小儿先天性气管性支气管的多层螺旋CT诊断

目的：介绍小儿先天性气管性支气管的分类及意义，探讨多层螺旋CT（MSCT）在该病中的诊断价值。方法：回顾性分析43例先天性气管性支气管患儿的计算机X线摄影（CR）、MSCT扫描影像资料，MSCT肺部常规10mm层厚扫描，在16层MSCT机进行1．25mm层厚、1．25mm层间隔重组，获得最小密度投影（minIP）、容积重组（VR）、表面遮盖技术（SSD）、仿真支气管内镜（VB）图像，记录病变的部位及与周围组织的关系和伴发异常。结果：43例病变经CT后处理技术全部清晰显示，CT横断面扫描显示37例，CR仅显示1例；43例中38例有先天性心血管病变，40例为右侧气管性支气管，3例为双侧气管性支气管，共有9例伴随气道狭窄，2例气管插管过深引起右肺上叶节段性肺不张。结论：MSCT对于诊断先天性气管性支气管，显示气道及其周围伴随组织有良好的价值。     

儿童CT仿真支气管镜的临床应用研究

目的：探讨儿童CT仿真支气管镜（CTVB）检查成像技术的特点，小儿气道及其病变的CTVB表现、应用价值和限度，并与纤维支气管镜（FOB）所见进行对比分析。方法：利用GE Hispeed螺旋CT对113例临床疑为气管、支气管腔内疾病的患儿胸部进行容积扫描，将其中经纤维支气管镜手术和病理证实的45例重建图像数据采用导航（ Navigator）软件进行三维重建，形成CTVB图像。结果：45例中，CTVB可100％显示Ⅰ-Ⅲ级支气管，对于Ⅳ-Ⅴ级支气管的 显示率分别为46．7％和13．3％。FOB仅能显示Ⅰ-Ⅲ级支气管`，Ⅲ级支气管的显示率为62．2％。CTVB发现狭窄34例，闭塞11例，占位16例。除3例透X线异物和2例炎性栓子误诊为肿块外，其他与FOB检查结果基本相符。结论CTVB是对CT常规检查方法的重要补充，它可弥补FOB的不足，但不能作为独立的诊断依据，必须结合CT原始图像或重建图像进行综合分析。     

电子束CT气管、支气管树三维重建的临床应用

目的；通过对73例气管，支气管树三维重建的临床应用进行回顾性分析，探讨CT气管，支气管树三维重建的临床应用前景。方法：搜集自10月至2000年2月共73例伴气管，支气管病变或其邻近病变患者。所有对象均接受电子束CT（EBCT）扫描。扫描条件：130kV，630mA，层厚为1．5或3．0mm，扫描方式为连续容积扫描，其横断面图像转入INSIGHT工作站进行三维重建，重建方式为表现遮盖显示法（SSD），重建阈值为－500－－300HU。结果：EBCT气管，支气管树三维重建可显示不同病变引起的气管。支气管树的异常形态改变，包括中央肺癌，炎症，支气管扩张，剑鞘气管，气管癌，先天性异常，肺癌术后等，以及气道邻近的良，恶性病变所引起的气道狭窄，可用于确定狭窄的部位，范围和程度。35例中央型肺癌的SSD三维重建；6例表现为支气管杵状中断，15例为锥状中断，5例为截断且断端不规则，8例为不规则偏心性狭窄，1例为右主支气管的裂开和右上叶支气管的截断。结论：EBCT气管，支气管树三维重建其有特征的征象用于中央气道良，恶性病变的诊断和鉴别诊断。CT气管，支气管树三维重建有一定的临床指导价值。     

