Synergistic CT-Bronchoscopy for Lung-Cancer Assessment

描述(由申请人提供)： 这一竞争性更新继续了设计一种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的协同组合改进了目前肺癌分期、诊断和治疗的程序。到目前为止，这个被称为虚拟导航器的系统结合了三维(3D)多探测器计算机断层扫描(MDCT)成像和支气管镜检查。它在三维肺CT图像评估和图像引导下纵隔内支气管镜活检方面显示出巨大的前景。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以下方法：(1)纵隔淋巴结的综合非手术分期；(2)扩展我们的周围型肺结节支气管镜活检的基本指导系统；(3)需要活检的肺结节的阳性特征和选择。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，规划和指导周围肺结节和纵隔淋巴结的支气管镜活检，从而减少手术活检和结节切除的次数，并使侵入性较小的纵隔淋巴结分期成为可能。目的2-设计基于多层螺旋CT对诊断重要的肺结构进行分析的方法，从而使多层螺旋CT图像能够更全面和有效地使用。目标4--进行人体研究，将完整的系统与标准实践进行比较。最近将CT应用于基于人群的高危吸烟者筛查的研究，发现了大量患有肺结节的受试者，以及无症状的纵隔淋巴结肿大的受试者。这些结节和淋巴肿大大多不是由癌症引起的。此外，支气管镜活检周围小结节和1-2厘米淋巴结的成功率较低，这是因为在穿越3D呼吸道结构时需要相当多的技能，而且很难在盲点上做出判断。对于小结节，经皮针刺活检的成功率也很低，并且有其他潜在的并发症。这就留下了手术切除，这在发病率、成本和切除良性结构的高比率方面有许多缺点。最后，一旦肺癌被诊断出来，治疗和治疗的影响在过去20年中基本保持不变。因此，需要采用以下方法：(1)可疑肺部病变的早期评估；(2)计划和指导活检程序，以提高产量，从而改善早期诊断和分期；(3)准确地将新疗法直接输送到肺肿瘤结节或受累淋巴结。这一竞争性更新提出了这样的方法。如果成功，该项目将对通过肺癌筛查或肺部其他MDCT应用发现的肺结节的管理以及肺癌的适当分期产生重大影响。最后，这些方法应该推广到其他器官系统，特别是在神经学、泌尿外科、妇科和胃肠病学中的应用。

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.