| Objectives 1 Using 256-slice spiral CT to compare the effect of ECG-bronchial artery CT angiography and chest double-phase enhanced CT on bronchial artery image quality.2Using 256-slice spiral CT to evaluate the effect of different vessel three-dimensional reconstruction methods on the quality of bronchial artery imaging.3 256-slice spiral CT ECG-bronchial arterial angiography and reconstruction of MPR+MIP were used to investigate the anatomy and blood supply of the lower bronchial artery in the middle and late stage of central lung cancer.Provide accurate imaging support before interventional embolization.Methods 1 400 patients with pulmonary CT in the 256-slice spiral CT of North China University of Technology were randomly divided into 2 groups,200 in each group,with group I:CT angiography of bronchial arteries,group II:chest double During the enhanced scan,at least one patient with bronchial artery(BA)was selected,136 patients in group I and 108 patients in group II.The image quality of the two groups was evaluated with reference to the coronary artery scoring criteria.Two pairs of 136 patients undergoing CT angiography of bronchial arteries were treated with group A(MPR+MIP),group B(MPR+VR),and group C(MPR+CPR).3 For the 135 patients who underwent chest CT scan or/and enhanced pulmonary tumors from July 2017 to May 2018 and who were diagnosed as bronchoscopy,biopsy,or postoperative confirmed central-stage lung cancer,CT angiography of bronchial arteries were performed in group III,and the bronchial artery angiography was performed on group I and group III by MPR+MIP combined post-processing method.The relationship between BA display,anatomical classification and the number of blood vessels,origin orientation and branch type were recorded in detail.At the same time,understand the three-dimensional positioning information of the beginning of the BA.All data were statistically analyzed using SPSS 22.0 software.Results There were no significant difference in clinical data between age and gender in each group(P>0.05).1 The image quality scores of group I and group II were 2.79±0.94and 2.17±1.08,and the difference was statistically significant(P=0.004,P<0.05).2 Of the136 patients,group A were able to determine the origin of BA.Only 17 patients in group B could not be identified.Group C were able to determine 128 cases of BA origin,and 8cases could not be identified.There was a statistically significant difference between groups A and B(χ~2=18.133,P<0.001);there was a statistically significant difference between groups A and C(χ~2=6.311,P=0.012,P<0.05);there was no statistical significance between groups B and C(χ~2=3.568,P=0.059,P>0.05).A total of 314 BAs were displayed in 136 patients.Group A could display all of them completely.Group B could only display108 BAs completely,of which 206 showed incomplete or no display.Group C could also display 291 BAs completely,but still 23 can not be fully displayed.There was a statistically significant difference between groups A and B(χ~2=306.559,P<0.001);there was a statistically significant difference between groups A and C(χ~2=23.874,P<0.001).In terms of BA origin and gross morphology,group A was significantly higher than group B and group C,and the difference was statistically significant(P<0.01).3 The bronchial artery display rate of tumor group was higher than control group(χ~2=53.402,P<0.001),the number of BA was more than control group(t=0.745,P=0.762,P>0.05),and the inner diameter was significantly thicker than that of the control group(t=3.084,P=0.002,P<0.05).Anatomical classification of BA:The right BA in control group and tumor group were common in type I,which were 53.1%(87/164)and 60.2%(109/181),respectively,and the difference was not statistically significant(χ~2=6.071,P=0.108,P>0.05).BA was more common in type IV,85.3%(128/150),89.8%(141/157).The origin of BA was:in control group,65.5%(57/87)type I,40%(18/45)type II BA originated from the right side wall of the thoracic aorta,and 53.6%(15/28)type III and 39.1%(50/128)type IV BA originated from the thoracic aorta,respectively.The left anterior wall and anterior wall,each 50%(1/2)V-type BA originated from the right anterior and right wall of the thoracic aorta,respectively,and 4.5%(14/314)of type VI BA ectopic origin.In tumor group,60%(61/109)type I,32.1%(17/53)type II BA originated from the right side wall of the thoracic aorta,47.6%(10/21)type III and 36.9%(52/141).Type IV BA originated from the left anterior wall and anterior wall of the thoracic aorta,and 100%(1/1)V type BA originated from the right wall of the thoracic aorta,and 3.8%(13/338)type VI BA ectopic origin.Z-axis localization at the starting point of BA:In control group and tumor group,type I and type II BA were located in the range of 2cm and 1cm below the tracheal carina,respectively,89.4%.(118/132),87.7%(142/162),and the III-V BA were mostly located1cm above and below the carina,which were 78.5%(124/158)and 74.8%(122/163),respectively.Academic significance(χ~2=1.278,P=0.258,P>0.05).BA branch types:10types were found in control group,and 11 types were found in tumor group.The most common ones were R1L1,which are 43.4%(59/136)and 44.4%(60/135),followed by R2L1,which are 18.4%(25/136)and 20.0%(27/135).Conclusions 1 The pulsation of large blood vessels such as the heart can affect the image quality of the BA.Apply ECG gating technology to reduce or eliminate motion artifacts to obtain high quality bronchial artery images.2 The method of post-processing with MPR+MIP can quickly and accurately display the anatomical features and general shape of BA imaging.3 256-slice spiral CTBA imaging technology can display bronchial artery very well.The anatomical classification and origin of BA were not related to lung cancer,and the inner diameter is closely related to lung cancer.BA is involved in the blood supply of central and advanced lung cancer,the 256-layer spiral CTBA imaging technology can provide a basis for the clinical preoperative search for BA pathway,postoperative evaluation of treatment effect or the search for the cause of surgical failure.Figure7;Table11;Reference 129. |
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