â… ,Animal Experimental Study Of Pulmonary Cryptococcosis â…¡,Image Study Of Large Airway Morphological Change And Diagnosis Value

【Background】Recent years, with broad-spectrum antibiotics, immunosuppressants and other drugs widely used in clinical and bone marrow transplantation and other medical means to continue to spread, increasing the incidence of pulmonary fungal infections,Which is the most common fungal disease of the lung disease is a pulmonary cryptococcosis neoformans infection caused by the acute or subacute pulmonary fungal disease.It occurs in immunocompromised hosts, such as neutropenia, acquired immunodeficiency syndrome (AIDS), cancer chemotherapy, patients with severe malnutrition. The lack of specificity of clinical signs, and imaging findings are complex and diverse, and often misdiagnosed as normal inflammatory response, tuberculosis, cancer, leading to delayed treatment.Recent years due to the increasing in immunocompromised patients and increased their awareness of the disease subacute or chronic clinical cases reported has increased, mostly confirmed by biopsy or surgical pathology, the incidence of acute pulmonary cryptococcosis due haste, combined with some immune deficiency Patients tend to develop short-term acute respiratory failure (ARF), clinical diagnosis difficult, diverse and complex imaging, only a few cases of autopsy reported.【Objective】Through establish the animal model of lung cryptococcal infection to study the imaging performance of CT , observe signs of the disease and evolution acute, comparative analysis of different immune status of the imaging differences between groups, and the line with the pathological control study to improve Acute pulmonary cryptococcosis understanding of imaging.【Methods】40 healthy New Zealand white rabbits, weighing 2.0 ~ 2.5kg. Rabbits were randomly divided into 2 groups, n = 20, respectively, immune suppression and immune normal group.Immunosuppression group at 5 days before inoculation by the ear vein injection of daily cytarabine 440 mg / m~2, 1 every other day after inoculation to maintain immunosuppression.All rabbits in the three days from the day before inoculation application of antibiotics to prevent bacterial infection, to vancomycin 15 mg / kg, ceftazidime 150 mg / kg intravenously, day 1; gentamicin 5 mg / kg intravenous Injection every other day 1.Standard strain of C. neoformans H99A,Fungi from Shanghai Changzheng Hospital Laboratory(Management Center of China Medical fungus Cryptococcus specialized laboratories preserved)。Preparation of medium sand castle's,Species recovery and dubbed a final concentration of 5×10~8cfu / ml。The sixth day, percutaneous tracheal puncture inoculation, all rabbits were anesthetized on the operating table fixed,Fixed trachea, with 1ml disposable sterile syringe inserted perpendicularly into the trachea 0.2ml bacterial suspension were injected into the C. neoformans,Immediately take the first tall rabbit low, so easy to enter the lower airway bacterial suspension.Within 24 hours after inoculation, blood culture Blood Circulation,Two groups of rabbits were inoculated before the chest CT scan,To screen Chubing rabbits, after inoculation continuously observed and recorded every other day,14-day observation period,After natural death or were killed rabbits get lung lesions, brain, and liver tissue fungal culture,While lung lesions for pathological examination (HE and PAS staining).【Results】1 Rabbit Model of different immune status of the situationImmunocompetent group the day of vaccination mean granulocyte count 0.21×10~9 / L,Immune normal group was 2.79×10~9 / L,And the difference was statistically significant(t=5.747,p<0.05).2 Rabbit Model of cases of pulmonary cryptococcosisModeling success immunosuppression group were 16, three fungal colonization status, a vaccination anesthesia death.Success of the CPC model immune normal group 14, three fungal colonization status.3 Different immune rabbit model of pulmonary cryptococcosis Comparison and CT chestImaging the two groups are infiltrating the main patch, the difference was not statistically significant (P value> 0.05).Two groups of vaccinated rabbits underwent chest CT examination, the positive performance of the main changes are implemented, followed by grinding the glass, the difference was not significant (P> 0.05),Acute immunosuppression group prone to nodules, the difference was statistically significant (P <0.05).Opacities of both lungs, mostly multiple (72%) and is more common under the pleura (80%), ground glass, and mostly randomly distributed nodules (68.7%, 75%).Two sets of bilateral lung lesions involving a single lobe, and no significant cases, immunosuppression group mostly multiple lesions, the difference was significant (P <0.05).During the experimental observation, CT scan the next day using a continuous method,Dynamic observation of each patient's imaging model and its dynamic development and changes,Immunosuppression group had lesions more than expand the range of (68.8%) between the two groups was statistically significant (P <0.05).4 Disease first appeared between the two groups time and survival time after inoculationImmunocompetent group time for the first time after inoculation lesion 3.12±1.09 days,Immune normal group was 4.14±2.98 days, no significant difference between the two groups (P = 0.245> 0.05).Immunocompetent group survival time after inoculation 6.63±2.92days,Immunocompetent group survival time after inoculation 6.63±2.92dys,Immune normal group longer survival time after inoculation, there was significant difference between two groups(P=0.027<0.05).5 Rabbit pulmonary cryptococcosis organ involvement outside the lung and blood cultureconditions 9 cases of immune suppression model group, liver tissue fungal culture positive,Immune normal group, only 2 cases of culture positive, statistically significant difference between two groups(P<0.05).Brain tissue fungal culture and blood culture was no significant difference by statistical analysis.6 Histopathology and CT analysis of the performance of the controlEye view of gross specimen, CT showed diffuse nodular mass type and model of mixed lesion of the lung lesions were solid rubber-like lesions. CT showed a model patch infiltrative lesions is more divergence in the white or red meat translucent lesions. The positive performance of chest CT in 5 cases the CPC appears nodules, mass shadow in 2 cases, of which A20, left lung mass shadow in rabbits were observed for the large abscess formation, the Center for the amorphous necrotic material, surrounded by a large number of inflammatory cell infiltration, peripheral Shows granulation tissue formation. Focal consolidation and ground glass microscope showed that most lesions alveolar wall thickening, inflammatory cell infiltration, alveolar exudate, interstitial congestion and hemorrhagic necrosis.【Conclusions】1 C. neoformans strains using the standard way through the respiratory tract infection in rabbits with different immune status can be successfully established model of pulmonary cryptococcosis. 2 Different immune state of acute pulmonary cryptococcosis infection imaging are of consolidation, followed by the ground glass, consolidation of multiple video and more for the lungs and is more common under the pleura, ground glass, and nodules, mostly Random distribution of acute immunosuppression group prone to nodules, and multiple lesions have expanded the scope of.3 Immune normal rabbit longer survival time after inoculation, the acute phase immune suppression group prone to secondary infection of the liver cryptococcosis.4 The performance of the chest CT were found with the pathological, nodules larger clumps often microscopic abscess formation, the Center for the amorphous necrotic material, surrounded by a large number of inflammatory cell infiltration, peripheral visible granulation tissue formation, and focal consolidation And the majority of ground-glass lesions showed alveolar wall thickening microscopy, inflammatory cells infiltration, alveolar exudate, interstitial congestion and hemorrhagic necrosis.PartⅡImage Study of Large Airway Morphological Change and Diagnosis Value【Background】Airway disease refers to the trachea and central bronchi occurred in benign and malignant disease,Including a lower incidence of benign and malignant tracheal,As insidious disease, smaller tumors are often non-specific symptoms and signs, often easily missed or delayed diagnosis.Central bronchial lesions occurred in the paragraph above refers to bronchial lesions, occurred in the central bronchi are relatively rare benign tumor,The most common is the central type lung cancer, lung cancer is currently the highest mortality,Various types of cancer has become the leading cause of death, morbidity and mortality rise,The central lung cancer accounts for about 60% of all lung cancer 70%,And the rise in recent years, the incidence of,If early detection and diagnosis of central lung cancer,Will no doubt significantly improved the prognosis of patients,The early symptoms are often not obvious,Radiographic showed only slight thickening of the bronchial wall, or mound-shaped cavity of the uplifted。