多层螺旋CT增强扫描对支气管动脉的检测能力及其意义
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摘要
前言
支气管动脉是支气管壁及肺支架结构的营养血管，大多数肺疾病都会伴有支气管动脉形态、分布及血流变化。支气管动脉也是胸部多种肺疾病的治疗给药途径。因此，对支气管动脉的各种相关研究已变得越来越重要。我们通过101例患者的多层螺旋CT增强扫描检测支气管动脉，探讨多层螺旋CT对支气管动脉显示的扫描技术和方法，以提高CT对支气管动脉的检测能力，并评价其临床意义。
材料与方法
本组资料收集肺癌40例，支气管扩张10例，肺部炎症10例，肺栓塞11例，正常对照组30例。所有病例均行多层螺旋CT薄层增强扫描，扫描范围由主动脉弓至膈顶，一次屏气下完成。扫描速度0.5秒／转，数据采集层厚1.0mm，螺距5.5；造影剂剂量为1.5ml／kg，注射速度3.0ml／s，延迟时间15s，重建间隔0.5mm，重建层厚1.0mm。由两位放射科医生阅片，确认支气管动脉。对支气管动脉起源、入肺路径进行归类。测量支气管动脉主干内径和肺癌病灶、转移淋巴结同一层面增强前后CT值。对各组左、右支气管动脉显示率进行X~2检验，然后行X~2分割两两比较各组间差异；对各组间左、右支气管动脉内径均数进行方差分析；对肺癌病灶和转移淋巴结强化程度与左、右支气管动脉内径进行Pearson相关分析。
结果
本研究共101例病例，两侧支气管动脉均未显示25例，均显示59例，17例只显示一侧；左侧显示率为67.33％，右侧显
示率为66.34%。一侧同时显示2支支气管动脉者，左侧13例，
右侧12例;1例左侧同时显示3支支气管动脉。全部病例中右
侧支气管动脉共显示79支，左侧共显示83支。右支气管动脉与
肋间动脉共干35支，左支气管动脉与肋间动脉共干1支，左、
右共干23支。右侧支气管动脉行于右主支气管后方入肺59支
(74 .7%)，内侧入肺29支(25.3%);左侧支气管动脉行于左主
支气管后方入肺23支(27 .7%)，上方入肺38支(4 5.8%)，内
侧入肺22支(26 .5%)。肺癌组支气管动脉确切进入病灶30例。
对各组左、右支气管动脉显示率进行r检验，然后行r分
割两两比较，肺癌组、支扩组与正常对照组显示率有显著差异(p
<0.005);其他各组间无统计学差异(p>0.005)。
对各组间左、右支气管动脉内径均数进行方差分析:肺癌组
与正常对照组、肺栓塞组、肺炎组、支扩组的左、右支气管动脉
内径均具有差异性，统计学显著(p<0 .05)。支扩组与其它各组
左、右支气管动脉内径均具有差异性，统计学显著(P<0.05)。
正常对照组、肺栓塞组、肺炎组间的支气管动脉内径无差异(p
)0 .05)。
左、右支气管动脉内径:右肺癌组分别为2.1000士0.4600nnn
和2.6150士0.65231们匡n;左肺癌组分别为2.1692士0.sl05Inln和
1 .9000士0.4848~。经检验右肺癌时右侧支气管动脉内径比左
侧粗，有统计学意义(目.8855，p<0.05);左肺癌时左侧内径
比右侧粗，有统计学意义(目.3600，p<0.05)。肺癌病灶和转
移淋巴结强化程度与左、右支气管动脉内径均呈正相关。
讨论
1.支气管动脉的多层螺旋CT显示技术
支气管动脉显示对CT的扫描条件、时间、方式都有较高要
求。与单层螺旋CT比较，多层螺旋CT在不增加扫描时间的前
，2
提下可实现更薄层厚、更大范围扫描。
本研究采用11llrn层厚，0.5秒/转扫描速度，20秒可以完成
22cm的大范围扫描，足以满足支气管动脉显示的扫描条件。所
用造影剂剂量和注射速度也与常规增强扫描一致。101例研究对
象的左、右支气管动脉总体显示率分别为67 .33%和66.34%，明
显高于MoriK所报道的39.1%和29.5%。
所以，支气管动脉多层螺旋CT扫描易于操作、方法简单，
提高了CT对支气管动脉的检测能力。并且在观察支气管动脉的
同时，还可以对肺部病变进行观察，不需要做单独扫描。
多层螺旋CT具有强大的图像处理功能，但表面遮盖法或容
积显示法等由于图像分辨率低，支气管动脉细小和其它血管遮挡
等原因，较少应用于支气管动脉显示。
支气管动脉纵隔段走行与冠状面角度较小，连续观察冠状
位N田R图像更容易追踪出支气管动脉纵隔段。NIPR图像还能
清晰显示支气管动脉周围解剖结构，更能真实反映支气管动脉形
态和走行。曲面重建图像会导致图像几何形状失真，不能清楚显
示血管与周围结构关系，所以可作为支气管动脉显示的补充成像
方法，但不能取代MPR和轴位图像。
目前，就影像学检查方法而言，即使主动脉造影也难以满意
和全面显示支气管动脉的起点和数目。我们的研究表明多层螺旋
CT增强扫描在显示支气管动脉起点和数目方面，可能比主动脉
造影更加敏感和准确。
由于支气管动脉进入肺内后更加纤细，以及周围的肺动、
静脉信号过强导致多层螺旋CT不能清晰显示支气管动脉肺内
段。
2.肺疾病的支气管动脉改变
本研究中，各组左、右支气管动脉显示率均有不同。其中，
肺癌组、支扩组与正常对照组的显示率有明显统计学差异。
造成显示率不同的原因主要由支气管动脉内径大小和其内
造影剂浓度决定。本研究中扫描条件、操作技术等人为因素对显
示率差异无影响。因此，各组显示?
Preface
