【摘要】：目的 聯(lián)合應(yīng)用64層螺旋CT支氣管樹三維重建、仿真內(nèi)窺鏡及橫斷面薄層重建3種圖像后處理技術(shù)顯示右肺中下葉段支氣管分支，并對(duì)其分支方式進(jìn)行分類，統(tǒng)計(jì)不同分支類型的出現(xiàn)率。 方法 從行64層螺旋CT胸部常規(guī)掃描的患者中隨機(jī)篩選出右肺中下葉段級(jí)支氣管通暢并顯示清楚的300例資料。采用重建層厚1.0mm，間隔0.7mm，軟組織算法重組所有資料的支氣管樹三維圖像及仿真內(nèi)鏡圖像；采用重建層厚2.0mm，間隔1.5mm，骨算法重建所有資料的橫斷面薄層圖像。 分別應(yīng)用支氣管樹三維重建和仿真內(nèi)窺鏡技術(shù)做出右肺中下葉支氣管圖像，再結(jié)合橫斷面薄層重建圖像對(duì)右肺中下葉段支氣管進(jìn)行分型，分析3種技術(shù)對(duì)段支氣管不同分支類型的顯示效果；聯(lián)合3種技術(shù)對(duì)右肺中下葉段支氣管進(jìn)行分型，統(tǒng)計(jì)分型結(jié)果及亞上段支氣管的出現(xiàn)率。采用以下標(biāo)準(zhǔn)統(tǒng)計(jì)圖像：支氣管樹三維圖像以分支方向、數(shù)目及管徑粗細(xì)作為初次判斷標(biāo)準(zhǔn)，容易辨認(rèn)右肺中下葉段支氣管中的獨(dú)立分支及較長共干；當(dāng)右肺中葉支氣管顯示三個(gè)分支但很難辨認(rèn)是較短共干或同時(shí)三分支時(shí)，或右肺下葉前底段、外側(cè)底段和后底段支氣管很難辨認(rèn)是依次分支或同時(shí)三分支時(shí)，再結(jié)合仿真內(nèi)鏡從開口分叉處觀察，以分叉處“隆嵴”的高低作為判定標(biāo)準(zhǔn)進(jìn)行區(qū)別；當(dāng)支氣管樹三維圖像、仿真內(nèi)鏡圖像出現(xiàn)亞上段支氣管或兩支內(nèi)側(cè)底段支氣管時(shí)，必須結(jié)合橫斷面薄層圖像以資鑒別；當(dāng)判斷外側(cè)底段支氣管與前底段或后底段支氣管共干時(shí)，必須結(jié)合三種圖像綜合分析。挑選兩位有經(jīng)驗(yàn)的胸部影像診斷醫(yī)師分別對(duì)三種重組圖像行雙盲法觀察。 結(jié)果 三種重建圖像對(duì)右肺中下葉段級(jí)支氣管的顯示率均為100%，對(duì)亞段級(jí)支氣管的顯示率均超過80%。依據(jù)段級(jí)支氣管分支形式的不同，右肺中葉段支氣管主要分為兩型：Ⅰ型是二分支型，共289例（96.3%）；Ⅱ型是三分支型，共11例（3.7%）。右肺下葉段支氣管主要分為三型：Ⅰ型是外側(cè)底段與后底段支氣管共干型，共230例（76.7%）；Ⅱ型是前底段與外側(cè)底段支氣管共干型，，共31例（10.3%）；Ⅲ型是內(nèi)側(cè)底段支氣管缺如型，共18例（6.0%）；其余為特殊類型共21例（7.0%）；亞上段支氣管出現(xiàn)者113例（37.7%），同時(shí)出現(xiàn)兩支亞上段支氣管者12例（4.0%），占所有亞上段支氣管者的10.6%（12例/113例）。 結(jié)論 支氣管樹三維圖像可立體顯示各段支氣管依次分支及較長兩兩共干類型，仿真內(nèi)鏡可腔內(nèi)觀察開口數(shù)目及“隆嵴”的位置形態(tài)，區(qū)別較短兩兩共干型與3分支型，橫斷面薄層圖像可辨認(rèn)亞上段支氣管，聯(lián)合應(yīng)用支氣管樹三維重建、仿真內(nèi)鏡及橫斷面薄層重建3種后處理技術(shù)，可以對(duì)右肺中下葉段支氣管進(jìn)行較準(zhǔn)確分型。 意義 本研究綜合運(yùn)用64層螺旋CT的三種后處理技術(shù)，可以三維立體觀察段支氣管的分支形式和其在橫斷面的走行分布，統(tǒng)計(jì)出右肺中下葉段支氣管的分支類型及亞上段支氣管的出現(xiàn)率，對(duì)解剖學(xué)研究起到了補(bǔ)充作用。由于以往的解剖研究多是建立在解剖標(biāo)本基礎(chǔ)上，樣本量小，操作復(fù)雜，而本研究是大量活體解剖，可重復(fù)性及準(zhǔn)確性更高。段支氣管分支類型復(fù)雜，常見分支類型可有多種，但目前教科書僅描述最常見分支形式，并被廣大放射科、胸外科醫(yī)生所接受。若能準(zhǔn)確知道每一位患者雙肺段支氣管的分支類型，可以幫助放射科醫(yī)師更準(zhǔn)確定位肺內(nèi)病變，為肺內(nèi)病變微創(chuàng)手術(shù)或纖維支氣管鏡活檢、治療等提供更多、更準(zhǔn)確的信息。
[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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