多层面CT重建诊断中央大气道良性病变

目的 :分析多层面CT三维重建诊断中央大气道良性病变的价值。材料和方法 :用多层面CT对 3 5例中央气道良性病变 (解剖性异常 5例 ,炎症性病变 18例及其它 12例 )扫描 ,并全部完成三维表面遮盖显示、容积显示和仿真内窥镜检查。所有病例第一次读片时仅有横断面图像 ,第二次读片时增加重建图像。结果 :三维重建帮助 4例横断面漏误诊的解剖性异常获得确诊 ,16例炎症性病变进一步详细显示 ,2例气管支气管裂伤明确范围和程度 ;虚拟内窥镜帮助 5例横断面上不能确诊的痰液获得确诊。结论 :CT三维重建可用于解剖性异常和痰液的诊断 ,对其它良性疾病主要是对病变的另一种形式的进一步显示。     

先天性支气管闭锁的MDCT诊断

目的：回顾性分析先天性支气管闭锁的多层CT（MDCT）影像特征，提高对该病的诊断准确性。方法：回顾性分析9例经临床随访或纤维支气管镜证实的先天性支气管闭锁的MDCT资料，全部病例采取各向同性（层厚≤1mm）CT容积采集，并同时重建5～10mm的常规图像，5例完成增强检查。结果：7例呈典型表现，MDCT表现为受累支气管近端与中心气道不相通，远端扩张，呈粗大而弯曲的分支，其内含气含液6例，单纯含液1例，受累肺组织肺气肿；5例增强扫描显示肺血管变细变少；2例呈不典型表现，直接显示支气管中断伴远侧肺结构紊乱1例，显示受累支气管闭塞伴扩张和含气、含液但无肺气肿1例。三维重建显示病变特征优于常规横断面。结论：先天性支气管闭锁多呈典型表现，包括闭锁的支气管扩张伴黏液栓和肺气肿，现代MDCT各向同性成像三维重建可充分显示其特征从而获得正确诊断；不典型表现需要结合纤维支气管镜检查进行诊断。     

多排螺旋CT对小儿气管、支气管异物诊断的体会

目的：回顾性分析探讨多排螺旋CT对小儿气管、支气管异物诊断的临床应用价值。方法：搜集20例临床可疑小儿气道异物，全部经螺旋CT扫描，将原始图象数据传输至工作站进行图象后处理，获得MPR，SSD，MIP，CTVE等重建图象进行诊断分析。结果：均能显示异物及在气管肉的位置，7例位于右侧支气管（5例位于右主支气管，1例位于右上吏气管，1例位于右中间支气管），5例位于左主支气管，8例位于气管。结论：多排螺旋CT图象后处理技术结合轴位图象是小儿气管、支气管异物诊断的重要手段，并对指导纤维支气管镜取异物具有重要意义。     

16层螺旋CT后处理技术在儿童气管、支气管异物的诊断价值

目的：研究16层螺旋CT三维重建及仿真内窥镜技术对儿童气管、支气管异物的诊断价值。方法：使用螺旋CT对22例怀疑儿童气管、支气管异物的病例行胸部CT平扫,图像重建后传送至工作站处理,使用多平面重建（MPR）及仿真内窥镜技术（CTVB）进行分析,全部病例经纤维支气管镜（FOB）或临床证实。结果：22例中,CTVB显示I～III级气管支气管100%,显示第IV级支气管45.5%;MPR显示I～III级气管支气管100%,显示第IV级支气管50.0%;FOB显示I～II级气管支气管100%,显示第III级支气管72.7%。结论：多层螺旋CT三维重建及仿真内窥镜技术能准确显示气管、支气管异物的位置、大小、形态及阻塞程度,是一种准确、安全的无创性诊断方法,给临床诊断、治疗提供直观的影像学资料,具有较高的诊断价值。     