MSCT can present the basic image of the same sex,To help show the early diagnosis of central lung cancer.As other airway diseases such as bronchial tuberculosis, lung cancer can also cause similar changes in bronchial,Therefore, evaluation of central airway lesions in the central bronchial changes contribute to lung cancer diagnosis and differential diagnosis.【Objective】Retrospective analysis of the trachea and central bronchial lesions Imaging,Concurrent benign and malignant lesions of the control of imaging findings,To improve their understanding of imaging, its diagnosis and differential diagnosis based on.【Methods】September 2008-January 2011 period, our hospital clinical information was collected in parallel MSCT examination 17 cases of tracheal diseases, including cancer, 7 cases were confirmed by bronchoscopic biopsy or surgery confirmed.12 cases of benign airway disease, including bronchoscopic biopsy in 2 cases, the rest are diagnostic imaging.All cases of airway disease, 11 cases of male, female 6; age from 32 to 75 years, mean 47 years.Central bronchial cancer were collected 81 cases of central lung cancer,Were confirmed by bronchoscopic biopsy or surgery confirmed,52 patients were male, female 29 cases;Aged 28 to 85 years, mean 59 years.3 cases of benign tumor of the central bronchi, bronchial cyst, 1 case of endobronchial tuberculosis in 5 cases, 2 cases of bronchial foreign body.All patients were using the GE LightSpeed VCT 64-slice spiral CT or spiral CT TOSHIBA Acquilion 16 scanner, scan from apex to lung base.Lobe lesions after conventional scanning the target reconstruction, the reconstructed image will be transmitted to Vitrea 1 or AW 02 post-processing post-processing workstation.Reconstructed image will be transmitted to the workstation target a variety of post-processing after the reconstruction, focusing on display trachea, bronchial lumen, wall, and lesions and trachea, bronchus relationship.Statistical analysis of the data by SPSS16.0 software, the relative number of adoption rates, than that between the two groups usingχ~2 analysis.【Results】1 MSCT post-processing techniques and the original axial images show the comparison of the airwayThe original axial images and the MSCT image of the lesion morphology post-processing, lesions involving the range,wall thickening, stenosis,and stenosis morphology showed there were significant differences (P <0.05). Read the original axial images the film,three cases of missed lesions,no significant difference between the two groups. 2 Comparative analysis of the situation of the wall of the trachea in benign and malignant diseaseDiagnosis of benign and malignant tracheal diseases, wall thickening, lesions were both inside and outside the lumen width of the base performance and to support the formation of malignant soft tissue tumor diagnosis, there was significant difference between the two groups. Both benign and malignant tracheal stenosis occurred, no significant difference between the two groups.3 Comparative analysis of imaging findings of central lung cancer with endobronchial tuberculosisCentral-type lung cancer showed bronchial wall thickening, and its inner wall finishing mostly clear, and the inner wall of endobronchial tuberculosis and more than vague, and the wide extent of disease between the two groups was statistically Differences. Central lumen endobronchial tuberculosis and lung cancer more than a narrow, no significant difference between the two groups.【Conclusions】1 In the original basis of axial images, MSCT post-processing technology to more accurately evaluate the trachea and central bronchial lesions on the scope and form, and whether the wall thickening, stenosis and luminal stenosis morphology, the diagnosis To provide more information and differential diagnosis.2 Diagnosis of benign and malignant airway disease process, the wall thickening, lesions were both inside and outside the lumen width of basal expression and the formation of soft tissue masses often important signs of malignant.3 Limitations of central lung cancer involving the bronchus, the wall thickening in the main cavity surface than finishing; endobronchial tuberculosis lesions are often broader, extensive wall thickening, more blurred and rough of the inner wall.