| Part one. The Anatomical CT Classification of Bronchial ArteryObject: To evaluate anatomical classification of bronchial artery with64-detector CTangiography and its clinical value.Materials and Methods:136patients underwent CT angiography of bronchialarteries (BAs) using volume rendering (VR), multiplanar reconstruction (MPR) andmaximum intensity projection (MIP). The three dimensional reformation images were usedfor anatomical classification of BA (six types). Spatial localizing data of BA ostia atthoracic aorta was measured simultaneously.Results: We identified358BAs:188right BAs and170left BAs. R1L1and R2L1BA patterns accounted for50%(68/136) and24%(33/136) respectively. The right BAswere commonly seen in type I (77/188,41%), while the left BAs were mostly seen in typeIV (110/170,65%). BAs originated from the right wall of the thoracic aorta were seen intype I, type II and type V with frequencies of100%(77/77),59%(32/54) and100%(9/9),respectively. BAs arised from the anterior wall were seen in type III and type IV withpercentages of83%(40/48) and56%(62/110). There were86%(255/298) BAs ostiaoriginating at thoracic aorta within range of±2cm from tracheal bifurcation.Conclusion: The CT classification of BAs combines with their ostia localizing dataplay an important part in BA interventional operation. Part Two. Bronchial Artery Angiography with Retrospective ECG-gatedCT: A Prospective StudyObject: To evaluate the rate of bronchial artery (BA) visualization and their imagequality with retrospective ECG-gated CT, compared with routine spiral CT scanninggroups.Materials and Methods: All patients gave written informed consent.120cases whounderwent pulmonary arterial enhancement scanning (PAES) were enrolled, according todesigned inclusion and exclusion criteria. They were randomly divided into three groups.Retrospective ECG-gated BA-CTA was used in Group A, which temporal resolution was227ms. Routine spiral CT scanning was used in Group B and Group C, which gantryrotation speed was0.4s/r and0.5s/r respectively. Bronchial arteries were divided intomediastinal BA and lobar BA. Two blinded observers independently assessed imagequality of mediastinal BAs by using a five point scale (score4~0). A score of4or3wasdifined as good image quality. Inter-group difference in enhancement CT value ofpulmonary and thoracic artery, CT effective doses etc. was compared.Results:①. The frequency of visualized mediastinal and lobar BA in Group A were100%(80/80) and62%(123/200) respectively, which was higher than Group B and GroupC. Theκstatistics of inter-and intraobserver agreement for evoluation of the image qualitywere0.80and0.84, respectively. The agreement analysis for image quality of mediatinalBA demonstrated obviously identicalκstatistics. The rate of good image quality for per-BAwas69%(66/95) in group A, which was much higher than Group B and C. The averageeffective dose (ED) of PAES in Group A was15.6mSv,96%higher than that in Group Band C.②. The rate of visualized mediastinal and lobar BA were89%(71/80) and33%(66/200) respectively, which was higher than Group C. The rate of good image quality forper-BA was36%(30/84) in Group B, which was much higher than group C. The averagesanning time was3.2s in Group B,36%of that in Group A (9.0s).Conclusion: There were satisfactory visualization and good image qualiy of BA with retrospective ECG-gated CT angiography, expect larger ED. There were a fair visualizationrate and image quality in use of0.4s/r spiral scanning that was fastest speed of LightSpeedVCT, because of its lower ED and faster scanning time. So, it is applicable in emergencyBA-CTA for patients of hemoptysis. |
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