The Application Study Of Bronchial Arteries With 64-Slice Spiral Computed Tomography Angiography

PART1 ANATOMICAL EVALUATION OF BRONCHIAL ARTERIES AND THE RIGHT INTERCOSTAL BRONCHIAL ARTERIES WITH 64-SLICE SPIRAL CT ANGIOGRAPHYSECTION 1 ANATOMICAL EVALUATION OF BRONCHIAL ARTERIES WITH 64-SLICE SPIRAL CT ANGIOGRAPHYObjective: To analyze the three-dimensional anatomical characters of bronchial arteries by using 64-slice spiral CT angiography (CTA) and evaluate its value of clinical application.Materials and Methods: The scan data of 112 patients who received enhanced chest CT scan with at least one bronchial artery clearly displayed were processed at the workstation. Their spatial anatomical characters were observed and analyzied by using volume rendering (VR), multi-planar reformation (MPR) and maximum intensity projection (MIP).Results: Of all, 280 bronchial arteries were clearly diaplayed with 158 right and 122 left. There were nine bronchial artery distribution patterns, of which the one right and one left (41.07 %,46/112) and the two right and one left (24.11%,27/112 )were commonly seen. The right bronchial arteries mainly originated from the right posterior intercostal artery(52.53%,83/158)and descending aorta (38.61%,61/158), while the left bronchial arteries mainly from the descending aorta (88.52%, 108/122).20 (7.14%) bronchial arteries with variations in their origination were found. There also were a number of common trunks (24.29%,68/280). The right bronchial arteries of the descending aorta were mainly arised from the right lateral wall and anterior wall, while the left bronchial arteries of the descending aorta and common trunks arised from the anterior wall of the aorta. The starting points of bronchial arteries were mainly at the range from T5 to T6. We made the direction of the descending aortic flow as the forward direction and the average inverse angle between the descending aorta and the bronchial arteries from it was 98.70°in right and 105.12°in left. The styles that bronchial arteries coursed across the main bronchi were diverse. The right bronchial arteries originating from the right posterior intercostal artery mainly coursed across the posterior wall of the right main bronchi (54.22%, 45/83) or passed both of the posterior and inferior walls of the right main bronchi (30.12%, 25/83). The right bronchial arteries originating from descending aorta mainly coursed across the inferior wall of the right main bronchi (78.69%, 48/61). The left bronchial arteries originating from descending aorta mainly coursed across the superior wall of the left main bronchi (47.22%, 51/108), or passed two or more walls of the left main bronchi (33.33%, 36/108).Conclusion 64-slice spiral CT angiography could clearly visualize the anatomical features of bronchial arteries and provide anatomic data for clinical treatment of hemoptysis and the lung cancers at advanced or intermediate advanced stage by infusing drugs into bronchial arteries.SECTION 2 ANATOMICAL EVALUATION OF THE RIGHT INTERCOSTAL BRONCHIAL ARTERIES WITH 64-SLICE SPIRAL CT ANGIOGRAPHYObjective: To evaluate the three-dimensional anatomical characters of the right intercostal bronchial arteries by using 64-slice spiral CT angiography (CTA) and to provide anatomic data for clinical treatment of hemoptysis and the lung cancers at advanced or intermediate advanced stage by infusing drugs into bronchial arteries.Materials and Methods:The scan data of 132 patients who received enhanced chest CT scan with right bronchial arteries clearly displayed in CT angiogram were processed at the workstation. Their spatial anatomical characters were observed and analyzied by various reconstructional techniques, including volume rendering (VR), multi-planar reformation (MPR), maximum intensity projection (MIP) and so on.Results:Of all, the right bronchial arteries of 91 cases (68.9%) originated from the posterior intercostal arteries. The right bronchial arteries in 90 cases arised from the right posterior intercostal arteries and only one case whose right bronchial artery arised from the fourth left posterior intercostal artery was accounted. It was found that the common trunks of the right bronchial artery and the posterior intercostal artery can be divided into 8 types and the type that the right bronchial artery had a common trunk with the third right posterior intercostal artery was observed most commomly. The starting points of common trunks were mainly at the range from T5 to T6 and most of them arised from the right wall of the descending aorta. We made the direction of the descending aortic flow as the forward direction and the average inverse angle of the intercostal- bronchial arteries trunks and the descending aorta was 102.6°.The distance between the starting point of common trunks and the intercostal bronchial arteries was at the range from 0.3㎝ to 4.2㎝ and the average distance was 2.3㎝ .The styles that the right bronchial arteries arised from the intercostal-bronchial arteries trunks were diverse.The included angle between the right bronchial arteries and the distal posterior intercostal arteries can be acute angle, rightangle and even obtuse angle,and the average angle is 90.7°.All beginning of the intercostal bronchial arteries were at the range from T4 to T6 and most of them were at the exact front of the vertebral body. They were not overstepping the caput costae toward right and left sides and the distance between them was 4.1cm averagely.Conclusion:The three-dimensional anatomical characters of the right intercostal bronchial arteries were complicated and CT angiography could clearly visualize these features.PART 2 FINDINGS AND CLINICAL VALUES OF FEEDING ARTERIES IN PATIENTS WITH PRIMARY LUNG CANCER USING 64-SLICE SPIRAL CT ANGIOGRAPHYObjective: To investigate the three-dimensional imaging characters of the feeding arteries in patients with primary lung cancer and the clinical value using 64-slice spiral CT angiography (CTA).Materials and Methods: The scan data of 63 patients who received enhanced chest CT scan with at least one bronchial artery clearly displayed were processed at the workstation. Among the 63 cases, there were 11 cases of peripheral lung cancer, 32 cases of