电子束CT（EBCT）用于仿真支气管镜

目的：探索ＥＢＣＴ 仿真支气管镜的成像方法和成像效果,并初步探讨其应用价值。材料和方法：５０ 例正常人群和３０ 例伴气管、支气管病变者。所有研究对象均接受ＥＢＣＴ 薄层扫描,其横断面图像转入ＩＮＳＩＧＨＴ 工作站进行三维重建。其后选用ＳＩＭＵＬＡＴＥＥＮＤＯＳＣＯＰＹ 程序进行仿真支气管镜。结果：运用ＥＢＣＴ 仿真支气管镜：５０例正常人群清晰地显示了气管、支气管内表面的正常形态与表现, 显示支气管腔可达段一级水平;１８ 例中央型肺癌患者显示腔内肿块的形态及内表面或支气管腔狭窄、阻塞,１２ 例气管、支气管良性狭窄患者分别显示病变的范围、形态及内腔表面的异常表现。３０ 例病例均可以显示病变部位以远的支气管管腔情况。结论：ＥＢＣＴ 仿真支气管镜可以清楚地显示气管、支气管内腔的正常或异常表现;可用于部分气管、支气管良、恶性病变的诊断。ＥＢＣＴ 仿真支气管镜提高了ＥＢＣＴ 用于气管、支气管病变的诊断能力,是对纤维支气管镜的补充。     

先天性支气管闭锁的多层螺旋CT和X线表现

目的分析先天性支气管闭锁的CT和X线表现，以提高对该病的认识和诊断。方法对11例支气管闭锁患者进行了多层螺旋CT（MSCT）扫描。其中3例经手术证实，6例有支气管镜结果，2例随诊1年以上。肺部常规10mm层厚扫描，在16层螺旋CT机进行1．25mm后处理重组，获得多平面重建（MPR）、最大密度投影（MIP）和最小密度投影（MinIP）图像，记录病变的部位和周围肺组织改变。结果11例病变CT均能显示黏液栓和周围气肿改变，其中3例黏液栓内含气体；x线平片亦能显示全部黏液栓，但仅显示8例气肿改变和2例黏液栓内的气液平。3例支气管闭锁位于左侧，8例位于右侧；发生于段支气管者10例，亚段1例；6例位于肺门旁，5例远离肺门。结论黏液栓和周围肺气肿改变是先天性支气管闭锁的典型表现，在先天性支气管闭锁诊断和鉴别诊断上，多层面螺旋CT能提供比x线平片更多的信息。     

气管支气管结核的多层CT诊断

分析气管支气管结核的多层CT(MSCT)表现,并探讨其诊断价值.材料和方法:回顾性分析38例(男12例,女26例,年龄14～53岁,中位数33岁)气管支气管结核,23例经组织学证实,15例经痰菌检查结合多种其他方法临床证实.MSCT检查采用5mm、2.5mm或lmm准直螺旋扫描,结合2.5mm或lmm的薄层扫描,22例做了增强扫描,全部病例均完成了至少2种后处理;32例同期完成了纤维支气管镜检查.5例瘢痕狭窄行支架治疗,治疗前后均行CT检查.结果:38例共检出58支病变,多支受累率44.7%(17/38);支气管狭窄44例,狭窄长度2cm以上93.2%(41/44);管壁不规则增厚,有时见腔内结节;多数(35/38)伴肺内结核病灶;可伴肺门纵隔淋巴结肿大.MSCT结合各种后处理技术可以有效显示病变特征,并特别有助于支架治疗前后气道通畅性的判断.结论:MSCT结合后处理技术可以有效显示气管支气管结核的特征,有助于诊断,并特别有助于支架治疗前后气道狭窄的判断.     

