多层CT容积漫游技术在先天性气管支气管狭窄的诊断价值

Diagnostic value of multi-slice CT volume rendering technique in congenital tracheobronchial stenosis

目的:探讨多层CT容积漫游技术(VRT)在先天性气管支气管狭窄的诊断价值。方法:搜集经影像学检查及临床病史证实的先天性气管支气管狭窄32例,所有病例均行多层CT薄层扫描及支气管树VRT重建,评价VRT在先天性气管支气管狭窄的诊断优势及不足。结果:VRT立体显示气管、主支气管及叶支气管近端单发或多发狭窄32例,其中环形狭窄8例,不规则狭窄15例,锥形狭窄9例;累及长轴范围最长46mm,最短2mm;轻度狭窄8例,中度狭窄13例,重度狭窄11例。18例阻塞性肺气肿中,VRT清晰显示16例,患侧肺组织体积增大,含气增多,其中6例伴有纵隔疝。结论:多层CT-VRT可立体显示先天性气管支气管狭窄部位、范围、程度及阻塞性肺气肿,弥补了CT轴位长轴范围显示不足,图像不直观的缺点,对临床治疗具有重要指导意义;对叶支气管远端及以下支气管狭窄、局限性肺不张及阻塞性肺炎显示有一定限度,诊断时应结合CT二维图像。

Objective：To investigate diagnostic value of multi-slice CT volume rendering technique （VRT） in tracheobronchial stenosis.Methods：32 cases of congenital tracheobronchial stenosis proved by imaging examination and clinic history were collected in the study. All cases had undergone thin slice scanning of multi-slice CT and VRT reconstruction of bronchus tree. The diagnostic superiority and shortage to congenital tracheobronchial stenosis were retrospectively evaluated. Results： 32 cases with single or multiple stenosis in trachea, main bronchus, and distal lobar bronchus were demonstrated in VRT stereo-images. It displayed annular stricture （n = 8）, irregular stricture （n = 15） and infundibulate stricture （n = 9） in air column of bronchus lumen. The longitudinal range of the longest stenosis was 46 mm, the shortest was 2 mm. There were low degree （n = 8）, moderate degree （n = 13） and severe degree stenosis （n = 11）. 16 in 18 cases of obstructive emphysema and 6 cases of mediastinal hernia were clearly revealed in VRT images. It made enlargement volume of pulmonary tissue and manifold air in lung. Conclusion：Multi-slice CT-VRT images can display the location, range, degree of congeni- tal tracheobronchial stenosis and obstructive emphysema with three dimensional ways. It makes up the demonstration shortage of longitudinal range and intuitionistic images. It has important instruction significance for clinical therapy. It has a certain limitation in demonstration of distal lobar bronchus and segment bronchus, local pulmonary atelectasis and obstructive pneumonia and should combine with two-dimensional images in the diagnosis.