三维CT在气管狭窄诊断中的应用  

The Application of Three-Dimensional CT on the Diagnosis of Tracheal Stenoses

作　　者：辛衍忠[1] 闫宇博[1] 张翔宇[1] 李吉尧[1] 崔键[1] 

机构地区：[1]哈尔滨医科大学附属第四医院胸外科,黑龙江哈尔滨150001

出　　处：《现代生物医学进展》2011年第22期4339-4343,共5页Progress in Modern Biomedicine

摘　　要：目的:我们检测三维CT在气管狭窄的诊断中的作用和纤维支气管镜相比较,用以帮助临床胸外科医生判断气管结构的解剖学特征。方法:对怀疑气管狭窄的患者64例及20例正常病例检查螺旋CT,其中52例发现腔内新生物造成狭窄,另外12例为外伤后狭窄,应用多平面重建(MPR)、容积重建技术(VRT)、仿真内镜(VE)等技术进行影像的后处理,结果与纤维支气管镜结果相比较。两名放射科医生双盲对照检测并描述了三维CT检查对气管狭窄位置及狭窄程度诊断的精确性。结果:影像形式的检测显示与软性纤维支气管镜结果相同的狭窄,并能够获得关于狭窄的精确的和非侵袭性的形态学上的特征描述,还能够获得疾病腔外范围的额外信息。支气管镜检测结果和多平面重建(MPR)、容积重建技术(VRT)、仿真内镜(VE)的检测结果之间无显著统计学差异(P值分别为0.715,0.413和0.417)。结论:三维CT对于气管来说和传统支气管镜相比能够提供一个高保真度、非侵袭、可再生的评价。他们在高等级气管狭窄的远端开放气道的评价方面具有重要作用,对于无法耐受传统支气管镜的患者是一个可靠的选择。Objective： We evaluated the ability of three-dimensional CT to estimate tracheal stenoses in comparison to convention- al fiberoptie bronchoseopy, with a view to assist thoracic surgeons in depicting the anatomical characteristics of tracheal strictures. Methods： Spiral CT was performed in 64 patients with suspected tracheal stenoses and in 20 normal subjects. Tracheal stenoses due to an endolu- minal neoplasm were detected in 52 patients, whilst traumatic tracheal stricture was observed in the other 12 patients. Multiplanar refor- matting （MPR）, volume rendering techniques （VRT） and virtual endoscopy （VE） for trachea evaluation were applied and findings were compared to fiberoptic bronchoscopy. The accuracy of the procedure in describing the localization and degree of stenosis was tested by two radiologists in a blinded controlled trial. Results： The imaging modalities tested showed the same stenoses as the ones detected by flexible bronchoscopy and achieved accurate and non-invasive morphological characterization of the strictures, as well as additional in- formation about the extralurninal extent of the disease. No statistically significant differences were observed between bronchoscopic find- ings and the MPR, VRT and VE image evaluations （P = 0.715, 0.413 and 0.417 respectively）. Conclusion： Three-dimensionaI CT may provide a high fidelity, noninvasive and reproducible evaluation of the trachea compared to bronchoscopy. They may play a role in as- sessment of airway patency distal to high-grade stenoses, and represent a reliable alternative method for patients not amenable to conven- tional bronchoscopy.

关 键 词：气管狭窄 三维CT 支气管镜 

分 类 号：R562.12[医药卫生—呼吸系统] R814.42[医药卫生—内科学]