An Imaging Anatomical Study In The Perioperative Period On Lung Transplantation For Idiopathic Pulmonary Fibrosis Based On Computed Tomography

Objective:Idiopathic pulmonary fibrosis(IPF)is an interstitial pneumonia with unknown causes,mainly occurring in old age,confined to the lungs,histopathological andjor imaging causes of chronic progressive fibrosis.Because of the irreversible natural course of disease and the unsatisfactory drug treatment,the prognosis of the patient is poor.Lung transplantation is the only effective method for the treatment of IPF.In lung transplant treatment of idiopathic pulmonary fibrosis,perioperative patients with chest related organs(including autologous lung,pulmonary artery,the aorta,heart,chest and implanted into the lungs,etc.)with a series of changes,the internal structure of these tissues and organs,organizations,morphology,size,location,physiological function changes and to transplant the adjustment ability of the body,often affect the curative effect and prognosis of patients.Therefore,only by accurately understanding and timely mastering the status of relevant tissues and organs in perioperative period of lung transplantation patients can we effectively carry out clinical diagnosis and treatment and improve the prognosis of patients.Computer Tomography(CT),especially the high resolution CT(HRCT),has the features of non-invasive convenience,short inspection time,high spatial resolution and density resolution,and strong ability to display human anatomical structure.This study took CT as the basic perspective and conducted imaging anatomy analysis of the relevant tissues and organs of the chest before and after lung transplantation in IPF patients,aiming to further understand the changes in the structure and function of the chest organs in the perioperative period of lung transplantation in IPF patients and further understand the value and role of CT in diagnosing and evaluating such patients.Methods:30 patients with idiopathic pulmonary fibrosis received lung transplantation between April 2016 and January 2018.Chest CT scans were performed on 30 patients before and after the operation,and CT angiography(CTA)of pulmonary or coronary arteries was also performed on some patients because of their condition.The imaging station was used for postoperative reconstruction and analysis,and the diameters of pulmonary trunk,ascending aorta,thoracic aorta,left and right cardiac diameter and thoracic transverse diameter were measured.The mean pulmonary artery pressure before and after operation was measured.The anatomy of chest CT images before and after surgery,the correlation between pulmonary trunk and pulmonary artery pressure,the changes in the diameter of large blood vessels such as CT cardiothoracic ratio,thorax,heart and pulmonary trunk before and after surgery,and the survival rate after surgery were mainly studied.Results:1.Preoperative chest CT images showed typical positive signs of IPF lung(e.g.,honeycomb changes,thickening of interlobular septum,traction bronchiectasis,reticular line,etc.),and distribution had certain characteristics(distributed in the progressive development of diffuse intrapulmonary diseases from the subpleural and basal parts of the lung).2.Postoperative chest CT images showed non-specific positive signs after chest surgery,which should be combined with clinical and laboratory tests.3.There was positive correlation between pulmonary arterial stem diameter and pulmonary arterial pressure.Both pulmonary arterial pressure and pulmonary arterial stem diameter were smaller after operation than before operation.4.Postoperative CT cardiothoracic ratio and thoracic transverse diameter were smaller than those before surgery.5.In this study,the one-year survival rate of unilateral lung transplantation was higher than that of bilateral lung transplantation.Conclusion:1.CT is of great value in the clear diagnosis,preoperative evaluation,postoperative complications and prognosis of IPF patients treated by lung transplantation.2.For IPF patients in the perioperative period of lung transplantation,CT can not only understand the working status of lung transplantation,but also understand the fimctional and motor status of autologous tissues and organs(untransplanted lateral lung,pulmonary artery,heart,thoracic,etc.)through visual comparison of image anatomy before and after surgery.3.CT pulmonary arterial stem diameter measurement is helpful for noninvasive evaluation of pulmonary hypertension in IPF patients.