多排螺旋CT在气管支架随访中的应用

目的:通过比较气道支架置入术后多排螺旋CT与气管镜随访检查的结果,评估多排螺旋CT的诊断价值。方法:收集130例(恶性疾病109例、良性疾病21例)行气管或支气管支架置入术患者,在术后3个月或并发症加重时行多排螺旋CT并行三维重建、多平面重建及曲面重建,在(1.2±0.6)天后行气管镜检查。由两名有经验的放射科医师对支架置入位置、形状、管腔的通畅和邻近气道的CT显示进行评估,并与气管镜结果进行比较。采用Kappa一致性检验两位医师的结果。以配对卡方检验判断CT诊断支架并发症的准确性。结果:61(46.9%)例患者的CT结果显示支架未见异常,其中5例显示不符,后者在气管镜检查显示支架内气管肉芽肿形成,管腔的轻微变窄(25%)。69例(53.1%)支架在CT上显示有异常改变,其中4例诊断肿瘤复发而气管镜证实为肉芽肿,其余65例与气管镜诊断一致。CT在发现支架置入术后局部异常的灵敏度为96.2%,特异性为100%,诊断准确性为93.1%。结论:CT作为一种非侵入性检查,对气管内植入支架相关检查结果准确性高,可在气管支架随访中起重要作用。

The Value of Multi-slice Spiral CT in Follow-up of the Tracheal Stent

Objective: Comparing the multi-slice helical CT with bronchoscopy findings of proximal-airways stenting to assess the value of multi-slice spiral CT. Methods: 130 patients with 130 endobronchial stents inserted for malignancy (n=109) or benign diseases (n=21) underwent follow-up multi-slice helical CT and with subsequent multi-slice reformation and three dimensional reconstruction at 3 months or complications aggravated. Bronchoscopy was carried out in (1.2±0.6) days. Of the stent location, shape, and adjacent lumen airway patency were evaluated by two experienced doctors. Kappa test was used to the check the consistency of the results of two doctors. Paired chi-square test to determine the diagnostic accuracy of CT stent complications. Results: CT results of 61 (46.9%) patients showed no complications, 5 patients showed discrepancies, the latter bronchoscopy show tracheal stent granuloma, a slight narrowing of the lumen (<25%). 69 cases (53.1%) showed abnormal changes in the lumen on CT. 4 cases were misdiagnosis as tumor recurrence and confirmed granuloma by bronchoscopy, the CT result of remaining 65 cases were consistent with the diagnosis of the bronchoscope. The sensitivity, specificity and accuracy of CT diagnosis was 96.2%, 100% and 93.1%, respectively. Conclusion: Computed tomography is an accurate noninvasive method for evaluating endobronchial stents. CT is a useful technique for follow up of patients who have undergone endobronchial stenting.