central lung cancer (37 cases confirmed by pathology and 6 cases confirmed by the synthesized clinical methods) and 20 cases without any chest lesion confirmed by CT as normal control group. The spatial imaging characters of the arteries supplying to lesion were observed and analyzied using volume rendering (VR), multi-planar reformation (MPR) and maximum intensity projection (MIP).Results:All 43 cases with lung cancer were supplied by the bronchial arteries and 8 cases of them were supplied by other arteries of systemic circulation at the same time. Three-dimensional imaging characters of these feeding bronchial arteries such as origins, numbers and diameters could be showed exactly. The type that only one bronchial artery supplied to lesion was found in 22 cases(51.2%),of which the main trunk of bronchial arteries were dilated and tortuous at different levels in 8 cases and both the main trunk and branches were dilated and tortuous in 14 cases. These feeding vessels all extended down to or entered into lesions. The type that two or more bronchial arteries supplied to lesion was seen in 13 cases(30.2%)and the anastomosis usually occurred. The type that bronchial arteries and other arteries of systemic circulation supplied to the same lesion was observed in 8 cases(18.6%).Conclusion: Bronchial arteries are the main feeding arteries of primary lung cancer and sometimes other arteries of systemic circulation also can supply to the lesion. The 64-slice spiral CTA can evaluate the three-dimensional imaging characters of the feeding arteries in patients with primary lung cancer safely and clearly, which can be used as the roadmap for the intervension therapy of lung cancer. PART3 CLINICAL VALUE OF 64-SLICE SPIRAL CT ANGIOGRAPHY IN THE DIAGNOSIS AND TREATMENT OF HEMOPTYSISObjective: To investigate the vessel imageology and its clinical value in patients with hemoptysis using 64-slice spiral CT angiography (CTA). Materials and Methods: 41 patients with repeated or massive hemoptysis underwent enhanced 64-slice spiral CT scan, including 13 cases of primary lung cancer, 21 cases of chronic inflammation (including bronchiectasis), 2 cases of primary lung cancer with bronchiectasis, 2 cases of vascular malformation and 3 cases of pulmonary sequestration. Their scan data were processed at the workstation and the three-dimensional imaging characters of the vessels associated with hemoptysis were observed and analyzied using various reconstructional techniques, including volume rendering (VR), multi-planar reformation (MPR), maximum intensity projection (MIP) and so on.Results: Abnormal bronchial arteries were found in all patients with lung cancer and chronic inflammation and one or more nonbronchial systemic arteries supplying to lesions were also found in some of them. There were 117 arteries supplying to lesions in 36 cases with lung cancer and chronic inflammation, including 84(71.8%)bronchial arteries, of which 10 bronchial arteries with ectopic origin were found, and 33 (28.2%) nonbronchial systemic arteries. The origin of the nonbronchial systemic arteries supplying to lesions had a close relationship with the site of lesions, the range that the lesions involved and pleural thickening and adhension. In the patients with vascular malformation or congenital diseases, there was 1 case of pulmonary arteriovenous fistula in which the tumor-like dilatation of the vascular sac cavity connected with the feeding artery and draining vein was showed, 1 case of bronchial arterial malformation in which anastomosis with several aneurysms was displayed and 3 cases of pulmonary sequestration in which the anomalous systemic arteries supplying to the abnormal portion of the lung were noted.Conclusion: 64-slice spiral CTA not only can supply detailed data of the feeding vessels of hemoptysis including their origin and number, but also can visualize these vessels clearly. It plays a very important role in the diagnosis and treantment of hemoptysis. PART4 COMPARATIVE IMAGING STUDY FOR FEEDING ARTERY CHANGES IN THE CHRONIC INFLAMMATION OF THE LUNG AND PRIMARY LUNG CANCER WITH 64-SLICE SPIRAL CT ANGIOGRAPHYObjective: To explore the difference of feeding artery changes between the chronic inflammation of the lung and primary lung cancer with 64-slice spiral CT angiography and to evaluate its clinical value in their differential diagnosis.Materials and Methods: The scan data of 61 patients, including 38 cases of primary lung cancer, 21 cases of chronic inflammation (including bronchiectasis) and 2 cases of primary lung cancer with bronchiectasis, who received enhanced chest CT scan with at least one bronchial artery clearly displayed were processed at the workstation. Three-dimensional imaging characters of the bronchial arteries were analyzied using volume rendering (VR), multi-planar reformation (MPR) and maximum intensity projection (MIP). The diameter of bronchial arteries was measured and the rate of nonbranchial systemic arteries supplying to lesion was calculated. Comparison of the cancer group and the chronic inflammation group was made in the diameter of bronchial arteries and the rate of nonbranchial systemic arteries supplying to lesion (2 cases of primary lung cancer with bronchiectasis were excluded from the statistics). Results : The diameter of bronchial arteries was 1.87mm and the rate of nonbranchial systemic arteries supplying to lesion was 18.42% in 38 primary lung cancers, while the diameter of bronchial arteries was 2.54mm and the rate of nonbranchial systemic arteries supplying to lesion was 47.62% in 21 chronic inflammations respectively. There was a significant difference both in the diameter of bronchial arteries and the rate of nonbranchial systemic arteries supplying to lesion between the cancer group and the chronic inflammation group (P<0.05).Conclusion: The dilation of bronchial artery in the chronic inflammation group is more prominent than in the cancer group and there are more nonbranchial systemic arteries supplying to lesion in the chronic inflammation group. The findings of feeding artery of the chronic inflammation in the lung and primary lung cancer with 64-slice spiral CT angiography are valuable in their differential diagnosis.