64层螺旋CT在右肺中下叶段支气管分支类型中的应用

发布时间：2019-06-26 08:32

【摘要】：目的 联合应用64层螺旋CT支气管树三维重建、仿真内窥镜及横断面薄层重建3种图像后处理技术显示右肺中下叶段支气管分支，并对其分支方式进行分类，统计不同分支类型的出现率。 方法 从行64层螺旋CT胸部常规扫描的患者中随机筛选出右肺中下叶段级支气管通畅并显示清楚的300例资料。采用重建层厚1.0mm，间隔0.7mm，软组织算法重组所有资料的支气管树三维图像及仿真内镜图像；采用重建层厚2.0mm，间隔1.5mm，骨算法重建所有资料的横断面薄层图像。 分别应用支气管树三维重建和仿真内窥镜技术做出右肺中下叶支气管图像，再结合横断面薄层重建图像对右肺中下叶段支气管进行分型，分析3种技术对段支气管不同分支类型的显示效果；联合3种技术对右肺中下叶段支气管进行分型，统计分型结果及亚上段支气管的出现率。采用以下标准统计图像：支气管树三维图像以分支方向、数目及管径粗细作为初次判断标准，容易辨认右肺中下叶段支气管中的独立分支及较长共干；当右肺中叶支气管显示三个分支但很难辨认是较短共干或同时三分支时，或右肺下叶前底段、外侧底段和后底段支气管很难辨认是依次分支或同时三分支时，再结合仿真内镜从开口分叉处观察，以分叉处“隆嵴”的高低作为判定标准进行区别；当支气管树三维图像、仿真内镜图像出现亚上段支气管或两支内侧底段支气管时，必须结合横断面薄层图像以资鉴别；当判断外侧底段支气管与前底段或后底段支气管共干时，必须结合三种图像综合分析。挑选两位有经验的胸部影像诊断医师分别对三种重组图像行双盲法观察。 结果 三种重建图像对右肺中下叶段级支气管的显示率均为100%，对亚段级支气管的显示率均超过80%。依据段级支气管分支形式的不同，右肺中叶段支气管主要分为两型：Ⅰ型是二分支型，共289例（96.3%）；Ⅱ型是三分支型，共11例（3.7%）。右肺下叶段支气管主要分为三型：Ⅰ型是外侧底段与后底段支气管共干型，共230例（76.7%）；Ⅱ型是前底段与外侧底段支气管共干型，，共31例（10.3%）；Ⅲ型是内侧底段支气管缺如型，共18例（6.0%）；其余为特殊类型共21例（7.0%）；亚上段支气管出现者113例（37.7%），同时出现两支亚上段支气管者12例（4.0%），占所有亚上段支气管者的10.6%（12例/113例）。 结论 支气管树三维图像可立体显示各段支气管依次分支及较长两两共干类型，仿真内镜可腔内观察开口数目及“隆嵴”的位置形态，区别较短两两共干型与3分支型，横断面薄层图像可辨认亚上段支气管，联合应用支气管树三维重建、仿真内镜及横断面薄层重建3种后处理技术，可以对右肺中下叶段支气管进行较准确分型。 意义 本研究综合运用64层螺旋CT的三种后处理技术，可以三维立体观察段支气管的分支形式和其在横断面的走行分布，统计出右肺中下叶段支气管的分支类型及亚上段支气管的出现率，对解剖学研究起到了补充作用。由于以往的解剖研究多是建立在解剖标本基础上，样本量小，操作复杂，而本研究是大量活体解剖，可重复性及准确性更高。段支气管分支类型复杂，常见分支类型可有多种，但目前教科书仅描述最常见分支形式，并被广大放射科、胸外科医生所接受。若能准确知道每一位患者双肺段支气管的分支类型，可以帮助放射科医师更准确定位肺内病变，为肺内病变微创手术或纤维支气管镜活检、治疗等提供更多、更准确的信息。
[Abstract]:Purpose Combined application of 64-slice spiral CT bronchial tree three-dimensional reconstruction, simulated endoscope and cross-section thin-layer reconstruction, three kinds of image post-treatment techniques are used to display the bronchial branches of the lower lobe of the right lung, and the branches of the right lung are classified and the appearance of different branch types is counted. Rate. Methods From the patients with the conventional scanning of 64-slice spiral CT, the lower lobe of the right lung was screened and displayed clearly in the right lung. The three-dimensional images of the bronchial tree and the simulated endoscopic images of all the data were reconstructed with the reconstruction layer thickness of 1.0 mm, the interval of 0.7 mm, and the soft tissue algorithm. The reconstruction layer thickness was 2.0 mm, the interval was 1.5 mm, and the bone algorithm was used to reconstruct the transection of all the data. The bronchial image of the lower lobe of the right lung was made by the three-dimensional reconstruction of the bronchial tree and the simulated endoscopic technique, and the bronchial tree of the lower lobe of the right lung was classified by the thin-layer reconstruction of the cross-section. The different branches of the segmental bronchi were analyzed by three techniques. Type of display effect; in combination of three techniques, the bronchi of the lower lobe of the right lung are classified, the result of the statistical classification and the upper segment The appearance rate of the bronchi is determined by using the following standard statistical images: the three-dimensional image of the bronchial tree is used as the primary judgment standard in the branch direction, the number and the diameter and the thickness of the pipe, The branch and the longer co-operation; when the middle lobe of the right lung displays three branches, but it is difficult to recognize that it is a short common or simultaneous three-branch, or the front bottom section, the outer bottom section and the back bottom section of the right lung are difficult to recognize as the branch or the three branches in sequence, and the simulation endoscope is combined with the simulation endoscope. It is observed at the bifurcation of the opening that the height of the long branch of the bifurcation is used as the judgment standard for distinguishing; when the three-dimensional image of the bronchial tree is used as the three-dimensional image of the bronchial tree, the subsegmental bronchi or the two inner bottom sections of the bronchial tree appear in the simulated endoscopic image, and the cross section must be combined The layer image is used for identification; when it is determined that the outer bottom segment bronchi is co-dry with the front bottom segment or the back bottom segment, it must be combined with three A comprehensive analysis of three types of images. Two of the two experienced chest image diagnostic doctors were selected for three types of recombinants, respectively. image line The results of the double-blind method showed that the display rate of three reconstructed images in the lower lobe of right lung was 100%, and the sub-stage branch was divided into two groups. The display rate of the tube is more than 80%. According to the different forms of the segmental bronchi, the middle lobe of the right lung is divided into two types: type I is the two-branch type,289 cases (96.3%), and the type II is the three-branch type. There were 11 cases (3.7%). The lower lobe of the right lung was divided into three types: type I was the common dry type of the outer and the posterior segment, and there were 230 cases (76.7%); the type 鈪

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