光学相干断层成像在肺动脉介入诊疗中的应用

目的 评价光学相干断层成像(OCT)在肺血管病的鉴别诊断与针对性治疗中的可行性和有效性.方法 采用美国Lightlab公司的OCT系统,对10例经肺动脉造影证实为狭窄和(或)闭塞(先经介入血管重建)的16条直径在2～6 mm的肺血管进行OCT扫描检查,并用该系统自带的分析测量软件进行分析测量.结果 对10例患者的16支肺血管进行了66次OCT检查,全部获取有特征性的清晰图像,无并发症发生.OCT表现为,肺动脉血栓栓塞(5例):动脉壁不增厚,内膜上附着红或白血栓,管腔狭窄;特发性肺动脉高压(3例):肺动脉直径在2～6mm,血管壁正常的3层结构消失,内膜粗糙、增厚,反光增强,管腔狭窄程度超过50%,最小管腔内径≤1 mm;不明原因的肺动脉狭窄(2例):内膜正常或增厚,纤维样增生,厚0.17～0.60 mm,管状附着在内膜上,致管腔狭窄60%～80%.肺动脉闭塞和(或)狭窄介入血管重建后:内膜不完整,内膜下脂质斑块,多处病变伴有斑块破裂,内膜碎片,红白血栓,局部夹层形成.结论 OCT可以在肺动脉疾病的各个发展阶段安全进行,能显示不同肺血管病变血管壁特征性的组织学改变,有助于肺动脉疾病的诊断、鉴别诊断及指导治疗.

Application of optical coherent tomography in pulmonary artery interventional diagnosis and therapy

Objective To evaluate the feasibility and efficacy of optical coherent tomography (OCT) in differential diagnosis and treatment of pulmonary vascular diseases. Methods OCT system (Lightlab, US) was used to scan 16 pulmonary vessels with diameters ranging from 2 mm to 6 mm in 10 patients with vascular stenosis and/or occlusion (after prior interventional revascularization) confirmed by pulmonary arteriography, followed by measurement and analysis with the built-in software of the system.Results Sixty- six OCT scans were performed for 16 pulmonary vessels in 10 patients, generating characteristic images in all the cases without any complications. Manifestations in OCT scans included pulmonary thromboembolism (n=5) with normal arterial wall thickness, red or white thrombus adhering to intima and stenosed lumen; idiopathic pulmonary hypertension (n=3) with pulmonary arteries 2 mm to 6 mm in diameter, disappearance of normal 3-layered structure of vessel wall, granulation and incrassation of intima, increased reflection, lumen stenosis ＞ 50%, and minimum inner diameter of lumen no more than 1 mm; pulmonary arterial occlusion of unknown reason (n=2) with normal or thickened intima, fibroid hyperplasia 0.17 mm to 0.60 mm by thickness, fistulous adherence to intima causing 60%-80% occlusion of lumen. Post- interventional revascularization of pulmonary arterial occlusion and/or stenosis: incomplete intima, subintima lipid plaques, multiple lesions with fracture of plaques, fragmented intima, red and white thrombus, and formation of local dissection. Conclusion OCT can be safely performed in various phases of pulmonary arterial diseases, and may demonstrate characteristic histological changes of vessel wall in different pulmonary angiopathy, facilitate diagnosis and differential diagnosis, and guide the therapy of pulmonary arterial diseases.