基于Cone Beam CT图像的呼吸运动分析

呼吸运动是有一定规律性的运动,传统呼吸运动模型用公式描述,不能准确反映不同病人的特点或同一病人不同时期的特点,无法满足实时准确分析的需要。为此,我们提出了一种通过跟踪病人自由呼吸状态下所采集的Cone Beam CT图像序列中的横隔膜的运动来建立病人呼吸运动模型的方法。该方法建立的模型与传统的呼吸运动理论模型非常相似,证明了它是可行且有效的,同时该方法更能实时准确地反映病人的呼吸运动规律,具有很高的临床实用价值。

Analytical Calculation of the Compton Single Scatter Component of Pencil Beam Scatter Kernel for Scatter Correction in kV Cone Beam CT (kV-CBCT)

The accuracy of conventional superposition or convolution methods for scatter correction in kV-CBCT is usually compromised by the spatial variation of pencil-beam scatter kernel (PBSK) due to finite size, irregular external contour and heterogeneity of the imaged object. This study aims to propose an analytical method to quantify the Compton single scatter (CSS) component of the PBSK, which dominates the spatial distribution of total scatter assuming that multiple scatter can be estimated as a constant background and Rayleigh scatter is the secondary source of scatter. The CSS component of PBSK is the line integration of scatter production by incident primary photons along the beam line followed by the post-scattering attenuation as the scattered photons traverse the object. We propose to separate the object-specific attenuation term from the line integration and equivalently replace it with an average value such that the line integration of scatter production is object independent but only beam specific. We derived a quartic function formula as an approximate solution to the spatial distribution of the unattenuated CSS component of PBSK. The “effective scattering center” is introduced to calculate the average attenuation. The proposed analytical framework to calculate the CSS was evaluated using parameter settings of the On-Board Imager kV-CBCT system and was found to be in high agreement with the reference results. The proposed method shows highly increased computational efficiency compared to conventional analytical calculation methods based on point scattering model. It is also potentially useful for correcting the spatial variant PBSK in adaptive superposition method.

Clinical Significance of Pathological and Anatomical Findings in Cone Beam CT Scans of the Maxillary Sinus

Objective: To determine the range and prevalence of pathological conditions and demonstration of significant anatomical structures in the maxillary sinuses using the cone beam computerized tomographic (CBCT) scan. Methodology: Case series of 60 CBCT scans of the maxillae. Results: Forty (67%) of the scans were of female patients while the rest (20, 33%) were of males. Remarkably, the majority of the scans were requested for those patients who sought dental implant fabrication. Overall, 35 (58%) scans demonstrated pathological features while 8 (13%) demonstrated significant anatomical structures. Pathological features included mucosal thickening in 26 (43%), polypoid lesions in 9 (15%), total antral opacification in 1 (2%) and foreign body in 1 (2%). The commonest anatomic feature was dental root protrusion into the maxillary sinuses in 8 (13%). Conclusion: The CBCT imaging is an important tool for investigating the maxillary sinuses for pathology and the demonstration of the associated anatomic relations.

Image quality of cone beam CT on respiratory motion

In this study,the influence of respiratory motion on Cone Beam CT (CBCT) image quality was investigated by a motion simulating platform,an image quality phantom,and a kV X-ray CBCT.A total of 21 motion states in the superior-inferior direction and the anterior-posterior direction,separately or together,was simulated by considering different respiration amplitudes,periods and hysteresis.The influence of motion on CBCT image quality was evaluated with the quality indexes of low contrast visibility,geometric accuracy,spatial resolution and uniformity of CT values.The results showed that the quality indexes were affected by the motion more prominently in AP direction than in SI direction,and the image quality was affected by the respiration amplitude more prominently than the respiration period and the hysteresis.The CBCT image quality and its characteristics influenced by the respiration motion,and may be exploited in finding solutions.

