支气管三维重建和仿真内窥镜的应用价值和限度

Virtual bronchoscopy and bronchotracheal 3 dimensional reconstruction: value and limitation

目的 研究ＣＴ支气管三维重建和仿真支气管内窥镜的临床应用价值和限度。方法１０ 例正常志愿者和５２ 例病人，行薄层双螺旋ＣＴ容积扫描后将图像传输至工作站并进行多层面／曲面重建（ＭＰＲ／ＣＰＲ） 、最小密度投影加气管曲面断层（ＭｉｎＩＰ＋ ＣＰＲ） 、三维（３Ｄ） 重建和仿真支气管内窥镜成像（ＶＢ），比较４ 种后处理方法对气道显示的差异和发现病变的敏感性及特异性等。结果 （１）４ 种后处理方法对气道显示均可达到３ 级或３ 级以下支气管。（２） ３Ｄ 和ＶＢ对病变的显示直观，整体感好。（３） 对正常志愿者气道测量显示，３Ｄ和ＶＢ对２、３ 级气道的评估存在误差，且差异有显著性（Ｐ＜０－０５）。（４） ＭＰＲ／ＣＰＲ、ＭｉｎＩＰ＋ ＣＰＲ、３Ｄ和ＶＢ发现气道病变的敏感性分别为９０－０％ 、８０－０％ 、６０－０％ 和５５－０％ ，而特异性则分别为９０－９％ 、８１－８ ％ 、７２－７％ 和６３－６％ 。结论 （１） ３Ｄ和ＶＢ对病变的显示直观，适合教学，有利于对病变的整体理解。（２）３Ｄ和ＶＢ存在失真和误差，

Objective To study the value and limitation of bronchotracheal 3 dimensional reconstruction(3D) and virtual bronchoscopy(VB) Methods Ten normal volunteers and 52 patients underwent thin slice double helical CT scan Images were transferred to Omnipro workstation and 4 kinds of postprocessing including multiple/curved planar reconstruction (MPR/CPR), minimum intensity projection plus MasterCut (MinIP+CPR), 3 dimensional reconstruction and virtual bronchoscopy were performed The differences of airway appearances and measurements, diagnostic sensitivity and specificity for bronchotracheal lesions of the 4 methods were compared Results (1)Four kinds of postprocessing were able to demonstrate segmental even subsegmental bronchial divisions (2) 3D and VB presented the morphology of airway and airway lesions in a vivid way in a way similar to endoscopy (3) There were inaccuracies in the measurement of lobar and segmental bronchi of normal volunteers with 3D and VB (4) The sensitivities of MPR(CPR), MinIP+CPR, 3D and VB for detecting bronchotracheal lesions were 90 0%, 80 0%, 60 0% and 55 0%,and specificities were 90 9%, 81 8%, 72 7% and 63 6%, respectively Conclusions (1) With direct, vivid and continuous display modes, 3D and VB are helpful in understanding of morphology of disorders and suitable for teaching (2) There are inaccuracies in 3D and VB assessment, and the sensitivity and specificity for detection of bronchotracheal lesions are not improved by using 3D and VB