Non-neoplastic tracheal lesions: comparison between virtual CT endoscopy and fiberoptic bronchoscopy

PURPOSE: To compare virtual endoscopy of the upper airways with fiberoptic bronchoscopic examination in patients affected by non-neoplastic inflammatory disease of the trachea. MATERIALS AND METHODS: Twelve patients with non-neoplastic tracheal stenosis or with tracheo-oesophageal fistula underwent a fiberoptic endoscopy and a spiral CT examination with the following protocol: collimation/table feed/reconstruction increment 3 mm/6 mm/1 mm from the larynx to the carenabronchial septum. Images were sent to a dedicated workstation equipped with a software allowing generation of 3D reconstructions and virtual endoscopic images. Lesion features were compared in the two examinations. RESULTS: In all cases the lesions features visualized with virtual display modality were confirmed by conventional endoscopy. Measurements were easily made on the 3D MPR images while conventional endoscopy allowed only a qualitative assessment of the lesion. In no cases did virtual endoscopy provide information on the mucosa appearance. Swallowing and breathing never caused significant artifacts during the 3D post processing. CONCLUSION: Virtual bronchoscopy is a useful technique for preoperative evaluation and for the follow-up of patients with non-neoplastic inflammatory disease of the upper airways.     

Comparison of CT and fiberoptic bronchoscopy in the evaluation of bronchial disease

CT was compared to fiberoptic bronchoscopy in a large series of patients to study the value of CT for visualizing bronchial disease. CT scans were available for review in 64 cases in which focal airway disease was identified with fiberoptic bronchoscopy and in 38 patients in whom the airways appeared normal at bronchoscopy. CT was positive in 59 of 64 cases in which lesions were detected endoscopically. If the results are analyzed according to the extent of involvement of individual bronchi, CT successfully identified 88 (90%) of 98 lesions. CT correctly excluded disease in 35 (92%) of 38 cases that were subsequently verified to be normal by fiberoptic bronchoscopy. In no case was the diagnosis of malignancy missed by CT. While extremely accurate in detecting focal lesions, CT was inaccurate in predicting whether a given abnormality was endobronchial, submucosal, or extrinsic (peribronchial). In three cases CT failed to detect submucosal extension into the left mainstream bronchus, which has important implications concerning the value of CT in staging bronchial malignancy. It is concluded that CT is helpful when bronchoscopy is contraindicated or refused. CT may also be used in selected cases when there is low clinical suspicion of endobronchial disease and as a complementary procedure to fiberoptic bronchoscopy for outlining the exact location of major mediastinal and hilar vessels, lymph nodes, and tumor in relation to adjacent airways.     

肺腺癌的螺旋CT表现特征及其病理学基础

目的：探讨肺腺癌局部生长的螺旋CT表现特点与组织病理基础的基础关性。方法：34例手术病理证实的肺腺癌采用扫描。结合组织病理发现，观察和评价和评价在螺旋CT上肿瘤内部结构，密度分布、边缘特征及周围肺组织改变。结果：34例肺腺癌中，肿块密度均匀14例（41％），不均匀20例（59％），分叶片22例（65％），空泡征10例（29％），短毛刺16例（47％），支气管气相7例（21％），血管集束征16例（47％），胸膜凹陷征19例（56％），毛玻璃样（ground galass opacity,GGO)征7例（21％），GGO征病理上代表肿瘤细胞沿肺泡壁生长，同时残留含气肺泡组织。结论：肺腺癌的螺旋CT表现可反映肿瘤生长的组织病理学特征。     

Dual-energy perfusion CT of non-diseased lung segments using dual-source CT: correlation with perfusion SPECT

Purpose

To determine the utility of dual-energy perfusion CT (DEpCT) of non-diseased lung segments, using dual-source CT, in comparison with perfusion single-photon emission computed tomography (SPECT).

Materials and methods

28 patients (18 male and 10 female; mean age 63 years; age range 18–86 years) underwent DEpCT and SPECT within a 3-day interval. The presence and location of perfusion defects in each segment of the lungs were evaluated.

Results

Perfusion defects were noted in 7 of 361 segments (1.9 %) by DEpCT and in 19 of 361 segments (5.3 %) by perfusion SPECT. DEpCT was in good agreement with perfusion SPECT for 338 of 361 segments (93.6 %). Intraobserver agreement was also good, ranging from 93.4 to 93.6 % (κ = 0.64–0.75, p < 0.01).

Conclusion

For non-diseased lung segments, DEpCT correlated well with SPECT.     