Tissue Density Mapping of Cone Beam CT Images for Accurate Dose Calculations

Purpose: To improve the accuracy in megavoltage photon beam dose calculation in CBCT-based radiation treatment (RT) plans, using a kilovoltage cone-beam computed tomography (CBCT)-to-density-step (CBCT-SF) function. Materials and Methods: The CBCT-SF table is constructed from differential histograms of the voxel values of CBCT and Fan-beam CT (FBCT). From the CBCT histograms, frequency peaks representing air, lung, soft tissue and bone are observed and their widths in CT numbers are assigned to the lower and higher bounds of the steps in the CBCT-SF. The CBCT-SF is entered into a planning system as an alternative to the clinical CT-to-density table. The CT image sets studied in this work consist of FBCT and CBCT scans of three patients: a prostate cancer patient, a lung cancer patient and a head and neck patient;and of a humanoid phantom at sections of the pelvis, the thorax and the head. Deformable image registration is used to map the patient FBCT scans to the corresponding CBCT images to minimize anatomical variations. Three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) plans are made on the FBCT image sets of the patients and the phantom. The plans are recalculated on the CBCT scans using both the conventional CT-to-density table and the CBCT-SF. Dose calculations on the CBCT images and FBCT images are compared using dose differences, distance to agreement (DTA), Gamma analyses and dose volume histogram (DVH) analyses. Results: The results show that IMRT plans optimized using CBCT scans and FBCT scans agree dosimetrically within 1% when the CBCT-SF is used for the CBCT-based plans, including thoracic IMRT plan. In contrast, up to 5% dose difference is observed between IMRT plans optimized on FBCT scans and CBCT scans for thoracic cases if conventional CT-to-density table is used on CBCT images. Conclusions: The simple stepwise mapping of the CBCT numbers to density using the CBCT-SF resolves the inaccuracies in dose calculations previously reported in CBCT-based RT plans. CBCT-SF can be used in Image-Guided adaptive radiotherapy planning.

利用Cone-Beam CT探讨支抗微螺钉周围骨密度与其稳定性的关系

目的:利用Cone-Beam CT测量支抗微螺钉周围骨密度值,探讨其与微螺钉稳定性的关系。方法:选取颌骨左右对称植入微螺钉后一侧松动而另一侧稳固的7名(共18枚微螺钉)正畸患者。拍摄CBCT,所得三维影像重建后用OnDemand 3DApplication软件对微螺钉骨内部分周围2mm范围内骨密度(以Hounsfield Unit表示)进行测量,自身对照比较分析双侧对称部位所植入微螺钉周围骨密度测量值间的差异。结果:松动微螺钉与稳定微螺钉骨内部分周围2mm范围内骨密度无统计学差异,两侧微螺钉钉尖部1/3、钉中部1/3及钉颈部1/3周围骨密度均无统计学差异。结论:微螺钉种植支抗的稳定性与其周围骨密度间未发现明显相关性。

基于Halcyon加速器百分百图像引导模式下盆腔肿瘤CTV-PTV边界外放的研究

目的探讨基于Halcyon加速器百分百图像引导模式下盆腔肿瘤临床靶区-计划靶区(Clinical Target Volume,CTV)-(Planning Target Volume,PTV)边界外放的摆位误差。方法选取2023年1—5月在Halcyon加速器上行调强放射治疗的19例盆腔肿瘤患者为研究对象,采集每个患者分次间、纠正后、分次内300套共900个锥形束CT图像,与计划CT进行配准融合,得到三维方向上的矢量误差,用X(左右)方向、Y(头脚)方向、Z(腹背)方向表示。计算摆位误差及分布趋势,并根据纠正后及分次内的摆位误差计算CTV-PTV的外放边界。结果X方向上,分次间、纠正后、分次内的摆位绝对误差分别为(2.07±1.82)、(0.19±0.19)、(0.30±0.28)mm;Y方向上,分次间、纠正后、分次内的摆位绝对误差分别为(3.87±2.67)、(0.23±0.31)、(0.27±0.23)mm;Z方向上,分次间、纠正后、分次内的摆位绝对误差分别为(0.72±0.83)、(0.20±0.22)、(0.30±0.27)mm,差异均有统计学意义(P<0.05)。纠正后和分次内X、Y、Z 3个方向分别有97%和96.33%的摆位误差在1 mm以内。CTV-PTV外放边界从6.36 mm缩小到1.06 mm。结论从摆位误差角度来看,基于Halcyon加速器百分百图像引导模式下的盆腔肿瘤治疗,根据纠正后和分次内的摆位误差计算CTV-PTV外放边界为1.1 mm。通过Halcyon加速器治疗盆腔肿瘤患者可降低摆位误差,提高患者靶区和危及器官的安全精度,缩小CTV-PTV边界外放值,减少正常组织的累及体积。

