支气管动脉-肺动脉瘘的临床和CT血管造影分析  

The clinical and CT two-phase imaging features of bronchial-pulmonary arterial fistula

作　　者：朱巧洪[1] 伍筱梅[1] 林翰菲[1] 曾庆思[1] 李娴[1] 孙翀鹏[1] 

机构地区：[1]广州医科大学附属第一医院放射科,510120

出　　处：《中华结核和呼吸杂志》2014年第9期687-691,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：广东省科技计划项目（2010B031600144）

摘　　要：目的 探讨支气管动脉-肺动脉瘘的临床特征,总结其影像学表现特征.方法 连续纳入2012年4-8月广州医科大学附属第一医院放射科行肺动脉造影的502例患者,其中男37例,女28例,年龄45 - 83岁,平均（69 ±11）岁.均行肺动脉和主动脉两期扫描,使用128层螺旋CT进行扫描.分析患者临床表现特征,并由2名放射科医生分别分析两期CT血管造影表现.结果 502例中65例符合CT支气管动脉-肺动脉瘘诊断标准.其中咯血32％,气促69％,低氧66％,D-二聚体升高70％,肺动脉高压64％.CT两期血管造影影像表现：肺动脉期分流征阳性者（65例）的肺/主动脉密度差为100-751 HU,平均（322±122）HU,表现为肺动脉分支近端局部充盈不良（12％）,整条肺动脉分支充盈不良（88％）;主动脉期分流征阳性者（58例）的主/肺动脉密度差为85 - 428 HU,平均（251 ±89）HU,表现为肺动脉分支近端局部异常高密度显影（24％）,整条肺动脉分支高密度显影（76％）,同时全部见增粗的支气管动脉向瘘区分布.65例支气管动脉-肺动脉瘘患者中56例存在肺脏基础病,其中蜂窝肺35例,肺不张16例,团块状慢性肺炎3例;9例存在肺血管病,其中慢性肺动脉栓塞4例,血管先天发育畸形3例,肺动脉炎1例,肺动脉瘤1例.437例非支气管动脉-肺动脉瘘患者中4例合并肺动脉病变,76例合并肺组织病变.经统计学分析,支气管动脉-肺动脉瘘与肺动脉病变及肺组织病变均有明显相关性（x2值分别为37.51和165.11,均P＜0.001）.结论 支气管动脉-肺动脉瘘好发于肺部慢性炎症及肺血管病变,良好的CT肺/主动脉两期扫描可以检出其血流动力学变化从而正确诊断该病,本病需要与肺动脉栓塞相鉴别.Objective To study the clinical features of bronchial-pulmonary arterial fistula,and to analyze its imaging features.Methods In continuous five months,502 patients for pulmonary angiography were analyzed by pulmonary/aortic arterial two-phase scanning.The 128-slice MSCT （Siemens Definition AS 128） was used with the following parameters：the speed of 0.5 s/weeks,the collimator width of 64 × 0.6 mm,the pitch of 0.9,the tube voltage of 120 kV,the contrast agent of 300 mg/ml（1.2 ml/kg）,and the flow rate of 4.3 ml/s.Automatic trigger technology was used,while the threshold of the main pulmonary artery trunk was set to 80 HU.After 4 s delay,the pulmonary-arterial phase was scanned for 3-5 s.Then,the aortic-arterial phase was taken after 12 s.Finally,the clinical features and CTA two-phase images were analyzed by two radiologists,respectively.The diagnozied criteria of CTA images for bronchial-pulmonary arterial fistula were as following.In pulmonary/aortic arterial two-phase scanning,pulmonary artery or aortic artery could be displayed,respectively.The filling defect of fistula＇s pulmonary artery was observed in pulmonary arterial phase.However,the filling defect of fistula＇ s pulmonary artery had significant filling in aortic arterial phase,with the similar density intensity of aortic artery.In addition,the thicken bronchial artery were observed in the fistula area.Results Clinical features：In all 502 patients,65 positive cases of the bronchial-pulmonary arterial fistula included 37 male cases and 28 female cases with ages from 45 to 83 years （69 ± 11）.The clinical symptoms included hemoptysis （32％）,anhelation （69％）,hypoxia （66％）,the raise of D2 dimer （70％）,and pulmonary hypertension （64％）.CTA two-phase images features：In the pulmonary-arterial phase,the intensity difference of pulmonary/aortic was [322 ± 122 （100-751）] HU.The local filling defect in the proximal pulmonary artery （12％） and the filling defect in the whole pulmonary artery （88％） were

关 键 词：支气管动脉-肺动脉瘘 体层摄影术 X线计算机 肺动脉造影 支气管动脉造影 

分 类 号：R816.4[医药卫生—放射医学]