螺旋CT对日本大耳白兔气道的测量研究

目的 探讨日本大耳白兔气管和主支气管各解剖径线的长度、角度及相关性,为进行气道疾病内支架介入治疗的动物实验研究奠定基础.方法 用多层螺旋CT扫描30只成年健康日本大耳白兔的颈胸部,测量和测算气管各段前后径、左右径,声门水平到隆突的气管长度,左右主支气管和中间支气管内径与长度,以及左、右主支气管长轴与矢状面的夹角.结果 气管各段直径、左右上肺尖叶支气管开口内径无差异,右主支气管长度、右主支气管长轴与矢状面夹角小于左侧,右主支气管内径大于左侧并有相关性.结论 多层螺旋CT测定的日本大耳白兔气管、左和右主支气管径线值,获得左、右主支气管内径值、长度、嵴下角之间的回归方程,有助于为兔实验提供相关气管和支气管的解剖参数.     

螺旋CT测量日本大耳白兔气道径线的窗宽窗位选择

目的探讨日本大耳白兔气管和主支气管解剖径线CT测量的窗位与窗宽选择,为气道支架动物实验奠定基础。方法多层螺旋CT扫描30只成年健康日本大耳白兔的胸部,分别常规肺窗、纵隔窗和特殊的脂肪窗测量气管胸段前后径、左右径、左右主支气管前后径。比较不同窗宽窗位下气管壁显示以及测量数据与解剖数据之间的差异。结果肺窗气管壁均清晰显示,但测量的结果偏小;纵隔窗气管壁显示模糊,测量的结果偏大;而脂肪窗气管壁显示均匀,测量的数据比较接近实际气管直径的解剖参数。结论多层螺旋CT测定日本大耳白兔气管左右径和前后径应选择脂肪窗为佳。有助于为人相关气管和支气管定制气道支架确定最佳的窗宽和窗位。     

多层螺旋CT对气管、支气管病变的诊断价值

传统CT影像能清晰显示气道的轴位像,但不能显示气管、支气管树的整体形态.多层螺旋CT可对气道进行多平面、三维立体和仿真支气管内镜重组,从任意角度观察气管、支气管树的轮廓,弥补了传统CT的不足.就多层螺旋CT气管、支气管树的重组技术、临床应用及其限度等方面的内容进行综述.     

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。     

多层螺旋CT对气管、支气管病变的诊断价值

传统CT影像能清晰显示气道的轴位像,但不能显示气管、支气管树的整体形态。多层螺旋CT可对气道进行多平面、三维立体和仿真支气管内镜重组,从任意角度观察气管、支气管树的轮廓,弥补了传统CT的不足。就多层螺旋CT气管、支气管树的重组技术、临床应用及其限度等方面的内容进行综述。     

螺旋CT多平面重建在小儿气道异物的临床应用

目的 回顾性分析螺旋CT多平面重建（MPR）对气道异物的临床应用价值。资料与方法 34例经纤维支气管镜证实的气道异物患儿行螺旋CT容积扫描,然后对CT薄层图像进行多平面重建,并分析其影像表现。结果 34例MPR均直接显示异物呈高密度影位于气管或支气管腔内,其中气管异物3例,右侧支气管异物15例（11例位于右主支气管,4例位于右中间段支气管）,左侧支气管异物16例（11例位于左主支气管,5例位于左下叶支气管）。结论 MPR对气道异物的显示率高,定位准,具有重要诊断价值。     

气管支气管树黏液表皮样癌的CT表现

目的 探讨气管支气管树黏液表皮样癌(MEC)的CT表现,以提高对其诊断水平.方法 回顾性分析经病理证实的24例气管支气管树MEC的CT、临床和病理学资料.结果 24例中主要临床表现有咳嗽、咯痰、发热、胸闷、气促、胸痛和咯血.19例为低度恶性型,5例为高度恶性型.病灶位于气管1例,主支气管6例,叶支气管12例,段及以下支气管5例.肿瘤呈无腔外浸润的边界清晰的腔内类圆形结节13例(位于叶支气管及以上气管)和条柱状3例(位于主支气管);呈非浸润性的边界清晰的腔内外类圆形结节、肿块6例,位于叶及以下支气管;呈浸润性的腔内外不规则肿块2例,均为高度恶性型.平扫12例,肿瘤均接近或等于肌肉组织密度,4例瘤内有钙化.增强扫描20例,1例因病灶小而观察不清,明显强化17例.20例有气管阻塞性改变.结论 气管支气管树MEC多为低度恶性,好发于主、叶支气管,CT上多表现为边界清晰的气管腔内或腔内外非浸润性占位,增强后明显强化,部分可有肿瘤钙化.     