D-CBCT在肺癌容积旋转调强计划精准治疗中的临床应用

目的探讨椎形束CT(D-CBCT)在肺癌容积旋转调强(VMAT)计划精准治疗中的临床应用。方法选取2019年10月~2022年10月在南通市第三人民医院放射治疗科就诊的100例肺癌患者。根据CBCT扫描模式不同,分为4D组(n=57)和3D组(n=43)。比较两组患者放疗摆位误差、内靶区(ITV)体积、靶区剂量、心脏受照剂量和肿瘤控制效果。结果在校正前后和治疗后,两组各摆位误差绝对值无统计学差异(P>0.05);4D组患者中下叶肿瘤ITV体积低于3D组(P<0.05);4D组的最大剂量(D_(max))、最小剂量(D_(min))和平均剂量(D_(mean))靶区剂量均高于3D组(P<0.05);4D组的V10、V20、V30及平均受量(D_(mean))等心脏受照剂量均低于3D组(P<0.05);4D组和3D组患者的客观有效率无明显差异(P>0.05)。结论可将D-CBCT应用于肺癌容积旋转调强计划精准治疗中,尤其采用4D-CBCT可更好提供靶区剂量,减少肺癌患者的中下叶肿瘤ITV体积和心脏受照剂量。

探讨定量CT及生物电阻抗测定内脏脂肪面积和骨密度的关系

目的:探讨采用定量CT(Quantitative computer tomography,QCT)及生物电阻抗(Bioelectrical impedance analysis,BIA)测定内脏脂肪面积(Visceral fat area,VFA)与骨密度(Bone density,BMD)的关系。方法:回顾性选取郑州大学第一附属医院健康管理中心1131例体检者行QCT和BIA测定的VFA及BMD,采用Pearson相关系数、多因素线性回归、单因素和多因素Logistic回归分析二者的相关性;并采用Bland-Altman评估两者测定VFA的一致性。结果:Pearson相关分析显示QCT和BIA测定的VFA与BMD呈负相关(r=-0.197和r=-0.288)。多因素Logistic回归分析显示VFA(BIA)是骨量下降的危险因素(OR=1.010,95%CI:1.005~1.015);VFA(QCT)是骨量下降的危险因素(OR=1.003,95%CI:1.001~1.005);Bland-Altman分析显示,QCT和BIA测量VFA具有较高的一致性。结论:VFA是骨量下降的危险因素,测定VFA的QCT和BIA两者具有较高的一致性,可以采用BIA测定的VFA评估骨量下降。

Delivered Dose Verification for Lung Cancer Stereotactic Body Radiotherapy Using Cone-Beam CT

Purpose: Verified the delivered dose distribution of lung cancer Stereotactic Body Radiotherapy (SBRT) using the cone-beam CT images. Methods: Twenty lung cancer patients who underwent SBRT with 100 CBCT images were enrolled in this study. Delivered dose distributions were recalculated on CBCT images with the deformed and non-deformed methods, respectively. The planned and delivered dose distributions were compared using the dose-volume histograms. Results: The delivered target coverage (V100) per patient inside target volume deviated on average were 0.83% ± 0.86% and 1.38% ± 1.40% for Pct vs. Pcbct and Pct vs. Pdcbct, respectively. The Conformity Index (CI) and Gradient Index (GI) showed a good agreement among the plans. For the critical organs, only minor differences were observed between the planned dose and the delivered dose. Conclusions: CBCT images were a useful tool for setup and dose delivery verification for lung cancer patients who underwent SBRT.

C臂锥形束CT引导下精准栓塞异位前列腺动脉治疗良性前列腺增生一例

良性前列腺增生的介入栓塞治疗是目前一种微创、有效的治疗方式,而精准辨识前列腺动脉(PA)是手术的关键。前列腺动脉异位起源于髂外动脉鲜有报道,笔者报道1例运用C臂锥形束CT精准辨识出异位前列腺动脉并在其引导下成功进行栓塞,术后盆腔MRI提示前列腺组织坏死明显,体积明显缩小,患者排尿困难症状明显改善。