多层螺旋CT仿真内镜对中央型肺癌的评价

目的研究多层螺旋CT(MSCT)仿真内镜(VE)在中央型肺癌的应用。资料与方法69例中央型肺癌，行MSCT扫描后进行VE成像。其中43例同期作纤维支气管镜（FBs)检查对照。结果VE下表现为支气管管腔闭塞34例，气管或支气管偏心性狭窄19例，管腔内占位病变16例。VE与FBS一致性达86．1％。差异主要在过诊为闭塞5例。结论MSCT VE可较好地辅助判断中央型肺癌的位置和支气管狭窄程度。     

气管、支气管黏液表皮样癌的多层螺旋CT表现

目的 分析原发于气管、支气管的黏液表皮样癌（MEC）的CT表现以提高对该病的认识水平。资料与方法 回顾性分析4例经手术病理证实的气管、支气管MEC临床资料和CT表现。所有病例行层厚为3mm胸部螺旋CT扫描,其中平扫3例,增强扫描2例。对所有病例进行多平面重建（MPR）、三维（3D）和仿真内镜（CTVE）重建后进一步观察。结果 1例气管MEC表现为受累气管壁局部增厚,肿瘤轻度强化。3例左主支气管MEC表现为主支气管腔内息肉样结节,并沿支气管方向生长,平扫肿瘤稍低于或等于肌肉密度,密度均匀;1例增强扫描显示肿瘤明显强化,1例见钙化;3例均有气道阻塞性改变,1例纵隔淋巴结肿大。结论 气管、支气管MEC的CT表现有一定特征性。多层螺旋CT的各重建图像能更完整、清晰地显示肿瘤,对临床治疗有重要提示意义。     

2D and 3D CT imaging correlated to rigid endoscopy in complex laryngo-tracheal stenoses

The aim of this study was to compare 2D and 3D CT imaging in the pre- and postoperative evaluation of complex benign larynges-tracheal airway stenoses with rigid endoscopy, considered as the gold standard. Six patients (aged 5–72 years) with a total of nine complex laryngo-tracheal stenoses underwent non-contrast helical CT scans (slice thickness 3 mm, pitch 1.3, reconstruction interval 1.5 mm) before and after surgical resection. With prototype software, virtual endoscopy (VE) post-processing algorithms were applied to the imaging data sets. The VE and multiplanar 2D findings were compared with rigid endoscopy, considered as standard of reference. All nine stenoses were correctly identified on 3D images and their anatomical locations correctly assessed on 2D reconstructions. Artifacts were met when patients were unable to suspend their breath, leading to one false-positive result. Two-dimensional images and 3D VE of tracheal stenoses proved to be efficient and complementary to the rigid endoscopy, permitting a reliable endoluminal 3D view and evaluation of the surrounding anatomical structures. Limitations of this technique relate to the maximal spatial resolution of 1.5 mm, the lack of color, and the inability to assess the mucosa. Virtual endoscopy is for complex laryngo-tracheal stenoses an excellent complement for rigid endoscopy, remaining the method of reference, and may be indicated with complicated pathological structures. Received: 15 September 1999 Revised: 11 February 2000 Accepted: 8 June 2000     

Virtual bronchoscopy in patients with central endobronchial stenosing lesions. Technique optimisation with single slice spiral CT

PURPOSE: To describe an original protocol for single slice spiral Computed Tomography (CT) virtual bronchoscopy in the evaluation of patients with central airway stenoses and compare the results with fibreoptic bronchoscopy. MATERIALS AND METHODS: Ten patients (4 female and 6 male; age range 22-60 years; mean age 44 years) with endobronchial disease diagnosed by fibreoptic bronchoscopy (8 malignant tumours, 1 benign tumour and 1 fibroid stenosis) underwent virtual bronchoscopy with single slice spiral CT. A panoramic spiral CT scan of the whole chest was first obtained. Once the area of interest had been identified, a new contrast enhanced scan was performed, from bottom to top, with the following parameters: 2 mm slice thickness, 1 mm reconstruction index, 1.3 pitch, 120 Kvp, 80 mAs. Virtual bronchoscopy was generated with an upper threshold of -500 HU from the cross-sectional images of the second scan on a dedicated workstation. Axial, multiplanar reformations (MPR), and virtual endoscopy simulation were simultaneously visualised. Virtual CT bronchoscopy findings were compared with those of fibreoptic bronchoscopy. RESULTS: The protocol we used to perform single slice spiral CT virtual bronchoscopy enabled us to obtain virtual bronchoscopy images that correlated well with fibreoptic bronchoscopy findings in all cases, as well as allowing the visualization of the airways beyond the stenoses. Information about tissues surrounding the tracheobronchial tree was also available from axial and MPR images. Only in 1 case were motion artefacts observed. CONCLUSIONS: The set of the most appropriate parameters for performing virtual bronchoscopy by single slice spiral CT has not yet been standardized. In our opinion the appropriate selection of the protocol to adequately realize virtual bronchoscopic images is crucial when using CT devices such as the above, so as to achieve the correct balance between the quality of image definition and exposure dose.     

