Synergistic CT-Bronchoscopy for Lung-Cancer Assessment

协同 CT 支气管镜检查用于肺癌评估

• 批准号: 7071822
• 负责人: William Evan Higgins
• 金额: $ 32.93万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-05-01 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7071822
• 关键词: bioimaging /biomedical imaging; bronchoscopy; clinical research; computed axial tomography; computer assisted diagnosis; diagnosis design /evaluation; human subject; image guided surgery /therapy; image processing; lung neoplasms; lymph node neoplasm; mediastinum; method development; neoplasm /cancer diagnosis; phantom model; respiratory disorder; sheep

DESCRIPTION (provided by applicant): This competitive renewal continues the goal of devising a computer-based virtual-endoscopic system for more effective lung-cancer assessment. It is driven by the following hypothesis: A synergistic combination of 3D MDCT imaging, image processing, and bronchoscopy improves current procedures for the staging, diagnosis, and treatment of lung cancer. The system devised to date known as the Virtual Navigator combines three-dimensional (3D) multidetector computed tomography (MDCT) imaging and bronchoscopy. It has shown great promise for 3D pulmonary CT image assessment and for image-guided bronchoscopic biopsy within the mediastinum. The objectives of this renewal are to build on these successes. In particular we now propose to develop and test methods that enable: (1) comprehensive nonsurgical staging of the mediastinal lymph nodes; (2) extension of our basic guidance system for the bronchoscopic biopsy of peripheral lung nodules; (3) positive characterization and selection of lung nodules needing biopsy. The project's specific aims are as follows: Aim 1 -- Devise computer-based methods for planning and guiding the bronchoscopic biopsy of peripheral lung nodules and mediastinal lymph nodes, thereby reducing the number of surgical biopsies and nodule resections and enabling less-invasive mediastinal lymph-node staging. Aim 2 -- Devise methods for MDCT-based analysis of diagnostically important pulmonary structures, thereby enabling more thorough and effective use of MDCT images. Aim 4 -- Perform human studies to compare the complete system to standard practice. Recent studies applying CT to population-based screening of at-risk smokers yield a large number of subjects with pulmonary nodules, as well as subjects with asymptomatic mediastinal lymph node enlargement. Most of these nodules and lymphadenomegaly will not be due to cancer. Further, bronchoscopic biopsy of small peripheral nodules and 1-2 cm lymph nodes have low yield, because of the considerable skill needed in traversing the 3D airway structure and the difficulty in making judgments on blind sites. Transcutaneous needle biopsy also has low yield for small nodules and has other potential complications. This leaves surgical removal, which has many drawbacks in terms of morbidity, cost, and the high rate of resecting benign structures. Finally, once lung cancer has been diagnosed, the impact of therapy and treatment remains largely unchanged over the last twenty years. Thus, methods are needed for: (1) early assessment of suspect lung pathologies; (2) planning and guidance of the biopsy procedure to improve yields and consequently improve early diagnosis and staging; and (3) accurate delivery of new therapies directly into the lung tumor nodule or involved lymph nodes. This competitive renewal proposes such methods. If successful, the project will have a major impact on the management of lung nodules detected by lung cancer screening or other MDCT applications to the lung, and on the appropriate staging of lung cancer. Finally, the methods should be generalizable to other organ systems, in particular to applications in neurology, urology, gynecology and gastroenterology.

描述（由申请人提供）： 这一竞争性更新继续设计一个基于计算机的虚拟内窥镜系统，以更有效地评估肺癌的目标。它是由以下假设驱动的：3D MDCT成像、图像处理和支气管镜检查的协同组合改善了当前肺癌分期、诊断和治疗的程序。该系统设计的日期被称为虚拟导航结合三维（3D）多探测器计算机断层扫描（MDCT）成像和支气管镜检查。它已经显示出很大的前景三维肺部CT图像评估和图像引导下纵隔内的支气管镜活检。这次更新的目标是在这些成功的基础上再接再厉。特别是，我们现在建议开发和测试的方法，使：（1）纵隔淋巴结的综合非手术分期;（2）扩展我们的基本指导系统，支气管镜活检周围肺结节;（3）积极的特点和选择肺结节需要活检。该项目的具体目标如下：目标1 -设计以计算机为基础的方法，用于规划和指导周围肺结节和纵隔淋巴结的支气管镜活检，从而减少外科活检和结节切除的数量，并实现侵入性较小的纵隔淋巴结分期。目的2 --设计基于MDCT的诊断重要肺部结构分析方法，从而使MDCT图像的使用更加彻底和有效。目标4 --进行人体研究，将整个系统与标准实践进行比较。最近的研究将CT应用于高危吸烟者的人群筛查，产生了大量患有肺结节的受试者以及患有无症状纵隔淋巴结肿大的受试者。大多数结节和淋巴结肿大不是癌症。此外，小的外周结节和1- 2cm淋巴结的支气管镜活检的产率低，因为在穿过3D气道结构时需要相当多的技能并且难以对盲点进行判断。经皮穿刺活检对小结节的检出率也很低，并有其他潜在的并发症。这就留下了手术切除，其在发病率、成本和切除良性结构的高比率方面具有许多缺点。最后，一旦肺癌被诊断出来，治疗和治疗的影响在过去二十年中基本保持不变。因此，需要用于以下的方法：（1）早期评估可疑的肺部病理;（2）规划和引导活检程序以提高产率，从而提高早期诊断和分期;以及（3）将新疗法准确地直接递送到肺肿瘤结节或所涉及的淋巴结中。这次竞争性更新提出了这样的方法。如果成功，该项目将对肺癌筛查或其他肺部MDCT应用检测到的肺结节的管理以及肺癌的适当分期产生重大影响。最后，该方法应该推广到其他器官系统，特别是在神经病学，泌尿学，妇科学和胃肠病学的应用。