CT仿真支气管镜临床应用评价

目的 以纤维支气管镜检查(FB)作对比,评价CT仿真支气管镜(CTVB)的临床应用价值。方法 85例符合做纤维支气管镜检查指征的患者,先行CT仿真支气管镜的检查,再做纤维支气管镜的检查。以纤维支气管镜检查为金标准评价CT仿真支气管镜的诊断率。结果 设定纤维支气管镜检查的诊断率为100％,以此为对照,CT仿真支气管镜对全部病灶诊断率为84．71％,对主气管病灶诊断率为100％,对1级支气管病灶诊断率为100％,对2级支气管病灶诊断率为91．30％,对3级支气管病灶诊断率为59．09％。结论 病灶发生在1,2级支气管上,CT仿真支气管镜与纤维支气管镜检查的检出率和诊断率基本一致。病灶发生在3级及3级以下的支气管上,CT仿真支气管镜与纤维支气管镜检查的诊断率有较明显的差异。CT仿真支气管镜对病灶发生在2级及2级以上的支气管病灶诊断基本可靠,CT仿真支气管镜对病灶发生在3级及3级以下的支气管病灶诊断不可靠。     

螺旋CT仿真支气管镜与纤维支气管镜检查在较大气道病变诊断中的应用比较

目的探讨应用螺旋CT仿真支气管镜技术(CTVB)对较大气道病变诊断方法的应用价值。方法应用螺旋CT仿真支气管镜技术(CTVB)及纤维支气管镜(FOB)对30例较大气道病变的患者进行检查并分析比较两种方法的差异。结果发现CTVB在较大气道所获得气道管腔内壁、腔内病变及管腔形态等方面的图像效果与FOB所见基本相同，且可以显示严重狭窄、阻塞部位远端的情况，可为气道手术方案提供重要参考资料，但无法提供黏膜色泽及细微改变。结论CTVB对较大气道病变是一种很好的诊断方法。     

X线、CT与纤支镜对支气管结核的诊断优缺点

目的提高对支气管结核的X线、CT、纤支镜表现的认识，避免误诊。方法72例支气管结核中男35例，女37例，年龄10～80岁，平均40．2岁。X线检查50例，CT检查42例，纤支镜50例。由6名影像医师、2名肺科医师诊断，总结X线、CT、纤支镜表现及分析误诊原因。结果X线误诊30例，CT误诊19例，纤支镜误诊32例。结论支气管结核其X线、CT、纤支镜表现各有特点，认为综合应用多种检查技术，对提高诊断准确率具有重要意义。     

多层螺旋CT仿真支气管镜技术在中央型肺癌诊断中的应用

目的评价多层螺旋CT仿真支气管镜(VB)在中央型肺癌诊断中的价值.方法对45例中央型肺癌患者行MSCT检查后进行VB成像,并与同期纤维支气管镜检查(FBS)结果进行对照.结果本组CTVB与FBS所见一致性达93.3%.CTVB可清楚显示腔内型病变大小、形态、部位,浸润型及腔外型病变管腔狭窄程度,结合其他三维重建技术亦可显示病变的侵犯范围.结论多层螺旋CTVB能准确地显示中央型肺癌病变位置、大小及支气管狭窄程度.     

Pulmonologist evaluation on new CT visualization for guidance to lung lesions during bronchoscopy

Objective: Endoluminal visualization in virtual and video bronchoscopy lacks information about the surrounding structures, and the traditional 2?D axial, coronal and sagittal CT views can be difficult to interpret. To address this challenge, we previously introduced a novel visualization technique, Anchored to Centerline Curved Surface, for navigated bronchoscopy. The current study compares the ACCuSurf to the standard ACS CT views as planning and guiding tools in a phantom study.

Material and methods: Bronchoscope operators navigated in physical phantom guided by virtual realistic image data constructed by fusion of CT dataset of phantom and anonymized patient CT data. We marked four different target positions within the virtual image data and gave 12 pulmonologists the task to navigate, with either ACCuSurf or ACS as guidance, to the corresponding targets in the physical phantom.

Results: Using ACCuSurf reduced the planning time and increased the grade of successful navigation significantly compared to ACS.

Conclusion: The phantom setup with virtual patient image data proved realistic according to the pulmonologists. ACCuSurf proved superior to ACS regarding planning time and navigation success grading. Improvements on visualisation or display techniques may consequently improve both planning and navigated bronchoscopy and thus contribute to more precise lung diagnostics.     

CT仿真支气管镜在中心型肺癌诊断中的应用

目的:评价CT仿真支气管镜(CTVB)在中心型肺癌诊断中的价值。方法:10例中心型肺癌均经纤维支气管镜(FOB)检查并经病理证实,对同一患者的CTVB和CT横断面图像进行观察分析。结果:CTVB发现支气管腔内肿物4例,支气管腔狭窄6例,与CT横断面图像的诊断结果相同。结论:CTVB能如实显示支气管腔内肿物及狭窄,整体感强,但必须与CT横断面图像相结合才能进行全面诊断。     

Admission chest CT complements fiberoptic bronchoscopy in prediction of adverse outcomes in thermally injured patients

