A Serial Study Of Bronchial Arterial Angiograpy

PurposesTo search for a better way than DSA to display the bronchial arterial (BA) supply of spinal cord, esophagus, trachea, etc.. And thereby to further evaluate the chance of BA supplying the above structures, in order to reduce the complications of trans-BA infusion and/or embolization.Materials and MethodsMultislice CT angiography of BA (BA-MSCTA) was performed on 19 patients suffering from lung cancer or hemoptysis due to bronchiectasis after undergoing digital subtraction of BA (BA-DSA). Totally 10ml of 45% contrast was injected into BA (1~2ml/s), BA-MSCTA was started 5s after injection, scanning from low cervix to the bottom of lung (collimation: 5mm; no overlap reconstruction ). The intra-spinal canal, esophageal, tracheal, etc. enhancement was noted. ResultsOn BA-DSA, except for one case in which a bronchial arterial was faintly displayed, no other spinal artery, no intra-spinal canal or esophageal or tracheal enhancement was seen. While on BA-MSCTA, intra-spinal canal enhancement was observed in seven cases, including five cases of spinal enhancement (5/19,26.3%). All the seven cases were associated with an intercostobronchial trunk. 15 cases of esophageal enhancement and 18 cases of tracheal enhancement were also observed.ConclusionsBA-CTA is superior to BA-DSA in displaying the BA supply of the spinal cord, esophagus, trachea, etc.. Spinal arteries are more likely to appear in case of a intercostobronchial trunk, and absence of spinal artery on DSA does notrule out the existence of the artery. The complications of trans-BA intervention are more likely due to chemical toxicity other than ischemia caused by embolization with particles.To Further evaluate the blood supply of lung cancer using multislice CT angiography of pulmonary and bronchial artery (PA-MSCTA; BA-MSCTA), and thereby provide some implication for interventional therapy of lung cancer.Materials and MethodsPA-MSCTA and BA-MSCTA were performed on 16 patients with primary lung cancer and on two patients with metastatic lung cancer after digital subtraction angiography of BA and PA (BA-DSA; PA-DSA) via trans-femoral arterial and venous route. For PA-MSCTA, 30ml of 45% contrast was injected into PA(10ml/s), and scan started when 20ml had been injected, covering the range of mass(collimation: 1mm; 50% overlap reconstruction). In one patient with diffuse metastatic nodules, the whole lung was scanned (collimation: 5mm; no overlap reconstruction). For BA-MSCTA, 10ml of 45% contrast was injected into BA (1~2ml/s), and scan was started 5s after injection, ranging from low cervix to the bottom of lung ( pitch 5mm, no overlap reconstruction ). Blood supply of the lung masses, either from BA or PA, if any, was assessed.Results Totally, 17 BA-CTA, 18 BA-DSA, PA-DSA and PA-MSCTA were performed. No hypertrophic tumor vessel or tumor stain was observed on either PA-MSCTA or PA-DSA. While on both BA-DSA and BA-MSCTA, diffuse tumor vessels and tumor were observed in all the cases. On BA-MSCTA, tumor vessel and contrast stain covering the whole range of the mass were seen in 12 cases, while in 5 cases defects of tumor vessel and stain were observed. Hilar and/or mediastinal lymph node enhancement was shown in 7 cases. In three of the four cases in which lymph nodes enhancement were seen on BA-DSA , more lymph nodes enhancement were seen on BA-MSCTA. ConclusionsMSCTA is a better way for evaluation of blood supply of lung cancer. By MSCTA, it is further demonstrated that PA does not supply primary or maybe either secondary lung cancer. There is no need of trans-PA route for interventional therapy of lung cancer, but multiple systemic blood supply should be noticed.PurposesTo analyze the anastomoses between bronchial arteries (BA) and its clinical implications.Materials and MethodsRetrospective and prospective analysis of BA DSA was carried out in 70 cases with lung cancer or hemoptysis undergoing BA infusion and/or embolization. In the former 38 cases, the hard copies (films) of angiog...