间质性肺病(ILD)患者常出现非诊断性高分辨率CT(HRCT)扫描和支气管肺泡灌洗(BAL)结果,导致需要侵入性手术或冷冻肺活检,这与显著的发病率相关。共聚焦激光显微内窥镜(CLE)和光学相干断层扫描(OCT)是高分辨率的激光和基于光的技术,可在支气管镜检查期间以不同的深度和视野提供肺泡腔的实时成像。
本研究的目的是将OCT和CLE成像与ILD中的HRCT成像相关联。
这是20例ILD患者的回顾性病例系列,这些患者在使用BAL进行标准支气管镜检查期间接受了肺泡CLE和OCT成像,指示后进行肺活检。将CLE和OCT成像与四种主要的HRCT模式和组织学进行比较。最终诊断基于多学科讨论诊断。
与HRCT相比,支气管镜CLE和OCT成像是可行和安全的,并提供了额外的高度详细的解剖信息。支气管镜实时CLE能够识别“肺泡细胞”(毛玻璃混浊)和肺纤维化(肺泡弹性蛋白纤维增加)。支气管镜实时OCT允许可视化“斑片状纤维化疾病”,“蜂窝”(微囊),和气道粘膜肉芽肿.
肺泡腔的支气管镜CLE和OCT是可行且安全的,并且能够微创,高分辨率检测特定ILD特征,有可能改善ILD诊断和监测,并减少手术或冷冻肺活检的需要。
Patients with interstitial lung diseases (ILDs) frequently present with nondiagnostic high-resolution CT (HRCT) scan and bronchoalveolar lavage (BAL) results, resulting in the need for invasive surgical or cryo-lung biopsy that is associated with significant morbidity. Confocal laser endomicroscopy (CLE) and optical coherence tomography (OCT) are high-resolution laser and light-based techniques that provide real-time imaging of the alveolar compartment during bronchoscopy with a different depth and field of view.
The aim of the study was to correlate OCT and CLE imaging to HRCT imaging in ILD.
This is a retrospective
case series of 20 ILD patients who underwent alveolar CLE and OCT imaging during a standard bronchoscopy with BAL, followed by a lung biopsy when indicated. CLE and OCT imaging were compared to four main HRCT patterns and histology. The final diagnosis was based on the multidisciplinary discussion diagnosis.
Bronchoscopic CLE and OCT imaging were feasible and safe and provided additional high-detailed anatomical information compared to the HRCT. Bronchoscopic real-time CLE was capable of identification of \"alveolar cells\" (ground glass opacities) and lung fibrosis (increased alveolar elastin fibers). Bronchoscopic real-time OCT allowed for visualization of \"patchy fibrotic disease\", \"honeycombing\" (microcysts), and mucosal granulomas in the airways.
Bronchoscopic CLE and OCT of the alveolar compartment is feasible and safe and enables minimally invasive, high-resolution detection of specific ILD features with the potential to improve ILD diagnostics and monitoring and decrease the need for surgical or cryo-lung biopsies.