多层螺旋CT与病理对照研究孤立性肺结节与支气管的关系

目的 研究孤立性肺结节(SPN)与支气管的关系及其类型，并探讨其诊断价值。方法 采用多层螺旋CT(MSCT)，前瞻性对直径≤3．0cm的75例SPN(其中恶性51例，良性24例)行层厚为0．5mm的容积靶扫描，经工作站行多层面重建(MPR)、曲面重建(CPR)和表面阴影成像(SSD)后处理重建，重点显示与SPN相关的支气管形态及其关系类型，并与手术大体标本、组织学切片对照：结果 (1)所有SPN与支气管的关CPR系均良好显示，CT显示SPN与支气管有关系者恶性组44例(86．3％)，良性组16例(66．7％)，其差异无显著意义(P=0．065)。(2)SPN-支气管关系分5型，Ⅰ型：支气管被SPN截断；Ⅱ型：支气管进入SPN，呈锥状中断；Ⅲ型：支气管在SPN内呈长段开放状，并可进一步分叉；Ⅵ型：支气管紧贴SPN边缘走行，管腔形态正常；Ⅴ型：支气管紧贴SPN边缘走行，管腔受压变扁。(3)就SPN性质而言，恶性结节最常见者为Ⅰ型，次为Ⅳ型，Ⅴ型最少见；良性结节最常见者为Ⅴ型，次为Ⅰ型，未见到Ⅱ型。就SPN-支气管类型而言，Ⅰ、Ⅱ和Ⅳ型多见于恶性结节；Ⅴ型多为良性结节；Ⅲ型良性略多见。结论 采用MSCT，超薄层靶扫描后行MPR、CPR和SSD重建能明显提高细小支气管的显示率，并准确地显示SPN-支气管关系，不同关系类型对应某些特定的结节，反映一定的病理改变。     

支气管三维重建和仿真内窥镜的应用价值和限度

目的 研究ＣＴ支气管三维重建和仿真支气管内窥镜的临床应用价值和限度。方法 １０例正常志愿者和５２例病人,行薄层双螺旋ＣＴ容积扫描后将图像传输至工作站并进行多层面／曲面重建（ＭＰＣ／ＣＰＲ）,最小密度投影加气管曲面断层,三维（３Ｄ）重建和仿真支气管内窥镜成像（ＶＲ）,比较４种后处理方法对气道显示的差异和发现病变的敏感性及特异性等。     

小型猪低剂量MSCT气道重组的实验研究

目的:探讨低剂量多层螺旋CT(MSCT)在气道重组方面的应用价值.方法:分别改变电流(20、50、100和150 mA)和管电压(100和80 kV),对6只小型实验用猪进行6个序列的胸部CT扫描,并采用最小密度投影(MinIP)、表面遮盖显示(SSD)和仿真支气管内镜(VB)等后处理技术对气道进行图像重组并评价图像质量,在MinIP和SSD重组图像上测量0～3级支气管管径并与在解剖标本上测量的0～3级支气管管径进行比较.结果:各序列重组图像上0～2级支气管管径测量值与解剖标本比较差异无显著性意义(P》0.05),20和50 mA组3级支气管管径测量值与解剖标本比较差异有极显著性意义(P《0.01),100 mA、150 mA、100 kV和80 kV组图像上3级支气管管径测量值与解剖标本比较差异无显著性意义(P》0.05).结论:低剂量MSCT气道重组图像能满足诊断需要,适用于诊断儿童气道疾病.     

多层螺旋CT三维重建在诊断气管支气管异物中的应用

目的 评价多层螺旋CT(multilayer spiral computed tomography,MSCT)三维 重建对气管支气管异物诊断的价值。方法 对30例怀疑为气管支气管异物的患 者,实施肺螺旋CT平扫及三维重建,与硬性支气管镜下手术情况对比,分析各种重建方法对支气管异物的显示情况及诊断价值。结果 30例患者均获清晰图像,23例异物部位与术中所见一致,出现位移1例,假阴性1例,异物咳出后检查3例, 左主支气管狭窄1例,吸入性肺炎1例,均未见异物。各种重建方法均可清楚显示气管、支气管异物的位置、形状、大小及异物所致气管、支气管狭窄的部位、程度和外形改变。结论 螺旋CT及图像后处理技术在气管支气管异物诊断中具有重要的临床应用价值。     