基于双调和插值的锥束CT金属伪影校正算法

在计算机断层扫描(CT)中,金属植入物会引入严重的伪影,导致图像质量降低影响诊断价值。为了对锥束CT中的金属伪影进行校正,提出了一种基于双调和方程的金属伪影校正算法。首先,对含金属伪影的重建图像进行双边滤波和金属阈值分割,获得金属和非金属图像;然后,对二者进行正向投影,获得金属投影区域和先验投影图像;接下来,利用先验投影图像对原始投影进行归一化,并对金属区域进行双调和方程插值修复,获得修复的投影数据;最后,对修复的投影数据去归一化,并利用FDK算法进行重建,再与金属图像融合获得最终的校正图像。为了验证该算法的性能,采用实际拍摄的数据进行金属伪影校正实验。结果表明,与常用的线性插值校正算法和归一化校正算法相比,所提算法ROI区域内图像的均方根误差分别减少了22%和8%,有效地抑制了金属伪影,优于常用的去金属伪影算法。

The Association between Lower Incisal Inclination and Morphology of the Supporting Alveolar Bone—A Cone-Beam CT Study

Aim To investigate the relationship between the positioning of the lower central incisor and physical morphology of the surrounding alveolar bone. Methodology Thirty-eight patients (18 males, 20 females), with mean age of 13.4 years, were included in this study. As part of orthodontic treatment planning the patients were required to take dental Cone-beam CT (CBCT) covering the region of lower incisors, the surrounding alveolar bone and the mandibular symphysis. The cephalometric parameters were designed and measured to indicate the inclination of lower central incisor and physical morphology of the adjacent alveolar bone. Computer-aided descriptive statistical analysis was performed using SPSS 15.0 software package for Windows. A correlation analysis and a linear regression analysis between the incisor inclination and the alveolar bone morphology were performed. Results Significant positive correlations were found between the lower central incisor inclination and the morphological contour of the alveolar bone (P<0.05). The lower central incisor root apex was closer to the lingual alveolar crest when it was buccally inclined. Conclusion The morphology of the alveolar bone may be affected by incisal inclination.

CBCT引导下对三维治疗床与六维治疗床配准放疗摆位误差的研究

目的利用锥形束CT图像引导三维放射治疗床与六维放射治疗床配准精度,并分析其放疗摆位误差,为临床使用三维放射治疗床的放疗流程管理提供参考。方法选取50例鼻咽癌患者、49例食管癌患者和25例直肠癌患者治疗前的锥形束CT图像为研究对象,在离线配准下设置相同的感兴趣区域,分别选择三维放射治疗床的线性方向和六维放射治疗床的线性与旋转方向进行骨性配准,分析配准后产生的摆位误差。结果鼻咽癌与直肠癌患者分别采用秩和检验与方差齐性独立样本检验,升降(Vertical,Vrt)方向与左右(Lateral,Lat)方向差异均有统计学意义(P<0.05),进出(Longitudinal,Lng)方向差异无统计学意义(P>0.05);食管癌患者采用秩和检验,Vrt方向上差异有统计学意义(P<0.05),在Lng和Lat方向上差异均无统计学意义(P>0.05)。3个部位的Lng方向上差异均无统计学意义(P>0.05)。鼻咽癌、直肠癌、食管癌3种病例患者在线性方向的容差值分别为3、5、5 mm时,其中2、4、4 mm容差范围的数量占比较大;在平移方向,2种配准方式的摆位误差基本都在临床设定值的范围内。六维配准显示,鼻咽癌患者的头脚旋转方向与食管癌和直肠癌患者3个旋转方向的摆位误差较大。结论三维放射治疗床配准时反馈的摆位误差信息量低于六维放射治疗床,使用三维放射治疗床摆位时需加强放疗全流程与旋转方向摆位技术管理,提高放疗摆位效率与放疗增益比。