Bronchial arteries are the nutrition vessels of bronchial wall and pulmonary support structure, most of pulmonary diseases are combined with the changes of bronchial arteries on morphology, distribution and blood flowing. Moreover, bronchial arteries are the therapeutic pathways of many pulmonary diseases. The related research on bronchial arteries has become very important, hi this study we collected 101 patients with enhanced MSCT scanning to detect bronchial arteries, evaluate the scanning technique of bronchial arteries with MSCT and try to improve the detective ability, further to evaluate its clinical signification.
Materials and methods
40 cases of lung cancer, 10 cases of bronchiectasis, 10 cases of pulmonary inflammation, 11 cases of pulmonary embolism, and 30 cases as normal contrast group. All cases were examined with thin-slice enhanced MSCT, scanned from aortic arch to diaphragm top in one breathing hold. Speed 0.5s/round, data collection thickness 1.0mm, pitch 5.5, contrast medium dose 1.5ml/kg, injection speed 3.0ml/s, delay time 15s, reconstruction interval 0.5mm, reconstruction thickness 1.0mm. Image data were reviewed by two radiology physician. Then grouped the data by arterial origin and pathway
entering in lung. Measure the inner diameter of bronchial artery and the CT value of the same foci of lung cancer and metastatic lymph node before and after enhancement. Contrast the detective rate of left and right bronchial artery in every group with X2 test, processing the inner diameter of left and right bronchial artery in every group by analysis of variance, the enhanced degree of cancer foci or metastatic node and inner diameter of both bronchial artery were analyzed with Pearson relative analysis.
Results
In 101 cases, the left and right bronchial artery were both undetected in 25 cases, both detected in 59 cases, detected one side in 17 cases; the left artery detective rate was 67.33%, while the right side was 66.34%. In 13 cases 2 bronchial arteries were detected in left side, while in 12 cases detected in right side; among which 3 arteries were all detected in left side. Altogether, MSCT scanning showed 79 right bronchial arteries and 83 left bronchial arteries. 35 right bronchial arteries were co-originated with intercostals arteries, and 1 left side co-originated. Co-originated left and right side bronchial artery were detected in 23 cases. 59 of right bronchial artery(74.7%) entered in the lung behind right main bronchus, the other 20(25.3%) entered through medial side, In 83 left side bronchial arteries, 23 arteries (27.7%)entered in the lung behind the left main bronchus, 38 (45.8%)entered in through the supra side, other 22(26.5%) through medial side of left bronchus, In 30 lung cancer cases MSCT images showed the bronchial arteries entered into the foci clearly.