慢性阻塞性肺疾病患者支气管管壁厚度与肺功能的相关性研究

目的：探讨慢性阻塞性肺疾病（ COPD）患者支气管管壁厚度与肺功能的相关性。方法选取安岳县人民医院2011—2013年住院COPD患者146例（ COPD组）,其中高危21例,轻度56例,中度35例,重度34例。选取同期健康体检者50例为对照组。测量支气管管壁横截面的气道壁外径（ D）和内径（ L）,计算管壁内径与外径比值（ T/D）,管壁面积占总气道总截面百分比（ WA%）,分析其与肺功能的相关性。结果 COPD组与对照组T/D、WA%比较,差异有统计学意义（ P <0.05）。COPD 组内比较,中度、重度 COPD 患者比轻度和高危组患者 T/D、WA%高,而轻度和高危组T/D、WA%比较,差异无统计学意义（ P>0.05）。T/D与第1秒用力呼气容积（ FEV1）呈负相关（ r=—0.564,P<0.05）,WA%与FEV1呈负相关（ r=—0.753,P<0.05）。结论中度和重度慢性阻塞性肺疾病患者支气管管壁厚度较轻度、高危及正常对照组显著增厚,且增厚程度与气道阻塞程度相关。     

创伤性气管支气管断裂的外科治疗

目的：探讨气管支气管断裂的外科诊治特点。方法：回顾性分析气管支气管断裂患者的临床特点、诊断及治疗经过,对32例气管支气管断裂患者就其伤情、手术要点及术后情况进行分析。结果：本组年龄14～55岁（平均35.2岁）,以交通事故伤为主。5例气管断裂和14例支气管完全断裂者诊断后即手术,不全断裂13例中,4例患者一过性治愈,后又出现狭窄,损伤累及气道周径1/3以下且未达全层者3例,其中2例经保守治愈,其余均手术治疗。术后再狭窄3例,经纤支镜咬除肉芽组织而治愈1例,再手术2例。结论：气道断裂早诊断、及时手术是避免术后再狭窄的关键。对小于气道周径1/3的裂伤可先试行保守治疗。     

RR-福莫特罗和rac-福莫特罗对人支气管舒张作用的比较

目的 :比较 RR-福莫特罗和 rac-福莫特罗对人支气管舒张作用。方法 :将内径 2～ 4 mm、长 15 mm的人支气管螺旋条置入持续供氧的浴槽内 ,静息张力为 1g,以蓄积给药法测定 RR-福莫特罗 (10 pmol·L-1～ 3.2 μmol·L-1)和 rac-福莫特罗 (10 pmol·L-1～ 3.2 μmol·L-1)在静息情况下 ,及氨甲酰胆碱 (10 μmol· L-1)或组胺 (10 0μmol·L-1)引起收缩情况下的张力改变。结果 :RR-福莫特罗在静息状况下支气管舒张作用强于 rac-福莫特罗 (P<0 .0 5 )。 RR-福莫特罗和 rac-福莫特罗对抗由氨甲酰胆碱和组胺引起的收缩 ,且 RR-福莫特罗的对抗作用强于rac-福莫特罗 (P<0 .0 5 )。结论 :RR-福莫特罗对人支气管的舒张作用强于 rac-福莫特罗。     

Interobserver variation in the diagnosis of bronchiectasis on high-resolution computed tomography

The purpose of our study was to determine interobserver variation in the analysis of high-resolution computed tomography (HRCT) in the lungs of patients with clinically suspected bronchiectasis. HRCT scans of 88 patients were analysed independently by three radiologists with variable experience in thoracic radiology using a subjective scoring system to record bronchi as normal, mildly abnormal or severely abnormal. The presence, severity and distribution of bronchial dilatation and bronchial wall thickening were recorded. Kappa values were calculated for assessment of interobserver agreement. Agreement between the three readers was good for the detection of bronchiectasis (kappa 0.78) and assessment of its severity (0.68), detection of bronchial wall thickening (0.64) and moderately good for the assessment of its severity (0.58) on a per-patient basis. When individual lobes were analysed, agreement was moderately good for the detection of abnormal bronchi (0.59). Agreement on the extent of abnormal bronchi using five categories was only fair (0.39), but was good when differences of one category were ignored (0.63). Interobserver variation with HRCT in suspected bronchiectasis appears satisfactory for comparative studies.     

Abnormalities of the airways and lung parenchyma in asthmatics: CT observations in 50 patients and inter- and intraobserver variability

The purpose of the study was to evaluate the CT abnormalities of airways and lung parenchyma in asthmatic patients and to assess inter- and intraobserver variability for these abnormalities. The CT scans of 50 asthmatic patients and 10 healthy volunteers were assessed independently by four independent chest radiologist who were masked with respect to the clinical information. Bronchiectasis involving mostly subsegmental and distal bronchi was noted in 28.5% of the asthmatic subjects and none of the non-asthmatics. Bronchial wall thickening, small centrilobular opacities and decreased lung attenuation were observed in 82%, 21% and 31% of asthmatic patients respectively, compared with 7%, 5% and 7% of healthy subjects. The intra- and inter-observer agreements for these four CT abnormalities were measured by the kappa statistic and ranged from 0.60 to 0.79 and from 0.40 to 0.60, respectively. It os concluded that asthmatic patients may exhibit bronchial wall thickening, bronchiectasis and morphological abnormalities suggestive of distal airways disease that can be assessed on CT scans with a clinically acceptable observer variability. Correspondence to: P. Grenier