离体猪肺的气管、支气管树遮盖表面显示法三维重建

目的：探讨CT扫描层厚和间隔对三维重建的影响。材料和方法：研究对象为10具离体新鲜猪肺标本。每一对象均接受层厚／间隔分别为3mm/3mm、3mm/1.5mm和1.5mm/1.5mm三种组合的EBCT扫描。扫描条件：130kV/630mA。扫描方式：连续容积扫描（CVS）。其横断面图像转入Insight工作站（accuimnage diagnostic corporation,USA)进行三维重建,重建方式为遮盖表面显示法（SSD）。重建值为－500Hu--300Hu。结果：（1）新鲜离体猪肺标本气管和支气管的一、二级分支的三维测量与解剖测量相符合。（2）3mm/3mm、1.5mm/1.5mm和3mm/1.5mm三组扫描参的猪肺气管、支气管一级分支的三维重建评分结果间无显著差异;对于二级支气管分支（3.67mm左右管径）的三维重建,3mm/1.5mm组的评分高于1.5mm/1.5mm组,有统计学意义;1.5mm/1.5mm组高于3mm/3mm组,也有统计学意义。结论：降低层厚或重叠扫描进行的三维重建可更好地显示较细的支气管,对于较粗的支气 管其影响不明显。     

Mucus plugs in the ventral bronchi travel less distance than those in the dorsal bronchi: HRCT observation in third-order or smaller bronchi

PURPOSE: To examine on HRCT whether there is a difference in the respiratory moving distance of bronchial mucus plugs between ventral and dorsal bronchi. MATERIALS AND METHODS: We examined 36 ventral and dorsal bronchi of the same order in 18 patients with mucoid impaction depicted on HRCT. CT data were obtained by multidetector-row CT. HRCT images of 0.5 mm thickness and 0.3 mm interval were reconstructed. We selected one slice including a mucus plug take-off from each bronchus. When they were not included in a slice, we reconstructed a 1-3 mm slab-thickness MIP image. In these images we measured the distance between the take-off of each bronchus and the hilar margin of the mucus in same-order ventral and dorsal bronchi. We also measured CT attenuation in the ROI of the subpleural region excluding vessels in the same slice. When the differences in distances (delta D) and CT attenuations (delta C) between inspiration and expiration were obtained, we analyzed the correlation between delta D and delta C in ventral and dorsal bronchi, respectively. We also compared delta D between ventral and dorsal bronchi. RESULTS: Mean delta C was 36.26 +/- 2.78 HU. Ventral delta D was 6.46 +/- 3.75 mm, and dorsal delta D was 2.57 +/- 1.59 mm. The correlation between delta C and dorsal delta D was significant (r = -0.78, p < 0.005), whereas that between delta C and ventral delta D was not (r = 0.23, p = 0.64). The ventral delta D was significantly smaller than the dorsal (p < 0.05). CONCLUSION: Between inspiration and expiration in the supine position, mucus plugs in the ventral bronchi travel less distance than those in the dorsal bronchi.     