基于CBCT与3D打印技术对完全性骨埋伏阻生牙患者术后VAS评分、并发症、邻牙功能恢复的影响

目的 探讨基于锥形束CT (CBCT)与3D打印技术对完全性骨埋伏阻生牙患者术后视觉模拟评分法(VAS评分)、并发症和邻牙功能恢复的影响。方法 选取2021年9月至2022年9月洛阳市中心医院收治的130例完全性骨埋伏阻生牙患者纳入研究,按随机数表法1:1配对原则分为观察组和对照组各65例。术前对照组患者经CBCT数据进行3D可视化处理,通过3D可视化模型制定手术方案;观察组患者应用CBCT与3D打印技术,获取实体模型进行术前评估、制定手术计划。比较两组患者的治疗效果、手术时间、术中出血量、牙窝完整性、邻牙松动度;比较两组患者手术前后的VAS评分、肿胀程度、张口受限度、牙齿功能、术中不良反应及术后并发症;随访至术后1个月,评估两组患者的软组织美学效果[红色美学评分(PES)]、满意度和生活质量[口腔健康相关生活质量(OHRQOL)]。结果 观察组患者的治疗优良率为96.92%,明显高于对照组的86.15%,差异有统计学意义(P<0.05);观察组患者术中出血量Ⅲ级占比、邻牙松动度Ⅲ级占比分别为6.15%、0,明显低于对照组的12.31%、6.15%,差异均有统计学意义(P<0.05);观察组患者的手术时间、牙窝完整性分别为(27.82±4.58) min、(2.87±0.42)级,明显优于对照组的(31.04±5.43) min、(3.66±0.24)级,差异均有统计学意义(P<0.05);术后1 d、3 d、7 d,观察组患者的VAS评分分别为(5.22±0.62)分、(3.56±0.78)分、(2.26±0.73)分,明显低于对照组的(6.13±0.64)分、(4.86±0.75)分、(3.41±0.90)分,差异均有统计学意义(P<0.05);术后1 d、3 d、7 d,观察组患者肿胀程度分别为(3.72±1.14) mm、(2.61±0.73) mm、(1.73±0.52) mm,明显小于对照组的(4.42±1.19) mm、(3.58±0.80) mm、(2.39±0.64) mm,差异均有统计学意义(P<0.05);术后1 d、3 d、7 d,观察组患者张口受限度分别为(5.82±1.65) mm、(4.54±1.20) mm、(3.37±0.88) mm,明显小于对照组的(7.26±1.43) mm、(5.63±1.22) mm、(4.25±0.98) mm,差异均有统计学意义(P<0.05);术后1 d、3 d、7 d,观察组患者的牙齿咀嚼功能评分分别为(32.62±4.12)分、(37.41±5.43)分、(41.36±5.61)分,明显高于对照组的(28.81±4.37)分、(31.23±5.25)分、(35.82±5.90)分,差异均有统计学意义(P<0.05);术后1 d、3 d、7 d,观察组患者的语言功能评分分别为(34.96±6.21)分、(40.67±7.23)分、(44.86±6.22)分,明显高于对照组的(30.22±5.79)分、(32.57±5.15)分、(37.58±6.14)分,差异均有统计学意义(P<0.05);术后1 d、3 d、7 d,观察组患者的吞咽功能分别为(34.96±6.21)分、(40.67±7.23)分、(44.86±6.22)分,明显高于对照组的(30.22±5.79)分、(32.57±5.15)分、(37.58±6.14)分,差异均有统计学意义(P<0.05);观察组患者术中不良反应、术后并发症发生率分别为4.62%、18.46%,明显低于对照组的15.38%、35.38%,差异均有统计学意义(P<0.05);术后1个月,观察组患者的PES评分、满意度分别为(10.25±0.51)分、95.38%,明显低于对照组的(8.68±0.43)分、84.62%,而OHRQOL评分为(12.57±1.55)分,明显低于对照组的(15.73±1.50)分,差异均有统计学意义(P<0.05)。结论 完全性骨埋伏阻生牙应用CBCT与3D实体模型打印技术制定手术计划可提高治疗效果,减轻术后疼痛、肿胀及邻牙松动,促进牙齿功能恢复,且有利于减少术中不良反应、术后并发症,提高患者满意度与生活质量。

Slice-wise reconstruction for low-dose cone-beam CT using a deep residual convolutional neural network

Because of the growing concern over the radiation dose delivered to patients, X-ray cone-beam CT(CBCT) imaging of low dose is of great interest. It is difficult for traditional reconstruction methods such as Feldkamp to reduce noise and keep resolution at low doses. A typical method to solve this problem is using optimizationbased methods with careful modeling of physics and additional constraints. However, it is computationally expensive and very time-consuming to reach an optimal solution. Recently, some pioneering work applying deep neural networks had some success in characterizing and removing artifacts from a low-dose data set. In this study,we incorporate imaging physics for a cone-beam CT into a residual convolutional neural network and propose a new end-to-end deep learning-based method for slice-wise reconstruction. By transferring 3D projection to a 2D problem with a noise reduction property, we can not only obtain reconstructions of high image quality, but also lower the computational complexity. The proposed network is composed of three serially connected sub-networks: a cone-to-fan transformation sub-network, a 2D analytical inversion sub-network, and an image refinement sub-network. This provides a comprehensive solution for end-to-end reconstruction for CBCT. The advantages of our method are that the network can simplify a 3D reconstruction problem to a 2D slice-wise reconstruction problem and can complete reconstruction in an end-to-end manner with the system matrix integrated into the network design. Furthermore, reconstruction can be less computationally expensive and easily parallelizable compared with iterative reconstruction methods.

