| Part 1 The comparison of DynaCT and spiral CT in tracheal measurementBackgroud and ObjectiveDynaCT is new imaging technology which uses flat digital subtraction angiography (DSA) device to generate images similar to the computed tomography (CT). The imaging system rotates 220°around the patient once and again, and acquires the high quality 3D images of the vascular, bone tissue and soft tissue in the same time. The images have been processed by the work station, and been transformed into 3D, sagittal, coronal, oblique and even curve section images, which are similar to the CT or MR images. DynaCT can clearly display the soft tissue around the vascular or bones. The vascular imaging system of DynaCT can offer more image information, which can be a great help in intervention operations. During or after the operation, the patient does not have to be transported to the CT room to do an inspection. It completely change the process of intervention treatment. DynaCT can provide more image information which is crucial in intervention diagnosis. The efficiency of intervention treatment has been improved, and the risk of the operation has been minimized. After DynaCT has been launched, it has been widely used in many medical fields, including neurology, oncology, angiography, orthopaedic surgery, hepatobiliary surgery. But the report which related to the tracheal application is few. The soft tissue around the tracheal has an intensive contrast with the tracheal on DynaCT images. It can be a great help to identify the tracheal structure and the location of the lesions, which provide reliable information to establish a treatment plan.MethodsWe have chosen 58 patients who have lesions in thoracic cavity. All of them have been inspected by DynaCT and spiral CT. The original data has been processed by the SyngoWorkplace, and generate 3D images. The diameter of the tracheal (TD), diameter of the around tracheal (AD), diameter of the left main bronchus (LBD), diameter of the right main bronchus (RBD) have been measured respectively.ResultsAll of these 58 patients, except 4 cases in which the patient's respiratory movement has interfered the imaging process. The measurements of the other 54 patients are as follows: DynaCT inspected group: TD=18.12±1.91mm, AD=16.23±1.71mm, LBD=13.43±1.62 mm, RBD=14.91±2.16mm; spiral CT inspected group:TD=17.2±1.85mm, AD=15.22±1.73mm, LBD=13.68±1.54mm, RBD=15.16±2.23mm. The measurements of each group have no significant difference (p>0.05)ConclusionThe result measured both by DynaCT and spiral CT has no significant difference. DynaCT can be used in measurement of the tracheal, chosen of the tracheal stent and assessment after operation. Keywords DynaCT ;Airway stent ; Stenosis Measurement of airway.Part2 The application research of DynaCT in tracheal stent implantationObjectiveCompare the incidence of complications after operation, improvement of respiration and life quality, in order to confirm whether the application of DynaCT in operation of tracheal stent implantation can reduce the probability of complications or improve life quality, and to forecast the development of DynaCT in the operation of tracheal stent implantation.MethodsObservation group:Under the monitoring of DynaCT, tracheal stent has been successfully implanted in 34 patients. All of these patients have accepted a DynaCT scan after the tracheal stent has been implanted, and the images have been reconstructed into 3D graph in order to measure the diameter of the tracheal. Control group:Analyze the data of the 37 patients accept the tracheal stent implantation under conventional DSA device. Compare the probability of complication after treatment, improvement of respiration and life quality of the patients in both groups. Improvement of respiration and life quality was evaluated in respiratory rating scale and ECOG rating scale.Results1.In the observation group:TD of the stenosis section before stent implantation is 2.70±1.41mm, and 7.32±1.61mm after stent implantation.2. In the observation group:In 30 cases the stents stick tight on the tracheal, and in 4 cases not. In 28 cases the stents expanded well, and in 6cases not.3. In the observation group:In 3 cases the stents displaced more or less.5 cases have severe infection after 5-7 days of anti-infection therapy.1 case has a blockade in upper lobe bronchus identified by DynaCT. The ECOG score:0-1 28 cases,2-46 cases. Rating of respiratory has improved fromⅢ-Ⅳclass into 0-Ⅱclass.4. In the observation group:In 8 cases the stents displaced more or less, and the stent has to be removed and implant again. 9 cases have severe infection after a week of anti-infection therapy.8 L-shape stents have been implanted, and 8 Y-shape stents have been implanted.2 case has a blockade in upper lobe bronchus identified by spiral CT. The ECOG score:0-126 cases,2-4 11 cases. Rating of respiratory has 1mConclusionThe dynamic monitor by DynaCT both in and after the operation, has dramatically minimized the complications after treatment, and improved the quality of life, which can be a great help to choose the proper stent and adjust the treatment plan. The location of the stent implantation become accurate, the risk of operation has been minimized. And the outlook of DynaCT's application in tracheal intervention is bright. |
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