Contrast the detective rate of left and right bronchial artery in every group with X2 test, there was significant difference between
lung cancer group, bronchiectasis group and normal group(P<0.005), while there was no statistic differences between other groups(P>0.05).
There was obvious statistic difference(P<0.05) in the diameter of bronchial artery between lung cancer group and other groups as normal, pulmonary embolism, pulmonary inflammation and bronchoectasis group; the same as bronchoectasis group compared with normal, embolism and inflammation group(P<0.05). While there was no statistic difference(P>0.05) between inflammation, embolism and normal groups.
The inner diameter of left and right bronchial artery in right lung cancer group were 2.1000±0.4600mm, 2.6150±0.6523mm respectively; 2.1692±0.5105mm, 1.9000±0.4848mm in left lung cancer group respectively. The inner bronchial artery diameter of the same side with cancer foci was larger than the other side without cancer(P<0.05). The enhancement degree of cancer foci and metastatic node was positively correlated with both side inner diameter of bronchial arteries.
Discussion
1.The MSCT detective technique of bronchial art
支气管动脉是支气管壁及肺支架结构的营养血管，大多数肺疾病都会伴有支气管动脉形态、分布及血流变化。支气管动脉也是胸部多种肺疾病的治疗给药途径。因此，对支气管动脉的各种相关研究已变得越来越重要。我们通过101例患者的多层螺旋CT增强扫描检测支气管动脉，探讨多层螺旋CT对支气管动脉显示的扫描技术和方法，以提高CT对支气管动脉的检测能力，并评价其临床意义。
材料与方法
本组资料收集肺癌40例，支气管扩张10例，肺部炎症10例，肺栓塞11例，正常对照组30例。所有病例均行多层螺旋CT薄层增强扫描，扫描范围由主动脉弓至膈顶，一次屏气下完成。扫描速度0.5秒／转，数据采集层厚1.0mm，螺距5.5；造影剂剂量为1.5ml／kg，注射速度3.0ml／s，延迟时间15s，重建间隔0.5mm，重建层厚1.0mm。由两位放射科医生阅片，确认支气管动脉。对支气管动脉起源、入肺路径进行归类。测量支气管动脉主干内径和肺癌病灶、转移淋巴结同一层面增强前后CT值。对各组左、右支气管动脉显示率进行X~2检验，然后行X~2分割两两比较各组间差异；对各组间左、右支气管动脉内径均数进行方差分析；对肺癌病灶和转移淋巴结强化程度与左、右支气管动脉内径进行Pearson相关分析。
结果
本研究共101例病例，两侧支气管动脉均未显示25例，均显示59例，17例只显示一侧；左侧显示率为67.33％，右侧显
示率为66.34%。一侧同时显示2支支气管动脉者，左侧13例，
右侧12例;1例左侧同时显示3支支气管动脉。全部病例中右
侧支气管动脉共显示79支，左侧共显示83支。右支气管动脉与
肋间动脉共干35支，左支气管动脉与肋间动脉共干1支，左、
右共干23支。右侧支气管动脉行于右主支气管后方入肺59支
(74 .7%)，内侧入肺29支(25.3%);左侧支气管动脉行于左主
支气管后方入肺23支(27 .7%)，上方入肺38支(4 5.8%)，内
侧入肺22支(26 .5%)。肺癌组支气管动脉确切进入病灶30例。
对各组左、右支气管动脉显示率进行r检验，然后行r分
割两两比较，肺癌组、支扩组与正常对照组显示率有显著差异(p
<0.005);其他各组间无统计学差异(p>0.005)。
对各组间左、右支气管动脉内径均数进行方差分析:肺癌组
与正常对照组、肺栓塞组、肺炎组、支扩组的左、右支气管动脉
内径均具有差异性，统计学显著(p<0 .05)。支扩组与其它各组
左、右支气管动脉内径均具有差异性，统计学显著(P<0.05)。
正常对照组、肺栓塞组、肺炎组间的支气管动脉内径无差异(p
)0 .05)。
左、右支气管动脉内径:右肺癌组分别为2.1000士0.4600nnn
和2.6150士0.65231们匡n;左肺癌组分别为2.1692士0.sl05Inln和
1 .9000士0.4848~。经检验右肺癌时右侧支气管动脉内径比左
侧粗，有统计学意义(目.8855，p<0.05);左肺癌时左侧内径
比右侧粗，有统计学意义(目.3600，p<0.05)。肺癌病灶和转
移淋巴结强化程度与左、右支气管动脉内径均呈正相关。
讨论
1.支气管动脉的多层螺旋CT显示技术
支气管动脉显示对CT的扫描条件、时间、方式都有较高要
