CAJ | 학술논문

目的与传统血管造影对照,回顾性分析评价双源CT(DSCT)血管成像显示咯血患者支气管动脉(BA)和非支气管体循环动脉(NBSA)的临床价值.方法回顾分析2010年1月至2013年12月山东省医学影像学研究所66例同时行血管造影和DSCT血管成像检查的咯血患者的资料,其中男46例、女20例,平均年龄45岁,年龄范围22～72岁.综合运用DSCT原始轴位图像与多平面重组(MPR)、最大密度投影(MIP)和三维容积重现(VR)等后处理技术显示和描述BA和NBSA分型、开口位置及走行等.由两位放射医师对DSCT结果进行一致评价,并与血管造影结果进行对比.结果 DSCT在66例患者共显示171支BA(右87支、左84支)和18支NBSA,其中右侧BA起自肋间-支气管动脉共干者、支气管动脉共干和胸主动脉者分别为52.9％ (46/87),36.8％(32/87)、10.3％ (9/87);左侧BA起自胸主动脉、支气管动脉共干和左锁骨下动脉者分别为59.5％ (50/84)、38.1％ (32/84)、2.4％ (2/84).与血管造影比较,DSCT诊断咯血责任血管(即扩张BA)的准确率88.7％ (133/150).DSCT正确诊断18支NBSA,漏诊7支;DSCT正确诊断5处支气管动脉-肺血管瘘,漏诊15处.结论 DSCT血管成像可以准确显示咯血患者BA和NBSA,能为栓塞治疗提供重要参考依据.
목적 여전통혈관조영대조,회고성분석평개쌍원CT(DSCT)혈관성상현시각혈환자지기관동맥(BA)화비지기관체순배동맥(NBSA)적림상개치.방법 회고분석2010년1월지2013년12월산동성의학영상학연구소66례동시행혈관조영화DSCT혈관성상검사적각혈환자적자료,기중남46례、녀20례,평균년령45세,년령범위22～72세.종합운용DSCT원시축위도상여다평면중조(MPR)、최대밀도투영(MIP)화삼유용적중현(VR)등후처리기술현시화묘술BA화NBSA분형、개구위치급주행등.유량위방사의사대DSCT결과진행일치평개,병여혈관조영결과진행대비.결과 DSCT재66례환자공현시171지BA(우87지、좌84지)화18지NBSA,기중우측BA기자륵간-지기관동맥공간자、지기관동맥공간화흉주동맥자분별위52.9％ (46/87),36.8％(32/87)、10.3％ (9/87);좌측BA기자흉주동맥、지기관동맥공간화좌쇄골하동맥자분별위59.5％ (50/84)、38.1％ (32/84)、2.4％ (2/84).여혈관조영비교,DSCT진단각혈책임혈관(즉확장BA)적준학솔88.7％ (133/150).DSCT정학진단18지NBSA,루진7지;DSCT정학진단5처지기관동맥-폐혈관루,루진15처.결론 DSCT혈관성상가이준학현시각혈환자BA화NBSA,능위전새치료제공중요삼고의거.
Objective To retrospectively evaluate the depiction of bronchial and nonbronchial systemic arteries with dual-source computed tomography (DSCT) versus conventional angiography in patients with hemoptysis.Methods DSCT and conventional angiography of thorax were performed in 66 patients with hemoptysis.There were 46 males and 20 females with a mean age of 45 (22-72) years.Findings on DSCT,including CT scans,maximal intensity projections and three-dimensional volume-rendered images were used to evaluate the visibility and traceability of bronchial and/or nonbronchial systemic arteries.CT scans were evaluated by two radiologists in consensus.The CT findings were compared with those of conventional angiography.Results A total of 171 (87 right,84 left) bronchial arteries and 18 nonbronchial systemic arteries were visible on DSCT.The right bronchial arteries arose from intercostal-bronchial trunk thoracic aorta (n =46),common trunk of both bronchial arteries (CBT) (n =32) and thoracic aorta (n =9) whereas left bronchial arteries arose from thoracic aorta (n =50),CBT (n =32) and left subclavian artery (n =2).Compared with angiography,the accuracy of DSCT in the diagnosis of hemoptysis responsible vessels (i.e.dilatation BA) was approximately 88.7％ (133/150).DSCT correctly diagnosed 18 nonbronchial systemic arteries,but missed 7 ; DSCT correctly diagnosed 5 bronchial-pulmonary vascular fistulas,but missed 15.Conclusion Excellent for evaluating hemoptysis,DSCT may identify the origin and ostial position of bronchial arteries,detect non-bronchial systemic arteries and act as a roadmap for percutaneous transcatheter embolisation.