气管支气管树的粘液上皮癌:12例病人的放射平片及CT表现

气管支气管树的粘液上皮癌是一种少见的气管支气管内肿瘤。仅占肺部原发恶性肿瘤的0.1％～0.2％,被认为是起源于沿气管支气管树分布的极少量的唾液腺。作者回顾分析了1990年1月～1997年9月经病理组织学证实的12例病人资料。男性5例,女性7例,年龄9～72岁。9例病人有临床症状,咳嗽6例,呼吸困难3例,咯血2例,胸痛2例,3例为偶然发现,无症状。根据肿瘤所在位置不同,可大致分为气管内、主支气管内、叶支气管内、段支气管内和亚     

肺癌的CT气管、支气管树三维重建

目的：通过对63例肺癌患者的气管、支气管树三维重建进行回顾性分析,探讨CT气管、支气管树三维重建对肺癌诊断和治疗的意义。材料和方法：收集自1997年10月至2000年2月已证实的肺癌患者共63例,包括中央型肺癌35例,周围型肺癌28例。所有病例均接受了EBCT扫描。扫描条件为130kV/630mA,层厚／间隔分别为3mm/3mm或1.5mm/1.5mm,扫描方式为连续容积扫描（CVS）。三维重建方式为遮盖表面显示法（SSD）。重建阈值为－500Hu--300Hu。结果：EBCT气管、支气管树三维重建显示中央型肺癌引起的气管、支气管树狭窄或闭塞的形态为：42．9％表现为锥状中断,22．9％表现为不规则偏心性狭窄,17．1％表现为杵状中断,14．3表现为截断且断端不规则,2．8％表现为右主支气管的裂开和右上叶支气管的截断。EBCT气管、支气管树三维重建可用于确定病变的准确部位,测定狭窄的范围和程序,可显示周围性肺癌及其与周围结构的关系。结论：EBCT气管、支气管树三维重建对于中央型肺癌和周围型肺癌的诊断和治疗具有一定的辅助作用。     

多层CT容积漫游技术在先天性气管支气管狭窄的诊断价值

目的:探讨多层CT容积漫游技术(VRT)在先天性气管支气管狭窄的诊断价值。方法:搜集经影像学检查及临床病史证实的先天性气管支气管狭窄32例,所有病例均行多层CT薄层扫描及支气管树VRT重建,评价VRT在先天性气管支气管狭窄的诊断优势及不足。结果:VRT立体显示气管、主支气管及叶支气管近端单发或多发狭窄32例,其中环形狭窄8例,不规则狭窄15例,锥形狭窄9例;累及长轴范围最长46mm,最短2mm;轻度狭窄8例,中度狭窄13例,重度狭窄11例。18例阻塞性肺气肿中,VRT清晰显示16例,患侧肺组织体积增大,含气增多,其中6例伴有纵隔疝。结论:多层CT-VRT可立体显示先天性气管支气管狭窄部位、范围、程度及阻塞性肺气肿,弥补了CT轴位长轴范围显示不足,图像不直观的缺点,对临床治疗具有重要指导意义;对叶支气管远端及以下支气管狭窄、局限性肺不张及阻塞性肺炎显示有一定限度,诊断时应结合CT二维图像。     

Comparison of three-dimensional virtual endoscopy with bronchoscopy in patients with oesophageal carcinoma infiltrating the tracheobronchial tree.

Virtual endoscopy (VE) is a technique for performing simulated bronchoscopy using helical CT data of the tracheobronchial tree. In order to evaluate a virtual three-dimensional (3D) endoluminal procedure for the tracheobronchial tree, comparison was made between bronchoscopy, axial CT images and minimal intensity projections (MIP). 21 patients were referred for helical CT because of oesophageal carcinoma shown by bronchoscopy to infiltrate into the trachea or bronchi. Axial CT images obtained on a helical scanner were transferred to a Sparc20 workstation. VE was compared with the axial CT images and the MIP concerning additional information on the location and degree of stenosis gained after 3D reconstruction of the inner surface of the tracheobronchial tree. The accuracy of this VE system was compared with bronchoscopy. Follow-up was performed in two patients to evaluate the tracheobronchial system after stent implantation. All stenoses were identified by VE with no statistically significant difference in detection of location or grading of the stenosis to real time bronchoscopy. Passage of subtotal stenosis was only possible with VE. VE is suitable for following up stent implantation. Submucosal lesions of the tracheobronchial tree could not be detected by VE. There was no statistically significant difference regarding the location of the stenoses between VE, axial CT slices, MIP and bronchoscopy. The VE showed only a statistically significant difference with regard to the degree of stenosis which was underrated on axial CT slices and MIPs. Pitfalls including mucus plugs and wall defects due to the wrong threshold value were a limitation of VE. VE is presently too time-consuming to use in every patient with an infiltrating tumour into the tracheobronchial tree. In conclusion, while VE cannot replace endoscopy of the tracheobronchial tree or the oesophagus, it is an accurate and non-invasive method for identifying endoluminal tumours, grading stenoses and visualizing the tracheobronchial tree beyond stenoses in a small number of patients who are not amenable to endoscopy.     