求。与单层螺旋CT比较，多层螺旋CT在不增加扫描时间的前
，2
提下可实现更薄层厚、更大范围扫描。
本研究采用11llrn层厚，0.5秒/转扫描速度，20秒可以完成
22cm的大范围扫描，足以满足支气管动脉显示的扫描条件。所
用造影剂剂量和注射速度也与常规增强扫描一致。101例研究对
象的左、右支气管动脉总体显示率分别为67 .33%和66.34%，明
显高于MoriK所报道的39.1%和29.5%。
所以，支气管动脉多层螺旋CT扫描易于操作、方法简单，
提高了CT对支气管动脉的检测能力。并且在观察支气管动脉的
同时，还可以对肺部病变进行观察，不需要做单独扫描。
多层螺旋CT具有强大的图像处理功能，但表面遮盖法或容
积显示法等由于图像分辨率低，支气管动脉细小和其它血管遮挡
等原因，较少应用于支气管动脉显示。
支气管动脉纵隔段走行与冠状面角度较小，连续观察冠状
位N田R图像更容易追踪出支气管动脉纵隔段。NIPR图像还能
清晰显示支气管动脉周围解剖结构，更能真实反映支气管动脉形
态和走行。曲面重建图像会导致图像几何形状失真，不能清楚显
示血管与周围结构关系，所以可作为支气管动脉显示的补充成像
方法，但不能取代MPR和轴位图像。
目前，就影像学检查方法而言，即使主动脉造影也难以满意
和全面显示支气管动脉的起点和数目。我们的研究表明多层螺旋
CT增强扫描在显示支气管动脉起点和数目方面，可能比主动脉
造影更加敏感和准确。
由于支气管动脉进入肺内后更加纤细，以及周围的肺动、
静脉信号过强导致多层螺旋CT不能清晰显示支气管动脉肺内
段。
2.肺疾病的支气管动脉改变
本研究中，各组左、右支气管动脉显示率均有不同。其中，
肺癌组、支扩组与正常对照组的显示率有明显统计学差异。
造成显示率不同的原因主要由支气管动脉内径大小和其内
造影剂浓度决定。本研究中扫描条件、操作技术等人为因素对显
示率差异无影响。因此，各组显示?
Preface
Bronchial arteries are the nutrition vessels of bronchial wall and pulmonary support structure, most of pulmonary diseases are combined with the changes of bronchial arteries on morphology, distribution and blood flowing. Moreover, bronchial arteries are the therapeutic pathways of many pulmonary diseases. The related research on bronchial arteries has become very important, hi this study we collected 101 patients with enhanced MSCT scanning to detect bronchial arteries, evaluate the scanning technique of bronchial arteries with MSCT and try to improve the detective ability, further to evaluate its clinical signification.
Materials and methods
40 cases of lung cancer, 10 cases of bronchiectasis, 10 cases of pulmonary inflammation, 11 cases of pulmonary embolism, and 30 cases as normal contrast group. All cases were examined with thin-slice enhanced MSCT, scanned from aortic arch to diaphragm top in one breathing hold. Speed 0.5s/round, data collection thickness 1.0mm, pitch 5.5, contrast medium dose 1.5ml/kg, injection speed 3.0ml/s, delay time 15s, reconstruction interval 0.5mm, reconstruction thickness 1.0mm. Image data were reviewed by two radiology physician. Then grouped the data by arterial origin and pathway
entering in lung. Measure the inner diameter of bronchial artery and the CT value of the same foci of lung cancer and metastatic lymph node before and after enhancement. Contrast the detective rate of left and right bronchial artery in every group with X2 test, processing the inner diameter of left and right bronchial artery in every group by analysis of variance, the enhanced degree of cancer foci or metastatic node and inner diameter of both bronchial artery were analyzed with Pearson relative analysis.