半导体激光辅助治疗慢性牙周炎的效果及CBCT分析研究进展

近年来,随着微创治疗理念的进一步提出,激光治疗因具有较好的杀菌抑菌、止血止痛、促进愈合等优势,在口腔疾病诊治中被广泛应用。刺激愈合过程和减轻疼痛是激光治疗最受欢迎的用途之一。在慢性牙周炎患者的临床诊疗中利用半导体激光配合牙周基础治疗的治疗方案得到了不少学者的认可并取得了一定的临床疗效,文章综述半导体激光辅助治疗慢性牙周炎的临床疗效及锥形束CT(cone beam CT,CBCT)分析研究进展。

锥形束CT测量成人上颌前磨牙根尖与上颌窦位置关系及其对即刻种植的影响

目的分析上颌前磨牙牙根与上颌窦空间位置关系,为该位点即刻种植时机、方案、术式及种植体选择等提供解剖依据。方法本研究已通过单位伦理委员会审查批准,并获得患者知情同意。收集2017年1月⁃2023年3月瑞华口腔门诊部就诊的264例患者(年龄20~65岁)口腔锥形束CT(cone beam CT,CBCT)影像,选取冠状面测量上颌前磨牙根尖到上颌窦下壁的最短距离,对牙根与上颌窦下壁的垂直关系分类,并就双侧、性别及不同年龄组进行比较。结果上颌前磨牙根尖至上颌窦下壁最短距离:上颌第一前磨牙单根型中位数为7.34 mm,双根型颊根中位数为7.80 mm,腭根中位数为7.36 mm;上颌第二前磨牙单根型中位数为2.56 mm,双根型中颊根中位数为1.73 mm,腭根中位数为1.23 mm。上颌第二前磨牙右侧单根型根尖至上颌窦下壁间最短距离在各年龄组间有统计学差异(P<0.05),20~29岁组最小(中位数1.52 mm),≥40岁组最大(中位数4.44 mm)。性别和左右侧对根尖到窦下壁距离的影响无统计学差异(P>0.05)。上颌前磨牙根尖与上颌窦垂直关系中,根尖不与上颌窦下壁接触的情况占比最高,垂直关系分类在单根型和双根型间无统计学差异(P>0.05)。结论上颌第一前磨牙根方大多可为即刻种植提供足够高度骨量,较易实现即刻种植;上颌第二前磨牙根方骨量不足常见,需充分利用拔牙窝骨壁或窦底皮质骨实现初期稳定性;根尖与窦下壁垂直关系分型分布受年龄及牙位影响,青年组较其他年龄组更易出现骨高度不足,需谨慎选择即刻种植适应证;牙根数量对牙根与上颌窦垂直关系影响不大,双根型因牙根直径小及根间骨性分隔,可为即刻种植提供更多骨支持。

