IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES To Boldly Go Where No Bronchoscope Has Gone Before Jonas Yserbyt, Lieven Dupont, Vincent Ninane, and Christophe Dooms Department of Respiratory Diseases, KU Leuven–University of Leuven, University Hospitals Leuven, Leuven, Belgium
Slim-designed bronchoscopes (field of view, 1,800 mm and 1208 ; high-definition resolution, 720 progressive scan) make it possible to navigate to some of the smallest airway branches of the tracheobronchial tree. The published images show that these bronchoscopes can even visualize structures at the bronchiolar level. We use probe-based confocal laser endomicroscopy (pCLE) as a positional reference for the reported images, a novel imaging technique that is able to visualize the three-dimensional structure of the pulmonary acinus. In contrast to white-light bronchoscopy, pCLE imaging is based on laser emission at a wavelength of 488 nm and produces a field of view of Figure 1. 600 mm with a lateral resolution of 3 mm (1). It uses a thin, semiflexible probe that can be advanced through the working channel of an endoscope into the tracheobronchial tree. Based on the physical principal of (auto) fluorescence, components of the respiratory tissue generating a fluorescent signal at the given excitation wavelength can be visualized whenever the tip of the probe is in perpendicular contact with bronchial or alveolar tissue (see Video E1 in the online supplement). The autofluorescence characteristics of elastic fibers, situated underneath the basal membrane, mainly contribute to the generated image. Figure 1 shows white-light optical images of the terminal bronchiole with a pCLE probe in place (typical spiral pattern in the elastic fibers, A), respiratory bronchiole (with alveolar openings, B), and alveolar ducts (before [C] and after [D] saline wash-out of air bubbles) obtained during diagnostic bronchoscopy. These anatomical locations are confirmed by pCLE at the same level and in the same patient (E, F, G, and H, respectively). n Author disclosures are available with the text of this article at www.atsjournals.org.
Reference 1. Thiberville L, Moreno-Swirc S, Vercauteren T, Peltier E, Cave´ C, Bourg Heckly G. In vivo imaging of the bronchial wall microstructure using fibered confocal fluorescence microscopy. Am J Respir Crit Care Med 2007;175:22–31.
This article has an online supplement, which is accessible from this issue’s table of contents at www.atsjournals.org Am J Respir Crit Care Med Vol 191, Iss 8, p 956, Apr 15, 2015 Copyright © 2015 by the American Thoracic Society DOI: 10.1164/rccm.201410-1920IM Internet address: www.atsjournals.org
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American Journal of Respiratory and Critical Care Medicine Volume 191 Number 8 | April 15 2015
Slim-designed bronchoscopes (field of view, 1,800 mm and 1208 ; high-definition resolution, 720 progressive scan) make it possible to navigate to some of the smallest airway branches of the tracheobronchial tree. The published images show that these bronchoscopes can even visualize structures at the bronchiolar level. We use probe-based confocal laser endomicroscopy (pCLE) as a positional reference for the reported images, a novel imaging technique that is able to visualize the three-dimensional structure of the pulmonary acinus. In contrast to white-light bronchoscopy, pCLE imaging is based on laser emission at a wavelength of 488 nm and produces a field of view of Figure 1. 600 mm with a lateral resolution of 3 mm (1). It uses a thin, semiflexible probe that can be advanced through the working channel of an endoscope into the tracheobronchial tree. Based on the physical principal of (auto) fluorescence, components of the respiratory tissue generating a fluorescent signal at the given excitation wavelength can be visualized whenever the tip of the probe is in perpendicular contact with bronchial or alveolar tissue (see Video E1 in the online supplement). The autofluorescence characteristics of elastic fibers, situated underneath the basal membrane, mainly contribute to the generated image. Figure 1 shows white-light optical images of the terminal bronchiole with a pCLE probe in place (typical spiral pattern in the elastic fibers, A), respiratory bronchiole (with alveolar openings, B), and alveolar ducts (before [C] and after [D] saline wash-out of air bubbles) obtained during diagnostic bronchoscopy. These anatomical locations are confirmed by pCLE at the same level and in the same patient (E, F, G, and H, respectively). n Author disclosures are available with the text of this article at www.atsjournals.org.
Reference 1. Thiberville L, Moreno-Swirc S, Vercauteren T, Peltier E, Cave´ C, Bourg Heckly G. In vivo imaging of the bronchial wall microstructure using fibered confocal fluorescence microscopy. Am J Respir Crit Care Med 2007;175:22–31.
This article has an online supplement, which is accessible from this issue’s table of contents at www.atsjournals.org Am J Respir Crit Care Med Vol 191, Iss 8, p 956, Apr 15, 2015 Copyright © 2015 by the American Thoracic Society DOI: 10.1164/rccm.201410-1920IM Internet address: www.atsjournals.org
956
American Journal of Respiratory and Critical Care Medicine Volume 191 Number 8 | April 15 2015