In burned patients, inhalation injury can result in progressive pulmonary dysfunction, infection, and death. Although bronchoscopy is the standard for diagnosis, it only assesses the proximal airway and does not provide a comprehensive analysis of pulmonary insult. Chest radiographs have not been proven helpful in diagnosis of inhalation injury. Our hypothesis is that a CT scan alone or in conjunction with bronchoscopy can be used as a prognostic tool for critically ill burn patients, especially those with inhalation injury. The authors performed a retrospective study of all patients admitted to the U.S. Army Institute of Surgical Research Burn Center between 2002 and 2008 with chest CT within 24 hours of admission. They divided subjects into two groups, those with evidence of inhalation injury on bronchoscopy and those without. They used a radiologist's score to assess the degree of damage to the pulmonary parenchyma. The primary endpoint was a composite of pneumonia, acute lung injury/acute respiratory distress syndrome, and death. The inhalation injury group consisted of 25 patients and the noninhalation injury group of 19 patients. Groups were not different in age, TBSA burned, and percentage full-thickness burn. By multiple logistic regression, detection of inhalation injury on bronchoscopy was associated with an 8.3-fold increase in the composite endpoint. The combination of inhalation injury on bronchoscopy and a high radiologist's score was associated with a 12.7-fold increase in the incidence of the composite endpoint. Admission CT assists in predicting future lung dysfunction in burn patients.     

CT仿真内窥镜及网格显示模式在中央型肺癌诊断中的应用

目的:探讨CT仿真内窥镜(CTVB)及网格显示模式(mesh display mode,MDD)在中央型肺癌诊断中的应用。方法:对10例经临床、病理证实的中央型肺癌患者行CTVB及MDD重建检查,包括鳞癌6例、腺癌2例、小细胞癌1例、大细胞癌1例。用螺旋CT机对患者进行扫描后,将数据重建成CTVB及MDD图像进行分析。结果:10例中CTVB及MDD显示肿瘤呈块状或结节状,引起管腔狭窄或闭塞。其中MDD显示支气管狭窄9支、闭塞4支,尤其是观察支气管肿瘤腔外侵犯的移行情况优于CTVB图像。但MDD显示支气管腔内瘤体则逊于CTVB图像。结论:CTVB及MDD是一种无创伤的诊断方法,但其敏感性和特异性有待今后进一步研究提高。     

Flexible fiberoptic bronchoscopy

Flexible fiberoptic bronchoscopy continues to be an important tool in the diagnosis of pulmonary disease. This article reviews the history, technology, methodology, applications, and complications of this diagnostic tool.     

纤维支气管镜及三维重建胸部CT在不典型支气管异物中的应用

目的 提高不典型支气管异物的临床诊治水平.方法 回顾性分析该院2007 ～ 2010年收治的有异物吸入史不典型的支气管异物患者12例临床资料.结果 异物种类各异,主要以植物性异物为主(60％),胸部影像学无特异表现；骨性和金属异物可通过肺部三维CT提供异物的精确阻塞部位；所有病例均经纤维支气管镜直视下窥见异物,并通过各种活检钳、鄂口钳等取出异物,成功率100％.结论 纤维支气管镜对不典型支气管异物的诊疗价值甚高,但同样详细询问病史及辅助检查诸如三维胸部CT重建亦至关重要.     

中央型肺癌MSCT三维重建、支气管镜及其病理对比研究

目的研究中央型肺癌(CLC)多层螺旋CT(MSCT)三维重建、支气管镜及其病理组织学表现,并对诊断结果进行对比。方法82例CLC患者,经MSCT平扫、增强动静脉期扫描、二维多平面及曲面重建(MPR及CPR)、三维容积重建(VR)、最大密度投影(MIP)及仿真内镜重建(CTVE)检查后,经支气管镜及其病理检查证实,52例又经术后病理证实。并将MSCT诊断结果与支气管镜及手术病理结果进行统计学对比分析。结果82例CLC的手术分型:腔内结节型7例,环状狭窄型27例,偏心狭窄截断型48例。MPR及CPR、MIP、CTVE诊断结果与横断扫描相比,差异无显著性;VR差异则有显著性。MSCT三维重建诊断结果与支气管镜及其病理相比,差异无显著性。结论MSCT三维重建能准确分型诊断CLC,评价气管、支气管树肿瘤侵犯程度与范围,同支气管镜具有相同的诊断效果。     

三期动态CT增强扫描联合超声支气管镜对周围型肺癌患者的诊断效能

目的  研究三期动态CT增强扫描联合超声支气管镜对周围型肺癌患者的诊断效能。方法  本研究为回顾性研究,将2018年1月~2020年1月在我院确诊的82例周围型肺癌患者设为观察组,另选取同期在我院进行健康体检的志愿者82例作为对照组。所有患者均采取三期动态CT增强扫描以及超声支气管镜检查,比较两组患者的CT值以及CT净增强值,分析单独检测以及联合检测对周围型肺癌的诊断效能。结果  观察组的CT值、强化峰值以及CT净增强值均高于对照组（P < 0.05）;Ⅲ~Ⅳ期患者的CT值、强化峰值以及CT净增强值均高于Ⅰ~Ⅱ期（P < 0.05）;不同病理分期患者的CT值、强化峰值以及CT净增强值之间的差异有统计学意义（P < 0.05）;联合诊断的特异性高于单独检测（P < 0.05）;联合诊断的曲线下面积高于单独检测（P < 0.05）。结论  采用三期动态CT增强扫描联合超声支气管镜对周围性肺癌患者具有很好的诊断效能,适宜推广应用。     

Vital staining in fiberoptic bronchoscopy

The authors report on the results obtained using vital staining in fiberoptic bronchoscopic investigations. Vital staining is performed during normal fiberoptic bronchoscopic investigations under local anesthesia. The method has proved very sensitive for cancerous and precancerous lesions of the bronchial mucosa.