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目的利用CT血管造影(CTA)显示支气管动脉(BA)和肺动脉(PA)三维影像学特征,进一步探讨肺癌血供。方法收集原发性肺癌147例及正常对照46例,采用多层螺旋CT胸部增强扫描获得原始图像,用容积显示(VR)、多平面重建(MPR)、最大强度投影(MIP)进行CTA重建,观察和分析BA、PA形态学特征及其与肺癌关系。结果肺癌组BA在VR中清晰显示136例,显示率为92.5%,平均2.3支/例;对照组BA清晰显示32例,显示率为69.6%,平均2.0支/例。肺癌组同侧BA管径较肺癌对侧和正常对照组BA明显增粗(P<0.05);肺癌同侧总截面积显著大于正常对照组(P<0.05),且较肺癌对侧明显增加(P<0.05);肺癌侧BA扩张扭曲呈蚓状走向肿瘤或进入肿瘤内,多分支网状吻合。肺癌组PA均清晰显示,54例PA穿过肿瘤或从瘤旁经过,未见异常变化;25例PA显影完整,受肿块推挤并从周围包绕肿块,形成手握球征;40例PA基本完整,肿块从外对PA环状包埋,PA管腔呈扁平状、偏心性或向心性缩窄或枯树枝征;28例PA受肿块包绕并残缺截断形成残根征。结论原发性肺癌BA明显扩张,总供血量明显增加;PA穿过肿瘤或狭窄截断。多重螺旋CTA同样证明肺癌主要为BA供血,未见PA供血证据。
Objective To evaluate the three-dimensional imaging features of bronchial artery (BA) and pulmonary artery (PA) by CT angiography (CTA) and to further explore the blood supply of lung cancer. Methods 147 cases of primary lung cancer and 46 cases of normal control were collected. The original images were obtained by multi-slice spiral CT and chest CT scanning. CTA reconstruction was performed with volume display (VR), multiplanar reconstruction (MPR) and maximum intensity projection (MIP) Morphological characteristics of BA and PA and their relationship with lung cancer were observed and analyzed. Results In the group of lung cancer, BA was clearly seen in 136 of 136 patients, showing a rate of 92.5% with an average of 2.3 per case. In the control group, BA was clearly displayed in 32 patients, showing a rate of 69.6% with an average of 2.0 per patient. The BA diameter of lung cancer group was significantly larger than that of contralateral and normal lung tissues in BA group (P <0.05), and the same side of lung cancer group was significantly larger than that of normal control group (P <0.05) P <0.05). In patients with lung cancer, the dilated and distorted BA showed a vermicular progression toward the tumor or into the tumor with a multi-branched mesh anastomosis. In PA group of lung cancer, it was clearly shown that 54 cases of PA passed through the tumor or passed from the tumor, no abnormal changes were found. 25 cases of PA developed completely and were pushed by the tumor and surrounded the tumor, Basically complete, the lumps were embedded in the PA rings from the outside, and the lumens of the PA tubes were flattened, eccentric or concentric narrowed or withered branches were signified. In 28 cases, the PA was surrounded by the masses and the trocar impacted. Conclusions BA is obviously expanded in primary lung cancer, and the total blood supply is significantly increased. PA is cut off by tumor or stenosis. Multiple helical CTA also proved that the main supply of lung cancer BA, PA no evidence of blood supply.