The Applying Value Of Dual Source CT With “Double Low” Technology Single-phased Angiography In The Follow-up Of The Patients With The Arterial Pulmonary Sequestration

Chapter Ⅰ The clinical,pathological,imaging features and the follow-up changes of the patients with the arterial pulmonary sequestra-tion:compared with those of intralobular pulmonary sequestrationObjective:To summarize the clinical manifestation,pathological and the follow-up changes of the patients with the arterial pulmonary sequestration,and compared with those of the intralobular pulmonary sequestration to improve knowing about this rare anomaly.Material and Methods:The imaging materials of 109 patients with pulmonary sequestration who were admitted to the Affiliated Hospital of Jining Medical University and the First People’s Hospital of Jining City from October 2009 to June 2018 were reviewed.Of them,37 were diagnosed as arterial pulmonary sequestration,the corresponding clinical,pathological,imaging materials and the follow-up records were retrospectively analyzed.37 patients with the arterial pulmonary sequestration underwent enhanced CT scans or CTA,of them,19 had chest radiographs,and 7 had DSA;and compared with the clinical,pathological and imaging materials of 24 patients with the intralobular pulmonary sequestration confirmed by histopathology at the same time.Results:The rate of the patients with the arterial pulmonary sequestration among the patients with the pulmonary sequestration was approximately 33.94%(37/109).(1)Clinical manifestations The main symptoms and signs of patients with arterial pulmonary sequestration included the recurrent hemoptysis(100%,37/37),persistent chest pain in the affected area(27.03%,10/37),fever,cough and sputum and higher white blood cell count accounted for 10.81%(4/37),respectively.While,the patients with the intralobular pulmonary sequestration usually suffered from the recurrent cough and sputum(66.7%,16/24).The difference of the recurrent hemoptysis,persistent chest pain,fever and higher white blood cell count between them was significant(P<0.05).(2)Histopathology The normal alveoli,abundant tortuous vessels and normal bronchi in the affected lung of the patients with the arterial pulmonary sequestration were its main pathological fearures,which were markedly different from the abnormal alveoli,bronchi and the infiltration of a large number of the inflammatory cells in its mesenchyma of the patients with the intralobular pulmonary sequestration.The difference of the alveoli and mesenchyma(including the dialated blood vessels,inflammatory cells infiltration and abnormal bronchi)was significant(P<0.05).(3)The imaging presentations The markedly dilated anomalous systemic arteries of the arterial pulmonary sequestration originating from the descending aorta supplied the partial or all of the basal segments of the inferior lung lobe,which were usually associated with the atherosclerosis(35.13%),aneurysms(8.11%)and aneurystic dilation(16.22%).The corresponding branches of the affected pulmonary artery usually presented aplasia.The volume of the affected lungs presented atrophic,its lung markings were thickened and increased.The reflux veins were from the ipsilateral inferior pulmonary veins,which usually depicted dilated to some degree.The bronchi or its branches demonstrated normal.But for those of the intralobular pulmonary sequestration,it usually had the smaller anomalous systemic artery,which were less accompanied by atherosclerosis.The affected lung usually presented solid,cystic,solid-cystic or focalized emphysematous changes.It did not have the normal bronchi,and did not connected with the other normal bronchi.Its branches of the affected pulmonary artery often depicted dysplastic.The difference of the diameter and accompanied lesions of the anomalous systemic artery,affected pulmonary segments,the branches of the affected pulmonary artery and bronchi and the changes in the affected lung between them was significant(P<0.05).(4)Folow-up changes 22 patients with the arterial pulmonary sequestration were followed up by the enhanced CT or CTA,the accompanied vascular lesions(dilated bronchial artery:3 cases;new aneurysm of the anomalous systemic artery:2 cases;enlarged aneurysm of the anomalous systemic artery:one case;enlarged aneurystic dilation of the anomalous systemic artery:4 cases)were found,accounting for 45.45%(10/22).Conlusion:The arterial pulmonary sequestration is rare,accounting for 33.94%among the pulmonary sequestrations.The persistent chest pain in affected area is also another common clinical manifestation besides the most common symptom(recurrent hemoptysis).The affected sides,range and the accompanied lesions present various besides its typical imaging presentations.The symptomatic patients with the arterial pulmonary sequestration should be followed up by the enhanced CT or CTA because of the more common vascular lesions occurring in them.Due to the significant difference from the intralobular pulmonary sequestration in the clinical,pathological and imaging appearances,The arterial pulmonary sequestration maybe a new congenital lung vascular lesion.ChapterⅡ The applying value of dual source CT with“double low”technology single-phased angiography in the follow-up of the patients with the arterial pulmonary sequestrationObjective:To explore the applying value of the“double low”technology of the dural-source single-phased CT angiography based on high-pitch(3.4),low tube voltage(100 kV),CARE Dose 4D,iterative reconstruction,electrocardiography-gated and less contrast material usage(55ml)in the follow-up of the patients with the arterial pulmonary sequestrations.Materials and methods:22 patients with the arterial pulmonary sequestrations from the Affiliated Hospital of Jining Medical University and the First People’s Hospital of Jining City were followed up for the different causes.Firstly,they underwent the chest CTA by the conventional double-phased scanning(the pulmonary-artery phase and the aortic phase),and they underwent the single-phased scanning with the“double low”technology based on high-pitch(3.4),low tube voltage(100 kV),CARE Dose 4D,iterative reconstruction,electrocardiography-gated and less contrast material usage(55ml).The objective parameters(vessel attenuation of the anomalous systemic artery,pulmonary artery and pulmonary vein,vessel noise and background noise)and subjective scores were quantitatively measured and signal-to-noise(SNR)and contrast-to-noise(CNR)were calculated.Two radiologists performed qualitative assessment grading visualization of the pulmonary vasculature and noise level.CTDI vol and DLP were recorded and the effective dose(ED)was calculated.The contrast material dosage and radiation dose of two groups were analyzed on SPSS 20.0.The measurement data were mean±standard deviation for statistical description and analyzed by paired t test.the enumeration data were analyzed by X~2 test.The difference is considered significant when the p value is bellow 0.05.Results:The background and vascular noises of 22 patients with the arterial pulmonary sequestrations increased in the“double low”protocol than those of the conventional protocol,the difference of the background noises between two protocols was significant(t=-4.51,-3.38,-3.71,P<0.05);while,there was nostatistical significance between two protocols about the objective evaluation of SNR and CNR for the image quality(t=0.66,0.00;0.96,0.42;0.18,-1.22,P>0.05).The subjective scores for the image quality of the anomalous systemic artery,pulmonary artery,pulmonary vein and the branching of anomalous systemic artery between two protocols were no statistically different(Z=-0.58,-0.45,-0.00,-0.45,P>0.05).The difference of the diagnosing accuracy between two protocols was no significant(X~2=1.02,P>0.05).The CTDI vol,DLP and ED of 22patients with the arterial pulmonary sequestration were significantly lower(t=73.79,58.35,58.17,P<0.05)in the“double low”protocol compared to the conventional protocol;the ED decreased by 90.29%.The dosage of the contrast medium in the double-low protocol was decreased by 36.29%than that of the conventional protocol.Conclusions:The“double low”technology of the dural-source,single-phased CT angiography based on high-pitch(3.4),low tube voltage(100 kV),CARE Dose4D,iterative reconstruction,electrocardiography-gated and less contrast material usage(55ml)can meet the requirement of the image quality of CTA for the followup of the patients with the arterial pulmonary sequestrations,and can greatly reduce the dose of radiation and contrast medium.