Current status and prospect of imaging examination methods for rejection after lung transplantation
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摘要: 肺移植是治疗终末期肺病的唯一有效手段,其术后发生的排斥反应是影响受者预后的主要因素。影像学检查可作为无创手段,辅助其他检查监测肺移植术后排斥反应。目前已报道的影像学方式较多,明确各种影像学检查的优势与不足,有助于排斥反应的早期诊断,使得肺移植受者可以得到及时治疗,进而提高其生活质量及预后。本文对肺移植术后排斥反应各种影像学检查的利弊及进展进行综述,为寻找肺移植术后排斥反应的最佳无创检查手段提供参考,提高受者远期生存。Abstract: Lung transplantation is the only effective therapeutic option for end-stage lung diseases, and postoperative rejection is the main factor affecting clinical prognosis of the recipients. Imaging examination can be utilized as a noninvasive tool to assist other examinations in monitoring rejection after lung transplantation. At present, multiple imaging examination methods have been reported. The advantages and disadvantages of various imaging examinations have been clarified, which may promote early diagnosis of rejection, deliver timely treatment for lung transplant recipients and improve the quality of life and clinical prognosis. In this article, the advantages, disadvantages and research progress upon different imaging examinations for rejection after lung transplantation were reviewed, aiming to provide reference for identifying the optimal noninvasive examination approach for rejection after lung transplantation and enhance the long-term survival of the recipients.
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表 1 肺移植术后排斥反应影像学检查方法
Table 1. Imaging methods of rejection after lung transplantation
影像学方法 影像学表现 优点 缺点 AR CLAD 胸部X线检查 肺间质纤细的网格影、肺段实变和肺门周围实变影 早期:表现正常
加重:肺血管纹理减少,亚段肺不张
晚期:不规则及不透明区域增加操作简单、成本较低 诊断效果不佳 CT检查 肺部磨玻璃影及小叶间隔增厚 BOS:肺体积和肺密度的纵向变化明显,伴有细支气管空气潴留支气管扩张
RAS:肺间质毛玻璃结节、蜂窝状改变和小叶间隔增厚密度分辨率较高、显示人体解剖结构能力强 辐射较大、准确性仍存在争议 MRI检查 超短回波时间MRI序列可显示AR引起的变化 肺通气动力学参数及区域异质性 高分辨率、高清晰度、可多参数成像与多方位扫描 价格昂贵 PET/CT检查 18F-FDG①摄取量增加 BOS:18F-FDG摄取量增加,纤维增生活跃、肺胸膜实质改变
RAS:18F-FDG摄取量降低唯一用解剖形态方式进行功能、代谢和受体显像的技术 无法精确定位病灶 超声检查 存在B线 BOS:胸膜下实变伴有B线
RAS:肺间质性纤维化无辐射、易用性、实时性、便携性、低成本 肺部气体干扰及肋骨遮挡,超声检查受限 注:①18F-FDG为18F-氟代脱氧葡萄糖。 -
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