CT Angiography Of Bronchial Artery

1. 1 Three-dimensional Anatomical Evaluation of Bronchial Artery with CT AngiographyObjective To evaluate the ability of CT angiography to identify and demonstrate the origins and courses of bronchial arteries, using the three-dimensional reformation technique. Methods 443 cases were examined with thin-section enhanced MSCT. Three-dimensional images of bronchial arteries were processed at the workstation. Spatial anatomical characters of the bronchial arteries using volume rendering(VR) and multiplanar reconstruction(MPR) or maxium intensity projection(MIP) were observed. Results In all, 359 cases were evaluated for at least one bronchial artery was displayed clearly in VR. The right bronchial arteries mainly appeared to be originating on the right intercostal artery (48.85%) and descending aorta (47.48%), while the left bronchial arteries on the descending aorta (97.84%). The right bronchial arteries of the descending aorta were mainly arised from right wall (45.89%), and then the anterior wall (42.51%), while the left bronchial arteries of the descending aorta mainly arised from anterior wall of the aorta (74.93%), the common trunk originated from the descending aorta mainly positioned anterior too (74.03%). There were eleven bronchial arteries distribution patterns, right one and left one was the most (53.48%), and then right two and left one (17.55%). 49.31% of the right bronchial arteries were coursing across the posterior edge of the right main bronchi, 35.55% coursing the inferior edge, while 60.11% of left bronchial arteries coursing forward across the superior edger of the left main bronchi, the others coursing inferior edge or the posterior edge. Conclusion The bronchial artery anatomy were complicated, and CT angiography could visualized the features clearly. 1. 2 Anatomical Evaluation of Intercostal Bronchial Arterieswith CT AngiographyPurpose To investigate the angiographic anatomy of intercostal bronchial arteries (ICBA) using 16-slices CT. Materials and Methods 399 cases with right BA clearly displayed in CT angiogram were enclosed, and a 16-slice CT scanner was used. The post-processing technique including volume rendering(VR) and maximum intensity projection(MIP) was applied at the Vitrea 2 workstation. The relationship of the right BA and intercostal arteries was studied, and the spatial anatomical charaters of the ICBA were observed. Results Of all, the right BA of 254 cases was originated from the intercostal arteries, and the ICBA in 243 cases were the main or the unique right BA. ICBA were mainly arised from the third and fourth right posterior intercostal arteries(87.40%). All common trunk were arised form the right wall of descending aorta, and most of them were the first branch. All of the beginning of the ICBA were at the range from T₃ to T₆ and not overstepping the caput costae toward right, 63.0% of them were at the exact front of the vertebral body. Conclusion The ICBA was the main bronchial artery in the right and its orifice was just at the front of the vertebrea, and its 3-dimensional anatomy could be revealed by the 16-slice CT angiography. 2 CT Angiography of Bronchial Artery and Pulmonary Arteryin Patients with Primary Lung CancerObjective To further evaluate the blood supply of primary lung cancer (PLC) using CT angiography of bronchial artery and pulmonary artery. Methods Thin-section enhanced MSCT (Aquilion 16) was performed in 164 cases of primary lung cancer (mean age, 61 years; age range, 45-81 years), 123 confirmed by pathology and 41 confirmed by the synthesized clinical methods. 46 cases without any chest lesion confirmed by CT as normal control group, (mean age, 53 years; age range, 38-75 years). Three-dimensional images of the bronchial arteries and pulmonary arterieswere processed at the workstation. Spatial anatomical characters of the bronchial arteries and pulmonary arteries were observed using VR and MPR or MIP. Results At least one bronchial artery was displayed clearly on VR in 152 of 164 cases of primary lung cancer and 32 of 46 cases of control group, the detective rate being 92.7% and 69.6% respectively. More BA branches in cancer group (25.8%) and the same side of cancer (40%) than the control group (7%) and the other side (8.8%) reached far from the segment bronchi or entered into the lesions. The caliber of the bronchial arteries and the total axial areas on the side of the lung cancer were significantly larger than those of the other side and of the control group (P<0.05). BA of the same side of lung cancer were dilated and tortuous, distributed into the masses, and their branches reticularly anastomosed. All PA were shown clearly, and were normal in 62 cases even crossing the masses, "hold ball" sign in 31 cases, "dead tree branch" in 43 cases, "residual root" sign in 28 cases. Conclusion The anatomy chatacters of bronchial arteries of primary lung cancer, such as the origin and distribution, could be displayed stereo and clearly by CTA and 3D postprocessing. It was easy to display them clearly by CTA. The bronchial arteries were dilated and blood flow was increased in primary lung cancer, and CTA could quantitatively analyze the bronchial artery dilataltion degree and the total blood supply. Pulmonary arteries passed through the masses or were interrupted. By using MSCT angiography of BA and PA, it is further demonstrated that BA is the main supply vessel of the primary lung cancer, and no evidence of PA supply is found. 3. 1 Evaluation of chest CT angiography in patients withhemoptysisObjective To investigate the imaging characters of associated vessels of hemoptysis using CT angiography (CTA). Methods Thin-section enhanced MSCT were performed on 46 cases of repeated or massive hemoptysis, including 31 bronchiectasis, 11 primary lung cancer, 4 vascular malformation. three -dimensional images of theassociated vessels were processed at the workstation. Their spatial anatomical characters were observed on VR and MPR or MIP. Results The main trunk of bronchial arteries in 13 cases were dilated, and no branches were displayed. Trunk and branches were dilated and tortuous in 19 cases, and anastomosed when two or more bronchial arteries supplied to lesion. Bronchial arteries and other arteries of systemic circulation supplied to same lesion in 10 cases. aneurysm was displayed in the bronchial arteriovenous fistula. the pulmonary artery and vein were dilated and tortuous in the pulmonary arteriovenous fistula. Conclusion The dilated bronchial artery was major cause of hemoptysis, and the other arteries of systemic circulation supplying to lesion could not be neglected. Vascular malformation caused hemoptysis too. CTA could reveal the related vessels safely and clearly. 3. 2 MDCT angiography of bronchial and nonbronchial systemicarteriesPurpose to retrospectively evaluate bronchial and nonbronchial systemic arteries at multi-detector row helical computed tomography (MDCT) angiograpy in patients with different pulmonary disorders. Materials and methods 39 patients (24men, 15 women; mean age, 63.4 years; range, 20-82years. 28 of the patients had an episode of hemoptysis.) with congenital and acquired pulmonary disorders of bronchial and nonbronchial systemic arteries supplying underwent multi-detector row helical CT angiography of the thorax with use of a 16-detector row scanner. Findings on CT angiograms, including maximum intensity projections(MIP), MPR, and three-dimentional volume-rendered images(VR), were used to retrospectively analyze the characteristic of bronchial and nonbronchial systemic arteries on CT angiogram. Results In 39 patients, a total of 128 bronchial arteries were identified. 42 branches of nonbronchial systemic arteries were detected: 19 branches of the internal mammary artery, 8branches of the subclavian artery, 8 branches of inferior phrenic artery, 5 branches of intercostal artery, 1 branch of thyrocervical trunk, 1 branch of celiac trunk.35 arteries entered into the lung parenchyma and extended down to the lesions dilatedly and tortuously. Every case except the sequestration was associated with pleural thickening when the vascular structures passed through the extrapleural fat. Conculsion multi-detector row helical CT angiography provides precise depiction of bronchial and nonbronchial systemic arteries, which may be useful in the diagnosis and assessment of the pulmonary diseases. A concerted search for a nonbronchial systemic arterial supply should be performed to increase the safety and effect of interventional therapy.