Results
In 101 cases, the left and right bronchial artery were both undetected in 25 cases, both detected in 59 cases, detected one side in 17 cases; the left artery detective rate was 67.33%, while the right side was 66.34%. In 13 cases 2 bronchial arteries were detected in left side, while in 12 cases detected in right side; among which 3 arteries were all detected in left side. Altogether, MSCT scanning showed 79 right bronchial arteries and 83 left bronchial arteries. 35 right bronchial arteries were co-originated with intercostals arteries, and 1 left side co-originated. Co-originated left and right side bronchial artery were detected in 23 cases. 59 of right bronchial artery(74.7%) entered in the lung behind right main bronchus, the other 20(25.3%) entered through medial side, In 83 left side bronchial arteries, 23 arteries (27.7%)entered in the lung behind the left main bronchus, 38 (45.8%)entered in through the supra side, other 22(26.5%) through medial side of left bronchus, In 30 lung cancer cases MSCT images showed the bronchial arteries entered into the foci clearly.
Contrast the detective rate of left and right bronchial artery in every group with X2 test, there was significant difference between
lung cancer group, bronchiectasis group and normal group(P<0.005), while there was no statistic differences between other groups(P>0.05).
There was obvious statistic difference(P<0.05) in the diameter of bronchial artery between lung cancer group and other groups as normal, pulmonary embolism, pulmonary inflammation and bronchoectasis group; the same as bronchoectasis group compared with normal, embolism and inflammation group(P<0.05). While there was no statistic difference(P>0.05) between inflammation, embolism and normal groups.
The inner diameter of left and right bronchial artery in right lung cancer group were 2.1000±0.4600mm, 2.6150±0.6523mm respectively; 2.1692±0.5105mm, 1.9000±0.4848mm in left lung cancer group respectively. The inner bronchial artery diameter of the same side with cancer foci was larger than the other side without cancer(P<0.05). The enhancement degree of cancer foci and metastatic node was positively correlated with both side inner diameter of bronchial arteries.
Discussion
1.The MSCT detective technique of bronchial art
引文
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13．韩铭钧，颜小琼，王丽雅，等．支气管肺癌的血液供应—大白鼠肺鳞癌模型的血管灌注与选择性支气管动脉造影的对照研究．中华放射学杂志，1988，22：243—245
14．肖湘生，欧阳强，韩希年，等．肺癌学供的DSA研究及临床意义．中华放射学杂志，1997，31：446—448
15．韩铭钧，冯敢生，杨建勇，等．肺动脉不参与肺癌供血—实验和DSA研究．中华放射学杂志，2000，34：802—804
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18. McGuinness G, Naidich DP, Leitman BS, et al. Bronchiectasis: CT evaluation. AJR, 1993, 160:253--259
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10． 张朝佑．人体解剖学．第二版．北京：人民卫生出版社
11. Liebow AA, Hales MR, Lindskog GE. Enlargement of the bronchial arteries and their anastomoses with pulmonary arteries in bronchiectasis. Am J Pathol, 1948, 25:211--231
12. Defabach ME, Charan NB, Lakshimmarayan S, et al. The bronchial circulation: small but vital attribute of the lung. Am Rev Respir Dis, 1987, 135:463--481
13．韩铭钧，颜小琼，王丽雅，等．支气管肺癌的血液供应—大白鼠肺鳞癌模型的血管灌注与选择性支气管动脉造影的对照研究．中华放射学杂志，1988，22：243—245
14．肖湘生，欧阳强，韩希年，等．肺癌学供的DSA研究及临床意义．中华放射学杂志，1997，31：446—448
15．韩铭钧，冯敢生，杨建勇，等．肺动脉不参与肺癌供血—实验和DSA研究．中华放射学杂志，2000，34：802—804
16. Wagner EM, Blosser S, Mitzner W. Bronchial vascular contribution to lung lymph flow. J Appl Physiol, 1998, 85:2190--2195
17. Song JW, Im JG, Shim YS, et al. Hypertrophied bronchial artery at thin-section CT in patients with bronchiectasis: correlation with CT angiographic findings. Radiology, 1998, 208:187--191
18. McGuinness G, Naidich DP, Leitman BS, et al. Bronchiectasis: CT evaluation. AJR, 1993, 160:253--259