe hemoptysis and the clinical value of MSCTA in interventional therapy.Methods:The clinical materials of one hundred and eight patients with pulmonary tuberculosis and severe hemopty-sis were collected.All cases underwent MSCTA,post-processing techniques including volume rendering (VR),maximum in-tensity projection (MIP),multi-planar reformation (MPR)and curved planar reformation (CPR)were used to obtain the anatomical information of orifice position and branching type for those normal and ectopic bronchial arteries.Digital subtrac-tion angiography (DSA)and bronchial artery embolization were performed within 3 days after MSCTA.Results:Of the 108 patients with pulmonary tuberculosis and severe hemoptysis,254 orifices of bronchial arteries in normal position (254/273, 93.0%),19 ectopic orifices of bronchial arteries (19/273,7.0%)and 170 vessels response for hemoptysis were detected. Using DSA as gold standard,the detection rate of bronchial artery and responsible vessels by MSCTA were 97.5% and 95%,respectively.Conclusion:In patients with severe hemoptysis,normal and ectopic bronchial arteries could be assessed on MSCTA,showing clinical value in assist interventional surgical treatment.Also,the accompanied pulmonary disease could be evaluated simultaneously.MSCTA could be used as the first choice of conventional imaging modality before bronchial artery embolization.