Imaging parenchymal lung diseases with confocal endomicroscopy
Imaging parenchymal lung diseases with confocal endomicroscopy
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DOI：
10.1016/j.rmed.2011.09.009
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发表时间：
2012-01-01
影响因子：
4.3
通讯作者：
Shah, Pallav L.
中科院分区：
文献类型：
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作者：
Newton, Richard C.;Kemp, Samuel V.;Shah, Pallav L.
背景：使用基于支气管镜探针的共焦显微内窥镜检查 (pCLE) 进行的“光学活检”可提供健康腺泡的自发荧光弹性蛋白支架的实时图像。 目标：如果静脉注射荧光素提供额外的诊断信息，则确定不同的实质肺病 (PLD) 如何改变 pCLE 图像，并评估 pCLE 用于研究 PLD 的安全性（英国 REC： 09/H0708/18)。方法：对 38 名患者和 4 名健康非吸烟者志愿者的 116 个支气管肺段进行了检查。 pCLE 图像与 HRCT、支气管肺泡灌洗和经支气管/CT 引导活检的共识多学科诊断相关。结果：pCLE 成像显示严重肺气肿，间隔壁之间的间距增加，肺大泡荧光突然消失，随后出现网状胸膜图像。其他 PLD 表现出小叶自发荧光和独特性的显着丧失。在所有成像疾病中，与健康腺泡相比，患病腺泡中的间隔壁和微血管弹性蛋白的区分更加困难。在体外 BAL 分析中，吸烟者显示出高度荧光的 15-30 微米细胞肺泡浸润 - 肺泡巨噬细胞。不同的静脉注射荧光素剂量只会产生带有气泡的超荧光前景。 pCLE 可引起胸膜炎不适，但不会出现气胸。 3 名患者出现短暂出血，并观察到邻接探头的间隔壁和微血管的体内撕裂。结论：由于弹性壁的丧失，可证明明显的肺气肿。高分辨率 pCLE 图像的细节在其他 PLD 中被削弱，而静脉内荧光素无法进一步清晰。尽管如此，pCLE 对于 PLD 研究是安全的。这些发现为未来利用 pCLE 的潜在效用作为 PLD 诊断多重评估模式的一部分奠定了基础。 (C) 2011 Elsevier Ltd. 保留所有权利。
Background: "Optical biopsy" using bronchoscopic probe-based confocal endomicrosocopy (pCLE) provides real time images of the autofluorescent elastin scaffold of the healthy acinus.Objectives: To establish how different parenchymal lung diseases (PLDs) alter the pCLE image, if intravenous fluorescein provides additional diagnostic information, and to assess pCLE's safety for investigating PLDs (UK REC: 09/H0708/18).Methods: 116 bronchopulmonary segments were examined in 38 patients and 4 healthy non-smoker volunteers. pCLE images were correlated with consensus multidisciplinary diagnosis from HRCT, bronchoalveolar lavage, and transbronchial/CT guided biopsies.Results: Severe emphysema is evident on pCLE imaging, with increased spacing between septal walls, sudden loss of fluorescence from bullae and a subsequent reticular pleural image. Other PLDs demonstrated marked loss of lobular autofluorescence and distinctiveness. In all diseases imaged, differentiation between septal wall and microvessel elastin is more difficult in diseased versus healthy acini. Smokers displayed a hyperfluorescent 15-30 micron cellular alveolar infiltrate - alveolar macrophages on in vitro BAL analysis. Varied intravenous fluorescein doses only create a hyperfluorescent foreground with bubbles. pCLE can cause pleuritic discomfort but there were no pneumothoraces. 3 patients had transient bleeding, and in vivo tearing of septal walls and microvessels abutting the probe was observed.Conclusions: Marked emphysema is demonstrable from loss of elastic walls. The detail of high-resolution pCLE images is attenuated in other PLDs without further clarity from intravenous fluorescein. Nevertheless, pCLE is safe for PLD investigation. These findings form a basis for future work to harness pCLE's potential utility as part of a multiassessment modality for PLD diagnosis. (C) 2011 Elsevier Ltd. All rights reserved.