多层螺旋CT仿真支气管镜对气管支气管病变的诊断价值

The diagnostic value of multi-slice spiral CT virtual bronchoscopy in tracheal and bronchial disease

目的评价多层螺旋 CT 仿真支气管镜(CTVB)对气管、支气管病变的诊断价值。方法对42例患者进行多层螺旋 CT 检查,在工作站得到仿真支气管图像,采用螺距1.35,重组间隔1 mm,重组层厚1.25 mm。其中35例为中央型肺癌、3例支气管内膜结核、3例支气管良性肿瘤经病理证实,1例支气管异物经临床证实。所有图像均经2名熟悉气管支气管解剖的放射科医师进行分析。结果42例中,35例中央型肺癌 CTVB 表现为气管支气管腔内结节状或丘状隆起者22例,狭窄13例,以上35例中央型肺癌横断面 CT 均显示病变部位支气管壁呈不同程度增厚。3例支气管内膜结核CTVB 均表现为支气管腔狭窄,横断面 CT 显示管壁增厚,管壁增厚范围长。3例气管支气管良性肿瘤CTVB 表现为腔内结节,横断面 CT 无相邻支气管壁的增厚。另1例支气管腔内异物 CTVB 表现为支气管腔内隆起性阻塞,横断面 CT 无相邻支气管壁的增厚。CTVB 可以越过狭窄部位对远端支气管进行观察。结论多层螺旋 CTVB 可以反映气管支气管腔内病变的形态,结合横断面 CT 对气管支气管病变的诊断具有参考价值。

Objective To assess the diagnostic value of multi-slice spiral CT virtual bronchoscopy （CTVB） in tracheal and bronchial disease. Methods Forty-two patients including central lung cancer （ n = 35） , endobronchial tuberculosis （ n = 3 ）, intrabronchial benign tumor （ n = 3 ）, and intrabronchial foreign body （ n = 1 ） were examined by using multi-slice spiral CT examinations. All the final diagnosis were proved by pathology except 1 patient with endoluminal foreign body was proved by clinic. All patients were scanned on GE Lightspeed 99 scanner, using 10 mm collimation, pitch of 1.35, and reconstructed at 1 mm intervals and 1.25 mm thickness. The chest images of transverse CT and virtual bronchoscopy were viewed by two separate radiologists who were familiar with the tracheal and bronchial anatomy. Results Among the 42 patients, the tumor of trachea and bronchial lumen appeared as masses in 22 of 35 patients with central lung cancer and bronchial stenosis was found in 13 of 35 patients with central lung cancer, and bronchial wall thickening was revealed on transverse CT in all 35 cases. 3 patients of endobronchial tuberculosis showed bronchial lumen narrowing on CTVB, the bronchial wall thickening was revealed on transverse CT, and the length of the wall thickening was long. 3 patients with intrabronchial benign tumor showed nodules in trachea and bronchial lumen on CTVB, and without wall thickening on transverse CT. CTVB could detect the occlusion of bronchial lumen in 1 patient with intrabronchial foreign body and CTVB was able to visualize the areas beyond stenosis, and the bronchial wall was without thickening on transverse CT. Conclusion Multislice spiral CTVB could reflect the morphology of tracheal and bronchial disease. Combined with transverse CT, it could provide diagnostic reference value for bronchial disease.