Myofibroblastic inflammatory tumor of the lung: CT findings with pathologic correlation

The objective of this study was to describe the computed tomographic (CT) features of myofibroblastic inflammatory tumor of the lung with histopathologic correlation. The medical records and imaging studies of eight patients with pathologically proven myofibroblastic inflammatory tumor of the lung were reviewed. On radiographs and CT images, a poorly circumscribed mass or nodule was evident in five patients (six lesions), and a well-circumscribed lesion was evident in three patients (three lesions). Seven lesions were peripheral and two were centrally located. At CT, five lesions were of heterogeneous attenuation and four homogeneous. Increased perilesional parenchymal abnormalities, which were caused by peribronchial inflammatory infiltrates, were observed in three cases. The predominant histopathologic feature was organizing pneumonia type in three cases, lymphoplasmacytic type in three cases, and both organizing pneumonia and lymphoplasmacytic type in two cases. Variable degree of fibrous histiocytoma type was observed in all cases. The imaging characteristics of myofibroblastic inflammatory tumor of the lung are variable and nonspecific. The authors conclude that most cases appear as solitary, peripheral lesions with a predilection for the lower lobes. Associated findings may include perilesional inflammatory changes. Because myofibroblastic inflammatory tumor cannot be reliably differentiated from other pulmonary lesions based solely on the imaging appearance diagnostic biopsy is mandatory. Interpretation of the imaging findings combined with the histopathologic features of disease may help make correct diagnosis.     

早期中央型肺癌CT诊断与支气管镜及病理组织学对照

目的 研究中央型肺癌早期CT表现及其病理学基础，并评价CT在鉴别诊断中的作用。方法 对17例病理证实的早期中央型肺癌及10例类似中央型肺癌的良性病变进行分析，CT采用SR 700及（或）Lightspeed Plus扫描机，3．0或1．5mm层厚薄层扫描，将CT表现与支气管镜及手术病理组织学表现对照。结果 17例病变CT均显示，3例显示为局部支气管管壁增厚、管腔内壁不规则，支气管镜显示黏膜表面粗糙、红肿。14例显示管腔狭窄、闭塞，其中4例合并亚段支气管黏液栓，10例合并阻塞性肺炎或肺不张，支气管镜表现为腔内息肉样病灶。病理组织学显示1例累及黏膜，5例累及黏膜下，11例侵犯支气管软骨层。10例良性病变中，CT检查怀疑6例恶性病变，4例不排除恶性，支气管镜检查5例显示内壁不均匀增厚、粗糙，2例管腔内凝血块，1例管腔内结节，2例未见异常。结论 薄层CT扫描能可靠地显示支气管细微病变，是诊断早期中央型肺癌非常有用的方法。     

High resolution CT of the lung parenchyma with pathologic correlation

The authors describe a technique for directly correlating high resolution CT scans and gross and histologic sections of the lung. They conclude that HRCT provides anatomic detail comparable to that seen on gross tissue inspection.     

High-resolution CT of parenchymal lung disease: precise correlation with histologic findings.

To provide a precise correlation between high-resolution computed tomographic (CT) findings and histologic studies of various parenchymal lung diseases, 20 fixed and inflated lungs were studied as follows: (a) Every lung was cut at the corresponding CT level into 1.5-mm-thick sections, (b) selected slices were cut into small blocks to prepare histologic slides, (c) each slide was photographed, and (d) the image of the entire lung section was reconstituted with the enlarged photographs (assembled as in a jigsaw puzzle). Results obtained in cases of normal lungs, pulmonary edema, alveolitis, hypersensitivity pneumonitis, emphysema, Pneumocystis carinii pneumonia, silicosis-asbestosis, and idiopathic pulmonary fibrosis demonstrated the method to be accurate in correlating high-resolution CT findings and the corresponding histologic data.     

Cost-effectiveness of CT thorax and bronchoscopy in haemoptysis with normal CXR for exclusion of lung cancer

As fibre-optic bronchoscopy and CT thorax become more widely used, patients with haemoptysis who had normal CXR and sputum results are more commonly offered both CT and bronchoscopy to exclude lung cancer. Doctors who are under possible litigation pressure arising from missed diagnoses of lung cancer are often exhaustive in their investigations, even when the haemoptysis has been transient. The present study aims to investigate the number of cancer patients who can be detected with the two investigations, and compare recent similar study results with archive results. We found that despite the use of more efficient investigation tools, the yield is paradoxically much lower and, hence, less cost-effective than that of previous studies. The likely reason is that doctors tend to over-investigate, even for short-term, minimal blood-streaked sputum, which is common among simple bronchitis. In order to be more cost-effective, these investigations should be used more selectively and for high risk patients such as those with prolonged haemoptysis and those who are heavy smokers.     

