On Clinical Application Of Dual-Source Computed Tomography To Bronchial Artery Imaging With Hemoptysis

Objectives:1. Exploring the superiority and clinical application of dual--source computedtomography to bronchial artery imaging with hemoptysis as a major clinical symptom.2. Studying the anatomy and variation of bronchial artery with dual--source computedtomography artery (DSCTA); evaluating the diagnosis of clinical severe hemoptysis withDSCT bronchial artery imaging examination.3. Investigating the correlation and conformance in evaluating DSCT bronchial arteryimagining and digital subtraction angiography (DAS).4. Probing into the diagnostic value and clinical application in clinical suspicious orconfirmed bronchiectasis lesion with DSCT bronchial artery imagingMaterials and MethodsWith DSCT,48patients with symptoms of severe hemoptysis and chest aches wereexamined with plain scan and thin-sliced enhanced CT scan. There were27males and21females. After the obtained data was conducted with thin slice reconstruction, imagereconstruction techniques, such as maximum intensity projection(MIP), multi-planarreformation (MPR), volume rendering (VR) were combined with add/remove structureand arbitrary angle rotation to show sufficiently the relations of bronchial artery route andits surrounding tissues. Digital subtraction angiography was used to identify the feedingarteries and communicating artery of patients with bronchiectasis and hemoptysis,Summaries of anatomy types and DS manifestation of patients with bronchiectasis andhemoptysis are to guide clinical embolization treatment, which is expected to help clinicaltreatment efficiency and cure rate. ResultsIn the48cases, there are31arteries in the bronchial arteries on the left shown clearly,with1.10arteries on average in one case.39arteries in the right bronchial arteries wereshown clearly and with1.39on average in each case. There are6types in distribution, andthe most common two are R1L1(37.5%,18out of48cases) and R2L1(20.8%,10out of48cases). Bronchial arteries on the right share the same artery with posterior arteries betweenribs on the right, esp., between the3rd and4th ribs. Descending posterior arteries comeafter. Bronchial arteries on the left mainly come from descending arteries, and aorticarches are the next. The opening of bronchial arteries on the right correspondingapproximately to T5-T6level is most common; the opening of bronchial arteries on the leftcorresponding to T5-T6level is most common. We used clear DSA results as goldstandard, and quantities which can show bronchial arteries as unit. BA—DSCTA imagingresults of48cases with simultaneous DSA examination and BA-DSA are compared, andthe results are the followings: The specificity is100%; the true positive is76; the truenegative is0; the false positive is6; the false negative is0; the sensitivity is92.9%。ConclusionDual-source CTA has higher spatial resolution and specificity, which can showanatomical characteristics of bronchial artery accurately and clearly by means of variousreconstruction techniques. DSCTA has grasped some information like the origin, walking,size of tube diameter of bronchial arteries, and has provided clear information for clinicaltreatment. DSCTA can make a three-dimensional representation of bronchial arterymorphological features. DSCTA can reduce intubation time for clinical embolizationtherapy and improve its success with higher quality. The application of this technology cangreatly reduce the exposure dose of both the patients and medical staff, which can offerimportant and necessary information for treatment planning, interventional catheterselection, path, and embolic material applied. What is more important about DSCTA is itsnoninvasive examination, which will protect patients from traumatic DSA examination andprovide patients with a new and effective technical choice. At the same time, DSCTbronchial artery image operates conveniently, and can display stereoscopically, directlyand rotate at any angle, which can show the anatomical relations of vessels at an arbitrarydirection and their surrounding tissues. The length and diameters of bronchial arteries canbe measured by3D measurement. The results of CTA imaging and DSA imaging werecompared and found that the sensitivity was96.6%and specificity was100%, while theimage quality can meet the clinical demand. The3D images of trachea and bronchialarteries can clearly display the starting point, walking route (pulmonary segment and mediastinal segment), and vascular diameter. The3D images can also show the shape, sizeand density of lesion and the connections of its edge with the surrounding tissues, plus thedegree and means of lesion enhancement after enhancement. DSCT bronchial vascularimaging is noninvasive, convenient and fast, and it can become a diagnostic method forbronchiectasis and severe hemoptysis, which is helpful to develop clinical interventionalembolization. There are also some defects: Patients have to receive a larger doses of Xradiation upon examination; we could not make a real-time and dynamic observation andcomparison of contrast media in hemodynamic changes at bronchial artery and pulmonaryarteriovenous fistula; there are false negative and false positive in judging vascularinvasion of mediastinal segment and pulmonary hilum; DSCTA also has the limitations oftime-consuming in image post processing. DSCTA will be better in future after continuouspractice and improvement.