Comparative study on anatomical analysis of diagnostic images of the mediastinum by endoscopic ultrasonography, MRI, and X-ray CT.

纵隔未老化的诊断是基于对图像的解剖分析。建立了纵隔的X线CT横断面影像解剖学。CT横断面图像重建的纵隔纵断面图像不适合精细解剖分析。纵隔未老化的诊断可通过MRI获得纵向断层图像。然而，由于运动伪影的存在，MRI没有足够的空间分辨率来进行分析。应用经食道内窥镜超声(EUS)实时动态成像技术对纵隔纵隔断面进行影像解剖分析，采用CT/T-9800型(通用电气)，TCT-60A型或TCT-70A型(东芝)，层厚10 mm，层间距10 mm，窗宽400，窗位50HU。使用Vista-0.5HP(Picker)、MRT-15A(东芝)或Signa(通用电气)进行短自旋回波法MRI。Transeso…更多的食道超声内窥镜使用EPB-503FS(5 MHz)线阵超声内窥镜，SAL-50A(东芝)，EPE-707FS(7.5 MHz)线阵，SSA-90A(东芝)，UST936-5(5 MHz)凸形内窥镜探头，SSD-650(ALOKA)。在黏膜表面麻醉下，采用滑动倾斜超声内窥镜经食道进行超声内镜治疗。图像由录像机和静态照片记录。对3种检查方法的图像进行对比分析，根据CT和MRI在不同层面上的横断面图像确定MRI和EUS的横断面方向。将经食道纵断面上的MR图像与经食道EUS的图像进行比较。MRI显示纵隔结构的轮廓。运动伪影经常出现在MRI上。MRI和CT对静态物体的分辨率在临床上是可以接受的。然而，对运动目标的分辨能力较差。实时经食道超声可以进行分辨率为毫米量级的精细分析。食管壁、椎体、肺、左头臂静脉、头臂干、左颈总动脉、锁骨下动脉、升主动脉、主动脉弓、降主动脉、上腔静脉、奇静脉、右耳廓、三尖瓣、右室、肺动脉瓣、肺干、右肺动脉、左肺动脉、气管、主支气管、左耳廓、右上、右下肺静脉、二尖瓣、左上、左下肺静脉、二尖瓣、下腔静脉、肝静脉、杠杆、心脏、胸膜、隔膜。经食道超声检查因空气污染而形成的死角，并用核磁共振覆盖骨骼。根据不同方向纵隔横断面的典型图像，制作纵隔不同方向的断层图像示意图，为了解CT、MRI和经食道实时超声对纵隔的动态影像解剖奠定基础。纵隔影像解剖学的广泛持续研究必须通过这三种模式的未来技术发展来实现。较少

Diagnostic unaging of the mediastinum is based on the anatomical analysis of the images. Transverse sectional imaging anatomy of the mediastinum by X-ray CT has been established. Reconstructed longitudinal sectional image of the mediastinum from transverse sectional images by CT is not suitable for fine anatomical analysis. Longitudinal sectional image is obtainable by MRI for diagnostic unaging of the mediastinum. However, MRI does not have sufficient spatial resolution power for analysis due to motion artifact. Real-time dynamic image by transesophageal endoscopic ultrasonography(EUS)is applied for analysis of imaging anatomy of the longitudinal sectional plane of the mediastinum.For X-ray CT, type CT/T-9800(General Electric), and type TCT-60A or TCT-70A(Toshiba)was used with 10 mm slice thickness, 10 mm slice spacing, window width of 400, and window level at 50 HU. VISTA-0.5HP(Picker), MRT-15A(Toshiba), or Signa(General electric)was used for MRI with short spin echo method. Transeso … More phageal EUS was performed by EPB-503FS(5 MHz)linear array ultrasound endoscope with SAL-50A(Toshiba), EPE-707FS(7.5 MHz)linear array with SSA-90A(Toshiba), or UST936-5(5 MHz)convex endosonographic probe with SSD-650(Aloka)was used. Under mucosal surface anaesthesia, EUS was performed through the esophagus with sliding and tilting the ultrasound endoscope. Images were recorded by VTR and still photographs. Images of these 3 modalities were compared, and anatomically analyzed.Directions of the longitudinal planes for MRI and EUS were determined by transverse sectional images of CT and MRI on the various levels. MR images on the longitudinal sectional plane through the esophagus were compared to the images by the transesophageal EUS. Outline of the mediastinal structures were revealed on the MRI. Motion artifacts were frequently appeared on the MRI. Resolution power of MRI and CT for static objects were clinically acceptable. However, resolution power for moving target was poor. Fine analysis with the resolution power at mm order was possible by real-time transesophageal ultrasonography. Following anatomical structures were identified by transesophageal EUS : esophageal wall, vertebra, lung, left brachiocephalic vein, brachiocephalic trunk, left common carotid artery, lest subclavian artery, ascending aorta, aortic arch, descending aorta, superior vena cava, azygos vein, right auricle, tricuspid valve, right ventricle, pulmonary valve, pulmonary trunk, right pulmonary artery, left pulmonary artery, trachea, main bronchi, left auricle, right upper-, right lower-, left upper-, and left lower-pulmonary vein, mitral valve, left ventricle, aortic valve, coronary artery, coronary sinus, inferior vena cava, hepatic vein, lever, heart, pleural space, and diaphragm. Dead angles by transesophageal EUS because of the air, and the bones were covered by MRI. Schematic illustrations of sectional images of the mediastinum through the esophagus were made based on typical images of longitudinal sectional plane at different direction.Fundamental knowledge was established to understand dynamic imaging anatomy of the mediastinum by CT, MRI, and transesophageal real-time EUS. Extensive continuing study for mediastinal imaging anatomy must be achieved by future technical development, of these three modalities. Less