喉部螺旋CT仿真内窥镜的临床应用

目的：评价CT仿真内窥镜成像在显示喉部疾病的应用价值。方法：22例喉部疾病患者包括15例喉癌，3例声带息肉，1例披裂炎症，1例咽喉后壁脓肿，以及2例声带固定，均经螺旋CT扫描，获自所有病例的仿真内窥镜成像均与纤维喉镜及手术所见对照分析。所有病例或细胞学证实。结果：CT仿真喉镜对正常解剖结构显示与纤维喉镜一致，显示病变范围优于纤维喉镜，CT仿真喉镜能从足端入路观察，但对较小病灶的显示不如纤维喉镜。结论：CT仿真喉镜能对喉部病变提供较全面的信息，因而它是纤维喉镜的一种很好的补充手段。     

电子束CT（EBCT）仿真支气管镜的实验研究

目的：运用EBCT探索CT仿真支气管镜发现不同大小腔内占位的能力。材料和方法：新鲜离体猪肺标本1具;小土豆块5块。小土豆块用于模拟小的腔内占位。扫描方式为EBCT连续容积扫描,三维重建方式为遮盖表面显示法。结果：3mm层厚扫描的EBCT仿真支气管镜可良好地显示2mm左右以上的气道内占位,显示1.5mm大小的占位时图像失真,对1mm大小的一没有显示;1.5mm层厚扫描的CT仿真支气管镜可良好地显示1.5mm左右以上的气道内占位,显示1mm大小的占位时图像失真。结论：EBCT仿真支气管镜可显示气道内的较小的占位病灶,其检出小占位病灶的能力有一定的限度,且与扫描层厚密切相关。     

Evaluation of tracheobronchial lesions with spiral CT: comparison between virtual endoscopy and bronchoscopy]

INTRODUCTION: The aim of this study is to describe the scanning parameters for virtual bronchoscopy in the evaluation of the tracheobronchial tree and to compare the results of this examination with the endoscopic findings. MATERIAL AND METHODS: 27 patients with tracheobronchial neoplasms suspected at preliminary clinical and chest film findings or postoperative follow-up for malignant disease were evaluated with spiral CT of the chest and bronchoscopy. Virtual endoscopy was performed on the pulmonary volume involved by the lesion, using narrow axial images (thickness 2 mm, table index 3 mm, reconstruction index 1 mm.) so as to obtain MPR, MIP and 3D reconstructions with 3D Endo Vew program (Philips Medical System, Eindhoven, Holland). We compared these reconstructions and the findings the normal spiral CT scanning with the corresponding endoscopic examinations. RESULTS: In all patients we were able to study the lobar and segmental bronchi in all patients and in 2 we also evaluated the subsegmental bronchi. 25 lesions in 23 patients were shown by virtual endoscopy (8 occlusions, 8 stenosis, 5 compressions, 3 flogosis with endobronchial mucus, 1 bronchocele) and in 4 patients the examinations were negative. The bronchoscopy was negative in 4 patients and positive in 23 patients with 25 lesions, but we had agreement in 23/27 patients (85,1%). In 2 patients virtual endoscopy showed the lesions in a different bronchus compared to bronchoscopy. In one patient we interpreted the obstruction as neoplastic instead of mucus inside the bronchi and in the last patient bronchoscopy was not performed due to his old age and the virtual endoscopy showed total obstruction of a segmental bronchus. DISCUSSION AND CONCLUSIONS: The results show that virtual endoscopy can study the tracheobronchial tree as far as the segmental bronchi, and sometimes also the subsegmental bronchi and the bronchi below a closed obstruction. In addition, it can evaluate the extraluminal location of the lesions. For these reasons virtual endoscopy provides a road map for bronchoscopy as a guide for transbronchial biopsy and for endobronchial treatment planning. The limitation of this technique is its inability to evaluate the mucosal surface and distinguish flogosis from neoplastic lesions by biopsy. It can be used however in the postoperative follow-up both for cancer and transplant, when immediate biopsy is not necessary.