双源CT支气管动脉成像技术在咯血诊断中的应用研究

发布时间：2018-05-04 03:40

本文选题：双源CT + 支气管扩张症　；参考：《泰山医学院》2012年硕士论文

【摘要】：目的探讨DSCT支气管动脉成像技术在诊断咯血相关异常支气管动脉疾病的优势及临床应用价值。以DSCTA研究支气管动脉的解剖及变异，评估DSCTA支气管动脉成像检查对临床大咯血的诊断价值；以及双源DSCTA支气管动脉成像检查对临床上怀疑或确诊支气管扩张病变的诊断价值及临床应用。探讨双源DSCTA支气管动脉成像与DSA成像评估中的相关性及一致性。材料和方法采用DSCT对48例临床以大量咯血、胸痛为主要症状的患者行胸部平扫及薄层增强扫描检查。其中男27例，女21例，现将获得的图像资料进行薄层重建图像后，使用（maximum intensity projection，MIP）最大密度投影技术、（multi-planarreformation-MPR）多平面重建、容积再现技术、（volume rendering，VR）等图像重建技术与Add/Remove Structure，任意角度旋转等功能充分结合起来，充分显示支气管动脉路径及其与周围组织的关系。结合术中数字减影血管造影术（DSA），确定支气管扩张并大咯血患者供血诸支共干及交通动脉，总结支气管扩张并咯血病人的供血动脉解剖学分型及DSA表现，指导临床进行介入栓塞治疗，提高临床治疗有效率及治愈率。结果在本统计组病例48例中，左侧支气管动脉亦能清晰显示51支，平均1.11支/例。右侧支气管动脉能够清晰显示65支，平均显示1.35支/例。支气管动脉的分布类型共存在6种分支类型，最为常见的是R1L1（37.5%，18/48例）、R2L1（20.8%，10/48例）两种类型。右侧支气管动脉主要与右侧肋间后动脉共干，，尤其是第3、4肋间后动脉共干，其次为直接来自降主动脉分支。左侧支气管动脉则主要来自降主动脉，其次是主动脉弓。最为常见的是右侧支气管动脉开口约对应于T5--T6水平，所有左侧支气管动脉开口对应于T5--T6水平最为常见。我们以DSA结果作为金标准，以能够显示支气管数量为单位，将本组48例同时进行DSA检查的BA--DSCTA成像结果与BA-DSA对比，结果特异度为100%，真阳性118支、真阴性0支、假阳性9支、假阴性0支，敏感度为92.9%。结论 DSCTA具有较高的空间分辨率及特异性，能够利用各种重建技术，准确、直观地显示出支气管动脉的解剖特征，掌握支气管动脉的开口、起源、走行、管径大小等信息，为临床提供了准确的信息；立体地再现了支气管动脉的形态特征，走形轨迹，为临床介入栓塞治疗，提高插管成功率、减少插管时间。此技术的应用大大减小了患者和医护人员的受照剂量，对治疗方案的设计规划、介入导管的选择，还有路径、栓塞材料的应用提供必要的信息。更重要的是DSCTA为无创性检查，使非血管患者免受创伤性DSA检查。将CTA成像结果与DSA成像结果比对，敏感度为92.9%，特异度为100%。气管支气管动脉三维图像除了能够清晰显示出支气管动脉的起始开口、部位、走形路径(肺内段和纵隔段)、血管管径等情况外，而且还可以清晰显示病灶的强化后病灶强化的形态，大小，密度以及边缘与周围组织的关系，以及强化程度和方式。不足之处是患者在检查时不得不接受较大剂量的X线辐射；不能够如DSA介入时对比剂在支气管动脉与肺动静脉瘘时的血液动力流向不能实时进行动态观察；图像后处理过程费时；存在一定的假阴性或假阳性。在判断纵隔、肺门大血管受侵时均为双源CTA的局限性。将来不断实践操作，不断总结改善，一定愈加完善。
[Abstract]:Purpose

To investigate the advantage and clinical application value of DSCT bronchial artery imaging technique in the diagnosis of hemoptysis related abnormal bronchial artery disease .
To investigate the diagnostic value and clinical application of dual - source DSCTA bronchial artery imaging ( DSCTA ) in the diagnosis of bronchiectasis .

Materials and Methods

With DSCT , the chest plain scan and thin layer enhanced scanning were performed on 48 patients with massive hemoptysis and chest pain . Among them , 27 male and 21 female patients were treated by thin layer reconstruction of image data , and the relationship between bronchial artery path and surrounding tissues was fully demonstrated by means of maximum intensity projection ( MIP ) maximum density projection technique , multi - plane reconstruction , volume rendering technique , volume rendering ( VR ) , etc .

Combined with the intraoperative digital subtraction angiography ( DSA ) , the blood supply arteries and the traffic arteries of the patients with bronchiectasis and hemoptysis were determined , the blood supply artery anatomy classification and DSA performance of the patients with bronchiectasis and hemoptysis were summarized , and the interventional embolization treatment was guided to improve the clinical treatment efficiency and cure rate .

Results

Among 48 cases in the present statistical group , 51 branches were clearly displayed on the left bronchial artery , with an average of 1.11 branches / case . The right bronchial artery could clearly show 65 branches , the average display 1.35 branches / cases . There were 6 types of branches in the distribution type of bronchial artery . The most common types were R1L1 ( 37.5 % , 18 / 48 ) , R2L1 ( 20.8 % , 10 / 48 cases ) .

The results of BA - DSCTA imaging of right - hand bronchial artery mainly come from descending aorta , followed by aortic arch . The most common is that right bronchial artery opening corresponds to T5 - -T6 level , all the left bronchial artery opening corresponds to T5 - -T6 level . The result of BA - DSCTA imaging with DSA is 100 % , true positive 118 branches , true negative 0 branch , false positive 9 branch , false negative 0 branch , sensitivity is 92.9 % .

Conclusion

DSCTA has high spatial resolution and specificity , and can be used in various reconstruction techniques to accurately and intuitively display the anatomical features of bronchial artery , grasp the information such as opening , origin , walk and size of bronchial artery , and provide accurate information for clinic .
The application of this technique greatly reduces the dosage of the bronchial artery , improves the success rate of the intubation , and reduces the intubation time . The application of this technique greatly reduces the patient and the medical personnel ' s exposure dose , and provides the necessary information for the design planning of the treatment plan , the selection of the interventional catheter , the relationship between the edge and the surrounding tissue and the enhancement degree and the way .
It is not possible to observe the dynamic flow of the contrast agent in the bronchial artery and the pulmonary arteriovenous fistula in real time when the bronchial artery and the pulmonary arteriovenous fistula can not be accessed by DSA ;
the post - image processing is time - consuming ;
There are some false negatives or false positives . The limitation of double - source CTA is the limitation of the two - source CTA .

【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R56

【参考文献】