Central airway stenoses: preliminary results of spiral-CT-generated virtual bronchoscopy simulations in 29 patients

The purpose of this study was to determine the feasibility of using virtual bronchoscopy simulations to depict stenoses of the tracheobronchial tree. Virtual bronchoscopy simulations, based on ray casting, were applied to spiral-CT data sets of 29 patients presenting 41 stenoses of the central airways, proved with fiberoptic bronchoscopy. Simulations of the inner walls of the airways were of good quality in 27 of 29 patients. Airway stenoses were depicted in 39 of 41 cases. Evaluation of the length of stenoses and surrounding tissues required simultaneous display of multiplanar reformations. Virtual bronchoscopy provides a valuable road map for bronchoscopy, in an image format familiar to bronchoscopists. Received 31 May 1996; Revision received 23 September 1996; Accepted 5 November 1996     

气管、支气管内膜结核HRCT价值及临床意义

目的 :探讨HRCT对气管、支气管内膜结核的诊断价值及临床意义。方法 :对 3 2例诊断明确的住院患者行胸部HRCT扫描 ,结合纤维支气管镜检查情况 ,重点观察病变气道内壁及管腔的形态变化以及其病变远侧肺实质的病变情况。结果 :气管、支气管壁病变检出率为 73 .92 % ,其中管壁轻度增厚 5 4.3 5 % ,明显增厚 19.5 7% ;气道管腔形态改变检出率为 67.3 9% ,其中管腔狭窄 <5 0 % 41.3 0 % ,>5 0 % 19.5 7% ,管腔闭塞 6.5 2 %。同时观察到气管、支气管周围及纵隔淋巴结肿大 7例 ,病变支气管远侧管腔内粘液栓 12例 ,管腔局限性扩张 5例 ,小叶性肺气肿 18例 ,肺不张 2例 ,肺内结核病灶 3 9例。结论 :HRCT作为无创性检查 ,在观察气道病变的部位和范围、气道病变与肺内病变的关系、危重患者纤维支气管镜检查前的定位准备及估计预后均有重要的临床意义。     

Tracheobronchial tree and pulmonary arteries: MR imaging using electronic axial rotation

Standard coronal magnetic resonance (MR) imaging cannot depict long segments of the tracheobronchial tree and left pulmonary artery owing to the normal thoracic kyphosis and posteriorly angled course of these structures. By the use of electronic axial rotation (EAR), however, MR is capable of imaging any plane. We used EAR in 25 patients undergoing MR examinations of the thorax. This technique allowed superior definition of the longitudinal axis of the tracheobronchial tree and left pulmonary artery. The right pulmonary artery was satisfactorily imaged by the standard coronal plane.     

螺旋CT气管重建技术评价肺癌与气管支气管的关系

目的探讨螺旋CT气管重建技术在评价肺癌与气管支气管的关系中的价值。方法对34例拟手术的病例和5例已手术的病例进行CT扫描,在工作站上进行重建处理,重建方法包括MPR,SSD及VR,分别分析轴位图像和重建图像并进行对比。结果在显示狭窄部位方面,重建图像优于轴位图像,可纠正轴位图像错误3例。在显示肿瘤与支气管的空间关系方面,重建图像可以非常清楚显示,而轴位图像没有一例可以提供这方面的信息。在显示狭窄程度方面,轴位图像判断的敏感性、特异性分别为67．4％,75．3％;重建图像判断的敏感性、特异性分别为86．2％,83．2％。在显示支气管侵犯范围方面,轴位图像判断的敏感性、特异性分别为72．4％,66．5％;重建图像判断的敏感性、特异性为89．3％,90．4％。结论螺旋CT气管重建技术对判断肺癌与气管支气管的关系很有帮助。     

