原発性肺癌術前検査としてのDSA装置による肺動脈造影の有用性

Preoperative evaluation of digital subtraction pulmonary angiography in primary lung cancer

　Digital Subtraction Angiography （DSA）は，人体を通ってきたX線をdetectorとしての1．1．-TV系を用いて検出し，情報をデジタル化して電算機によってサブトラクションを主とする画像処理を行って画像化する方法である^1）。経静脈性に造影剤を注入して動脈の造影が可能であり，また検査の時間短縮ができ，非侵襲的な検査法として注目されている。しかし，そのmotion artifactのため，従来は肺血管造影（PAG）には不向きとされてきた。

　さて，DSA装置による肺血管造影（DSA-PAG）の肺門部血管浸潤病変の評価の有用性については，すでに共著者である呉屋^2,3）が報告しているが，今回われわれは原発性肺癌術前ルーチン検査としてのこの検査の有用性に関して検討し，有効な知見を得たので報告する。

The preoperative evaluation of the resectabilityfor primary lung cancer was studied by using dig-ital subtraction pulmonary angiography (DSA-PAG).

Thirty operative cases with primary lung cancer performed DSA-PAG as preoperative test at random for 3 years from June 1985 were subjected in this study.

The apparatus used is DSA device (Angiotoron) of a product of Siemens Co., Ltd.

The findings obtained by DSA-PAG were retro-spectively studied according to the surgical findings, operative modes and postoperative histopathological findings. Moreover, at the same time, usefulness of DSA-PAG was evaluated comparing its findings with preoperative enhanced CT interpretation.

The useful findings were obtained in 10 cases of 30 cases (33%). Its contents were 2 cases with inva-sion of the left atrium, 2 cases with invasion of su-perior and inferior pulmonary vein, 5 cases with invasion of truncus pulmonary artery and 1 case with interlobar invasion. The findings in all cases were superior to those obtained by the enhanced CT.

The decision of operative modes confirming inva-sion of tumor or metastatic lymph node is one of the important aims of the preoperative test. DSA-PAG can be carried out simply and safely on out-patient basis, additionally, favorable result can be especially obtained in invasion lesions of blood ves-sels of hilus regions. From the result, informations of regions unknown by preoperative CT were ac-curately obtained.

As a rule, DSA-PAG should be performed by the preoperative routine test of primary lung cancer.