Becker Heinrich D, Slawik Matthias, Miyazawa Teruomi, Gat Merav
Department of Interdisciplinary Endoscopy, Thoraxklinik at Heidelberg University, Heidelberg, Germany.
Respiration. 2009;77(2):179-94. doi: 10.1159/000182972. Epub 2008 Dec 9.
In many patients, the benefit of interventional bronchoscopy cannot be appropriately objectified.
We investigated a new technique, vibration response imaging (VRI), for breathing sound mapping to determine whether it could provide additional, valuable objective qualitative and quantitative information in central airway obstruction (CAO) and patient outcome following interventional bronchoscopy.
VRI images from 83 patients with suspected central airway stenosis and 25 healthy volunteers were evaluated by two raters blinded to the subjects' status. Qualitative and quantitative dynamic and static features were documented for the final assessment of images as normal or abnormal and changes after the intervention. As a secondary goal, stenosis location was also evaluated and compared to bronchoscopic findings. Treatment outcome analysis (improved vs. not improved) was performed by comparing baseline and follow-up images in 64 evaluations of interventional bronchoscopy. VRI measurements of treatment outcome were compared to standard tests, i.e. dyspnea score, pulmonary function testing (PFT, i.e. FEV(1), FVC and FEV(1)/FVC), chest X-ray/computed tomography and bronchoscopy, the latter being considered the gold standard).
There was 95% (115/121) agreement between raters and clinical assessment in distinguishing between normal and abnormal images. The sensitivity and specificity of VRI were 97 and 88%, respectively. The accuracy of VRI in locating the pathology compared to bronchoscopy was 85% (17/20) for tracheal and 88% (51/58) for bronchial obstruction; overall accuracy was 83%. Correct detection of the affected side in bronchial obstructions was 88%. The overall accuracy of VRI in defining the outcome of interventional bronchoscopy was 84%.
Obstruction location and procedure outcome were reliably identified according to specific patterns of lung images. VRI proved at least as good as standard tests in locating CAO and has the potential for becoming a valuable complementary tool in evaluating treatment outcome in patients with CAO. If our results are confirmed by further studies, VRI may replace PFT or imaging procedures in cases in which such tests cannot be performed or are not readily available at the time of the intervention.
在许多患者中，介入性支气管镜检查的益处无法得到恰当客观的评估。
我们研究了一种新技术——振动反应成像（VRI），用于呼吸音映射，以确定其是否能在中央气道阻塞（CAO）以及介入性支气管镜检查后的患者预后方面提供额外的、有价值的客观定性和定量信息。
83例疑似中央气道狭窄患者和25名健康志愿者的VRI图像由两名对受试者状况不知情的评估者进行评估。记录定性和定量的动态及静态特征，以最终评估图像是正常还是异常以及干预后的变化。作为次要目标，还对狭窄部位进行了评估，并与支气管镜检查结果进行比较。通过比较介入性支气管镜检查64次评估中的基线图像和随访图像进行治疗结果分析（改善与未改善）。将VRI测量的治疗结果与标准测试进行比较，即呼吸困难评分、肺功能测试（PFT，即FEV(1)、FVC和FEV(1)/FVC）、胸部X线/计算机断层扫描和支气管镜检查，后者被视为金标准）。
评估者与临床评估在区分正常和异常图像方面的一致性为95%（115/121）。VRI的敏感性和特异性分别为97%和88%。与支气管镜检查相比，VRI定位病变的准确性对于气管阻塞为85%（17/20），对于支气管阻塞为88%（51/58）；总体准确性为83%。支气管阻塞中患侧的正确检测率为88%。VRI在定义介入性支气管镜检查结果方面的总体准确性为84%。
根据肺部图像的特定模式可可靠地识别阻塞部位和手术结果。VRI在定位CAO方面至少与标准测试一样好，并且有可能成为评估CAO患者治疗结果的有价值的辅助工具。如果我们的结果得到进一步研究的证实，在无法进行此类测试或在干预时无法轻易获得此类测试的情况下，VRI可能会取代PFT或成像程序。