CT引导胸穿肺活检对纤支镜阴性的肺部肿块诊断价值

目的：评价CT引导下经胸穿肺活检对纤维支气管镜检查阴性的肺部肿块患的诊断价值。方法：搜集290例肺部肿块患接受CT引导下经胸穿肺活检，其中43例患曾接受过纤维支气管镜检查，又检查结果为阴性，回顾性分析了该43例患的病理结果、肿块大小和穿刺并发症情况。结果：发现恶性26例(腺癌11例、鳞癌8例、支气管肺泡癌3例、未分化癌和腺鳞癌各2例)；良性4例(结核2例、结节病1例、炎性假瘤1例)；仍有13例未能明确结果，该13例中有6例因诊断或治疗的原因行手术治疗，发现5例为恶性(鳞癌2例、未分化癌1例、小细胞癌1例、腺癌1例)，1例为良性病变(结核)。结论：CT引导下经胸穿肺活检对纤维支气管镜检查阴性的肺部肿块患有很高的临床价值，它的明确诊断率与部位关系不大，而与肿块的大小正相关。     

CT仿真支气管内窥镜的临床应用研究

目的评价ＣＴ仿真支气管内窥镜的临床应用价值。方法 ４５例患者均有纤维支气管镜对照并经病理证实。使用内窥镜软件将图像数据重建为三维支气管树图像,通过鼠标操作进入支气管腔内检查。     

CT仿真支气管内窥镜的临床应用

目的 评价CT仿真支气管内窥镜（VB）成像方法及临床应用。方法 对50例CTVB检查经纤维支气管镜或病理证实的患者进行分析。中心型肺癌27例,肺癌术后4例,支气管憩室1例,正常支气管81例。将螺旋CT扫描数据传室Aclvantage Windows3.1版本工作站（GE Medical Systems),用Smmoth Navigator软件功能建成CTVB图像进行分析。结果 CTVB能100％地观察到以上支气管和80％以上亚段支气管。27例中心型肺癌发现支气管狭窄23处,闭塞4处,肺癌术后支气管残端4处,右中间段支气管憩室1例。结论 CTVB是一种极其优越的无创性观察支气管腔的方法,与纤维支气管镜相比,有其优点和限度。分析图像时结合原始图像和MPR图像,则可提供腔壁和腔外的更多信息。     

纤维支气管镜在诊治儿童难治性肺炎肺不张中的作用和安全性分析

目的探讨纤维支气管镜诊治儿童难治性肺炎肺不张中的作用及安全性。方法对我院2010年1月—2013年11月间经确诊后收治的66例难治性肺炎肺不张患儿的临床资料进行回顾性分析。结果经纤维支气管镜、CT检查后确诊,66例肺不张患儿中以炎症最为多见,共62例(93.9%),呼吸道异物1例(1.5%),支气管软化症1例(1.5%),声门下狭窄1例(1.5%)。经纤维支气管镜下对上述患儿进行反复清理、支气管肺泡灌洗以及清除异物治疗后,肺不张均在10 d内得以完全复张,整体复张率为100%;其中有3例需行第2次纤支镜治疗,治疗后得以复张。无心搏骤停、感染等并发症发生。结论采用纤维支气管镜诊治儿童难治性肺炎肺不张,既可明确诊断,同时还可以安全、有效、准确地取出异物,吸取分泌物及进行肺部灌洗。因此,采用纤维支气管镜诊治儿童难治性肺炎肺不张的疗效显著且安全可靠。     

Tumor angiogenesis and dynamic CT in lung adenocarcinoma: radiologic-pathologic correlation

PURPOSE: The purpose of this work was to evaluate the correlation of tumor angiogenesis and dynamic CT in lung adenocarcinoma. METHOD: Thirty-five consecutive patients with lung adenocarcinoma underwent dynamic chest CT. Maximum attenuation of dynamic CT was compared with microvessel densities (MVDs) and vascular endothelial growth factor (VEGF) expression by immunohistochemistry. RESULTS: The mean peak attenuation (A(PA)) of lung adenocarcinoma correlated with MVD (r = 0.689, p < 0.0001). VEGF positiveness of lung adenocarcinoma was 63%. There was a significant difference in A(PA) between VEGF-positive and -negative lung adenocarcinomas (39.9 +/- 3.9 and 24.3 +/- 2.3; p < 0.05). The mean MVDs of VEGF-positive adenocarcinomas were significantly higher than those of negative ones (82.5 +/- 5.9 and 49.2 +/- 7.1; p < 0.05). The mean A(PA) of VEGF-positive lung adenocarcinomas correlated positively with MVD (r = 0.707, p < 0.0001). CONCLUSION: The A(PA) value of dynamic CT reflects MVD in lung adenocarcinoma. The A(PA) value of dynamic CT might be an index for VEGF-related tumor angiogenesis.