Hussein Saad Rezk Abudlwahed
Department of Radio-diagnosis, Faculty of Medicine (Fisal branch), Al-Azhar University, Assiut, Egypt.
Curr Probl Diagn Radiol. 2013 Mar-Apr;42(2):33-9. doi: 10.1067/j.cpradiol.2012.05.005.
Bronchoscopy is an important diagnostic method for the tracheobronchial, thoracic, and mediastinal lesions. It is limited by the physical progression of the bronchoscope. This represents a problem when assessing difficult airways, such as a lumen narrowed from any cause. Bronchoscopy can be performed with flexible fiberoptic bronchoscopy (FOB), which remains the best modality for the evaluation of endoluminal and mucosal lesions of the respiratory tract. However, FOB has important limitations. It cannot view structures outside the bronchial wall, such as the mediastinal lymph nodes and vascular structures. Additionally, FOB frequently provides little information about the extent of the extraluminal diseases or airway patency distal to high-grade bronchial stenosis. In view of these limitations, some authors have suggested that virtual bronchoscopy (VB) may replace FOB. VB is a novel computed tomography-based imaging technique. It allows a noninvasive intraluminal evaluation of the tracheobronchial tree. In addition to its direct roles in patient care, VB has great potential in education, bronchoscopy training, and procedure planning. VB can be performed when FOB is contraindicated or considered risky, as in cases with airway narrowing. Also, it can be done as a preliminary evaluation before FOB. VB is not effective for the detection of subtle mucosal abnormalities, such as erythema or early sessile lesions. The aim of this pectoral essay is to present overview of VB and the author's experience of using of VB, based on computed tomography data, in diagnosis of different tracheobronchial lesions.
支气管镜检查是诊断气管支气管、胸部和纵隔病变的重要方法。它受到支气管镜物理推进的限制。在评估困难气道时，如因任何原因导致管腔狭窄，这就成为了一个问题。支气管镜检查可通过可弯曲纤维支气管镜（FOB）进行，它仍是评估呼吸道腔内和黏膜病变的最佳方式。然而，FOB有重要局限性。它无法观察支气管壁外的结构，如纵隔淋巴结和血管结构。此外，FOB常常难以提供有关管外疾病范围或高度支气管狭窄远端气道通畅情况的信息。鉴于这些局限性，一些作者建议虚拟支气管镜检查（VB）可能会取代FOB。VB是一种基于计算机断层扫描的新型成像技术。它允许对气管支气管树进行无创腔内评估。除了在患者护理中的直接作用外，VB在教育、支气管镜培训和手术规划方面也有很大潜力。当FOB禁忌或被认为有风险时，如在气道狭窄的情况下，可进行VB。此外，它也可在FOB之前作为初步评估。VB对检测细微的黏膜异常，如红斑或早期无蒂病变无效。这篇文章的目的是基于计算机断层扫描数据，概述VB以及作者使用VB诊断不同气管支气管病变的经验。
