Li Jing, Xu Kaihao, Li Zhaonan, Li Yahua, Zhou Xueliang, Liu Juanfang, Yao Yuan, Liu Zaoqu, Jiao De-Chao, Han Xinwei
Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Quant Imaging Med Surg. 2022 May;12(5):2709-2720. doi: 10.21037/qims-21-858.
Angiographic computed tomography (CT) is useful in various medical contexts, but little research has been presented regarding the application of cone beam CT (CBCT) in airway stenting. This study set out to evaluate the clinical feasibility of using CBCT in airway stent placement in a single-center retrospective cohort.
A total of 228 patients with stenosis or fistula diseases were treated with metallic airway stents in the First Affiliated Hospital of Zhengzhou University from January 1, 2015, to December 31, 2018. Of them, 128 patients underwent fluoroscopy-guided airway stenting. CBCT scanning was performed on the other 100 patients during and after treatment, and their images were compared with those from postoperative multidetector CT (MDCT). The outcomes and complications in the CBCT-guided and fluoroscopy-guided groups were also assessed via Pearson's χ test or Fisher's exact test.
Tracheal stenting was performed successfully on the first attempt for 90 patients in the CBCT-guided group and 123 patients in the fluoroscopy-guided group. The mean measured diameters of the central airway in the CBCT images and MDCT images were 18.2±2.81 and 19.0±2.33 mm, respectively, and the mean lengths were 58.7±16.82 and 58.5±17.06 mm, respectively. In the CBCT-guided group and the fluoroscopy-guided group, the mean scores for visibility of the distal bronchus were 3.7±0.49 and 3.9±0.34, respectively; the mean scores for the pulmonary parenchyma were 3.3±0.71 and 3.9±0.31, respectively; and the mean scores for the airway above the upper stent graft were 1.8±0.41 and 4.0±0.20, respectively. Two of the three anatomical areas were reproduced in a diagnostically relevant way. The major complications rate was 7% and 19% in the CBCT-guided and fluoroscopy-guided groups, respectively.
CBCT produces images with sufficient quality to replace MDCT as a reasonable control measure after stent implantation, and its use during surgery reduces complications relating to airway stent placement.
血管造影计算机断层扫描（CT）在各种医疗环境中都很有用，但关于锥形束CT（CBCT）在气道支架置入中的应用研究较少。本研究旨在评估在单中心回顾性队列中使用CBCT进行气道支架置入的临床可行性。
2015年1月1日至2018年12月31日，郑州大学第一附属医院共有228例狭窄或瘘管疾病患者接受了金属气道支架治疗。其中，128例患者接受了透视引导下的气道支架置入。另外100例患者在治疗期间和治疗后进行了CBCT扫描，并将其图像与术后多排螺旋CT（MDCT）图像进行比较。还通过Pearson卡方检验或Fisher精确检验评估了CBCT引导组和透视引导组的结局和并发症。
CBCT引导组90例患者和透视引导组123例患者首次尝试气管支架置入均成功。CBCT图像和MDCT图像中中央气道的平均测量直径分别为18.2±2.81和19.0±2.33mm，平均长度分别为58.7±16.82和58.5±17.06mm。在CBCT引导组和透视引导组中，远端支气管可视性的平均评分分别为3.7±0.49和3.9±0.34；肺实质的平均评分分别为3.3±0.71和3.9±0.31；上支架移植物上方气道的平均评分分别为1.8±0.41和4.0±0.20。三个解剖区域中的两个以具有诊断意义的方式再现。CBCT引导组和透视引导组的主要并发症发生率分别为7%和19%。
CBCT产生的图像质量足以替代MDCT作为支架植入术后的合理对照措施，并且在手术过程中使用CBCT可减少与气道支架置入相关的并发症。