不同颈椎骨龄青少年下颌骨外斜线区骨量的锥形束CT评价

背景:微种植钉在青少年群体中的应用日益增多,但目前国内外关于青少年外斜线区骨量的研究却十分鲜见,未见对不同生长发育时期青少年外斜线区骨量的系统性研究。目的:运用锥形束CT对不同颈椎骨龄青少年下颌骨外斜线区骨量进行测量,探究不同颈椎骨龄青少年外斜线区骨量差异及该区域骨量与颈椎骨龄的相关性。方法:收集2020-2021年在西南医科大学附属口腔医院正畸科就诊的105例青少年患者矫治前的锥形束CT资料,采用颈椎成熟法分为CS3组(n=24)、CS4组(n=26)、CS5组(n=29)及CS6组(n=26)。应用Mimics Medical 21.0软件对青少年外斜线区进行三维重建,分别测量下颌骨右侧第一磨牙及第二磨牙釉牙骨质界下6,11 mm颊侧骨宽度,釉牙骨质界颊侧4,5 mm处骨高度,测量分4个层面:第1层面为下颌右侧第一磨牙近中根所在层面;第2层面为下颌右侧第一磨牙远中根所在层面;第3层面为下颌右侧第二磨牙近中根所在层面;第4层面为下颌右侧第二磨牙远中根所在层面。结果与结论:①在同组内,4组青少年外斜线区颊侧骨宽度均自第一磨牙近中向第二磨牙远中逐渐增大,釉牙骨质界下6 mm及11 mm颊侧不同层面间骨宽度比较差异均有显著性意义(P<0.05),且距釉牙骨质界下11 mm颊侧的骨宽度均大于6 mm处;4组青少年外斜线区颊侧骨高度自第一磨牙近中向第二磨牙远中逐渐增大,釉牙骨质界颊侧4 mm及5 mm处不同层面间骨高度比较差异均有显著性意义(P<0.05),且距釉牙骨质界颊侧4 mm处的骨高度均大于5 mm处;②在相同层面下,CS3组、CS4组、CS5组第4层面距釉牙骨质界下方11 mm颊侧骨宽度均小于CS6组(P<0.05);CS3组及CS4组第3层面釉牙骨质界颊侧4 mm及5 mm处骨高度、第4层面釉牙骨质界颊侧5 mm处骨高度均小于CS6组(P<0.05),CS3组第4层面距釉牙骨质界颊侧4 mm处骨高度也小于CS6组(P<0.05);③Spearman相关性分析显示,青少年外斜线区骨量除部分测量位点与颈椎骨龄有弱相关外,其余测量位点骨量与颈椎骨龄无相关性;④结果显示,青少年外斜线区骨量随颈椎骨龄的增长变化不明显,CS3-CS6青少年外斜线区第二磨牙近中根及远中根颊侧满足微种植钉植入的骨量要求,为适合的植入位置。

两种锥形束CT转化二维图像与传统头颅侧位片定量分析颈椎骨龄的一致性

背景:传统的头颅侧位片始终存在放大失真、左右重叠不一致等问题,而锥形束CT能真实展现颅面部的三维结构。对锥形束CT进行三维重建,再将所选区域内的锥形束CT转化为二维图像,能使左右侧基本重叠一致且能减小周围组织结构的影响。目的:探究两种不同整合厚度的锥形束CT转化二维图像与传统头颅侧位片定量分析颈椎骨龄的一致性。方法:收集118例青少年正畸患者的锥形束CT及头颅侧位片资料。首先在3D imaging software中对锥形束CT影像进行三维重建,重建后在矢状向界面中分别选择两种不同整合厚度的锥形束CT影像并转化为二维图像,两种图像分别被命名为ICB-1、ICB-2。再运用智贝云对头颅侧位片、ICB-1、ICB-2中的第2颈椎基底部凹陷与椎体下缘所成的角度(@2)、第3颈椎与后面高的比值(AH3/PH3)、第4颈椎高度与宽度的比值(H4/W4)及颈椎骨龄等项目进行测量计算,间隔2周后再随机抽取20例青少年重复上述测量。采用组内相关系数(ICC)法评价3种图像各自测量颈椎骨龄的可重复性;采用配对t检验分析3种图像两两间测量颈椎骨龄的一致性;采用Kappa检验分析3种图像两两组间对颈椎骨龄分期评估的一致性。结果与结论:①除头颅侧位片组AH3/PH3的ICC<0.9,各组其余测量项目ICC均>0.9;②配对t检验结果显示,除ICB-1组与头颅侧位片组、ICB-1组与ICB-2组间AH3/PH3、H4/W4差异有显著性意义(P<0.05),3组其余项目的测量结果两两组间均无统计学差异(P>0.05);③Kappa检验结果显示,3组颈椎骨龄分期评估结果两两组间的Kappa系数均>0.8(P<0.001);④提示ICB-1、ICB-2测量颈椎骨龄的可重复性优于头颅侧位片,头颅侧位片、ICB-1、ICB-2两两组间对颈椎骨龄的测量均有良好的一致性,但考虑到对颈椎椎体结构记录的完整性,ICB-2较ICB-1更适合用于颈椎骨龄定量分析。