Lee Karen S, Sun Maryellen R M, Ernst Armin, Feller-Kopman David, Majid Adnan, Boiselle Phillip M
Center for Airway Imaging, Department of Radiology, and Division of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, Boston, MA.
Center for Airway Imaging, Department of Radiology, and Division of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, Boston, MA.
Chest. 2007 Mar;131(3):758-764. doi: 10.1378/chest.06-2164.
To assess the accuracy of dynamic expiratory CT for detecting airway malacia using bronchoscopy as the diagnostic "gold standard."
A computerized hospital information system was used to retrospectively identify all patients with bronchoscopically proven airway malacia referred for CT airway imaging at our institution during a 19-month period. CT was performed within 1 week of bronchoscopy. All patients were scanned with a standard protocol, including end-inspiratory and dynamic expiratory volumetric imaging, using an eight-detector multislice helical CT scanner. For both CT and bronchoscopy, malacia was defined as >/= 50% expiratory reduction of the airway lumen. CT and bronchoscopic findings were subsequently jointly reviewed by the radiologist and bronchoscopist for concordance.
Twenty-nine patients (12 men and 17 women; mean age, 60 years; range, 36 to 79 years) comprised the study cohort. CT correctly diagnosed malacia in 28 of 29 patients (97%). The most common presenting symptoms were dyspnea in 20 patients (69%), severe or persistent cough in 16 patients (55%), and recurrent infection in 7 patients (24%). The estimated radiation dose (expressed as dose-length product) for the dual-phase study is 508 mGy-cm, which is comparable to a routine chest CT.
Dynamic expiratory CT is a highly sensitive method for detecting airway malacia and has the potential to serve as an effective, noninvasive test for diagnosing this condition.
以支气管镜检查作为诊断“金标准”，评估动态呼气CT检测气道软化的准确性。
利用计算机化医院信息系统，回顾性识别在19个月期间转诊至我院进行CT气道成像且经支气管镜检查证实存在气道软化的所有患者。CT检查在支气管镜检查后1周内进行。所有患者均采用标准方案进行扫描，使用八探测器多层螺旋CT扫描仪进行吸气末和动态呼气容积成像。对于CT和支气管镜检查，气道软化定义为气道腔呼气时缩小≥50%。随后，放射科医生和支气管镜医生共同复查CT和支气管镜检查结果，以判断一致性。
29例患者（12例男性和17例女性；平均年龄60岁；范围36至79岁）组成研究队列。CT在29例患者中的28例（97%）中正确诊断出气道软化。最常见的症状为20例患者（69%）出现呼吸困难，16例患者（55%）出现严重或持续性咳嗽，7例患者（24%）出现反复感染。双期研究的估计辐射剂量（以剂量长度乘积表示）为508 mGy-cm，与常规胸部CT相当。
动态呼气CT是检测气道软化的一种高度敏感的方法，有潜力作为诊断该疾病的有效、非侵入性检查。