气管支气管病变的多层螺旋CT诊断

目的:回顾性分析41例气管支气管病变的多层螺旋CT(MDCT)影像资料,探讨MDCT对气管支气管病变的诊断价值。材料和方法:搜集自2006年5至2007年8月共41例气管支气管病变的MDCT资料,常规横断面为6mm层厚,回顾性重建为1mm层厚、1mm层间隔,并于同步工作站进行三维重建,包括CT仿真支气管内镜(CTVE)、多层面/曲面成像(MPP/CPR)、最大/小密度投影(MIP,MinIP)、表面遮盖成像(SSD))和容积重组(VR)。结果:MDCT结合多种三维重建可以很好地显示气管支气管的正常和异常,肺癌、支气管结核、支气管腔内占位以及邻近病变所致气道狭窄各有特点。三维重建对狭窄部位、范围和程度的确定显示很好。结论:MDCT结合多种后处理三维重建对气管支气管的各种类型病变有较好的诊断和鉴别诊断价值。     

Iatrogenic bronchopleural fistula caused by feeding tube insertion

Nutritional supplements administered through flexible small caliber feeding tubes are an increasingly popular substitute for parenteral hyperalimentation. Small and large caliber nasogastric tubes can inadvertently pass into the tracheobronchial tree, even in the presence of an endotracheal tube with an inflated cuff. We report three patients who had small caliber feeding tubes passed through the tracheobronchial tree perforating into the pleural space. Potential complications include immediate or delayed pneumothorax, tension pneumothorax, hydropneumothorax, and empyema. Prompt post-insertion chest radiography is required to verify correct placement of small caliber feeding tubes.     

Congenital anomalies of tracheobronchial branching patterns: spiral CT aspects in adults

Congenital abnormalities of the bronchi have been classically described with chest X-rays, conventional tomography, bronchography, CT and MR imaging. Recently, the capacity of spiral CT to explore a complete volume with no gap and excellent multiplanar reformations has been emphasized. The contribution of this technique to the analysis of congenital anomalies of tracheobronchial branching patterns encountered in adult patients is illustrated. Agenesis, aplasia, and hypoplasia are discussed, followed by bronchial atresia and abnormalities of bronchial divisions. In most cases spiral CT permits a full and correct evaluation of the malformation as well as its associated anomalies. It appears therefore to be the preferable technique for studying such anomalies of the tracheobronchial tree. Moreover, knowledge of CT aspects of the main congenital bronchial abnormalities along with complete visualization of the tracheobronchial tree will probably lead to detection of more incidental anomalies. Received 10 February 1997; Revision received 18 April 1997; Accepted 21 April 1997     

Role of multi slice computed tomography in the evaluation of congenital anomalies of tracheobronchial tree and lungs

ObjectiveTo evaluate the role of MSCT in the evaluation of congenital anomalies of tracheobronchial tree and lungPatients and methodsTwenty nine patients with congenital anomalies of tracheobronchial tree and lung were examined using four and six MDCT.ResultsSeven patients (24%) had congenital cystic adenomatoid malformation where successful differentiation of the type was possible. Three patients (10.3%) with bronchopulmonary sequestration were categorized as two (7%) intralobar and one (3.5%) extralobar sequestrations. Four patients (14%) had congenital lobar overinflation. Four patients had Scimitar syndrome with right pulmonary artery hypoplasia, right sided lung hypoplasia, anomalous arterial supply and anomalous pulmonary venous drainage together with pulmonary hypertension. Abnormal bronchial anatomy was revealed in two patients with pulmonary isomerism and one patient with situs inversus. Bronchogenic cyst, tracheal bronchus, Kertagner's syndrome, pulmonary agenesis and horse shoe lung were seen in one patient each. Dynamic MSCT shows the lunate configuration of the trachea during forced expiration in one patient with tracheomalacia. In one patient with tracheo-esophageal fistula, the extent of fistulous tract and the resulting bronchial aspiration were demonstrated.ConclusionMSCT proved to be indispensable as a preoperative planning modality and an essential investigation for congenital anomalies of the lung and tracheobronchial tree.     

Carcinoid tumor of the lung presenting as a pleural mass: CT diagnosis.

Carcinoid tumors of the lung typically arise centrally within the tracheobronchial tree. We report a rare case of a carcinoid tumor presenting as a pleural mass. The classification and X-ray features are described.