| ObjectiveLearning the origins,distributions and variations of pulmonary arterial branches lays an anatomical foundation for the diagnosis of pulmonary vascular diseases such as pulmonary embolism,tumors and arteritis,and for the successful implementation of thoracoscopic segmentectomy.Because of the clinical risk of related diseases and the increasing incidence in recent years,it puts forward higher requirements for doctors to locate the anatomical structures of pulmonary artery quickly and accurately.The studies of pulmonary artery anatomy and variation are mainly based on human anatomy and pulmonary angiography.However,there are only few reports on related researches using multi-slice spiral CT angiography(MSCTA)domestic and overseas.The objective of this paper is to study the branching forms of pulmonary arteries in right lower lobe by MSCTA and to discuss its application value in anatomy and clinic.Materials and methodsTotally 120 cases of pulmonary artery CT angiography and chest pain triple CT angiography were selected,including 74 males and 46 females,aged 32-84 years,with an average age of 51.2 years and medianage of 47 years.The pulmonary arteries of right inferior lobe were clearly displayed by post-processing at the workstation.Compared with the axial images,the main pulmonary arterial branches of right inferior lobe were identified on 3D images.The numbers of branches of right inferior lobe A6 and branching conditions of basal stem were counted and compared with the experimental data of anatomy.ResultsThe numbers of branch of A6 were 1,2 and 3,with the proportions of 82.5%,16.7%and 0.8% respectively.In the first type,majority of A6 s divided into two subsegmental arteries,accounting for 96.0%,while a few divided into three subsegmental arteries,with no obvious co-trunk conditions among the three branches,accounting for 4.0%.There were 19 branching types in basal stem in the right lower lobe.Among them,A7 was most complex and unstable,which divided into one or two branches,it could co-trunk with one or two arteries among A5,A6,A8,A9 or A10.According to the co-trunking conditions of A7 with other Segmental arteries,we divided them into three categories:The category is no coⅠ-trucking conditions of A7,which could be subdivided into two types: Ia and Ib,representing single-branch and double-branch A7 respectively.Ia:A7,A8,A9+10,accounting for 25.8%;A7,A8+9,A10,accounting for 14.2%;A7,A10,A8,A8,A9+10,accounting for 0.8%;A7,A8,A9+10,accounting for 2.5%;Ib.A7,A7,A8,A9+10,accounting for 2.5%;The category is that A7 only coⅡ-trunked with single segmental artery,which could be subdivided into four types: IIa-IId,representing A7 co-trunking with A5,A6,A8 or A10 respectively.IIa: A5+7,A8,A9+10,accounting for 1.7%;A5+7,A8+9,A10,accounting for3.3%;IIb: A6+7,A8,A8,A9+10,accounting for 0.8%;IIc: A7+8,A9+10,accounting for26.7%;A7,A7+8,A9+10,accounting for 1.7%;A8,A7+8,A9+10,accounting for 3.3%;A7+8,A8,A9+10,accounting for 4.2%;IId: A5+8,A8+9,A7+10,accounting for 0.8%;A7+10,A8+9,accounting for 2.5%;A8,A9,A7+10,accounting for 0.8%;The category is that A7 coⅢ-trunked with two pulmonary segmental arteries,which could be subdivided into three types: IIIa-IIIc,representing A7 co-trunking with A5+8,A8+9,A9+10 respectively.IIIa: A5+7+8,A9+10,accounting for 2.5%;IIIb: A7+8+9,A10,accounting for 0.8%.IIIc:A7,A8,A7+9+10,accounting for 0.8%;A7+8,A7+9+10,accounting for 4.2%.The results showed that the most common types were A7+8,A9+10 and A7,A8,A9+10,accounting for 26.7% and 25.8% respectively,followed by A7,A8+9,A10,accounting for 14.2%,and this three main types accounted for about 66.7% of the total,while others were rare types.ConclusionThe anatomical structures and courses of pulmonary artery are complex.Multi-slice spiral CT combined with volume rendering can clearly show the anatomical structure and spatial relationship of pulmonary artery.It is of great value in the localization of pulmonary embolism and other pulmonary artery related diseases,and in guiding surgical precise segmental resection. |
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