摘要目的 探索虚拟支气管镜导航软件(DirectPath)使用不同重建层厚的CT图片数据重建出三维支气管树的效果,评估该软件引导常规/超细支气管镜进入肺外周目标支气管的能力.方法 入选行胸部CT扫描发现肺孤立性结节者60例,其中8排螺旋CT扫描组(8排组)30例,64排螺旋CT扫描组(64排组)30例.8排组获取的图片可以刻录成1.25 mm层厚的重建数据,64排CT组图片可分别刻录成1.25 mm和0.625 mm两组层厚的重建数据.将所有入选者的重建数据导入DirectPath导航软件中,软件自动重建出三维支气管树,并模拟出目标支气管的图像,记录所有入选者重建出的三维支气管树及右B1a、右B6a、右B10a 3支支气管最远端所在的支气管级别和最短直径.结果 所有入选者均重建出了三维支气管树.1.25 mm层厚时,64排组重建出的三维支气管树优于8排组(Z＝-2.849,P=0.004),且64排组重建出的右B1a、右B6a级别更远.64排组中,0.625 mm层厚较1.25 mm层厚能重建出级别更远、直径更小的支气管,但2种层厚重建出的三维支气管树差异无统计学意义(Z＝-1.732,P=0.083).60例入选者,1.25 mm层厚时,重建出右B1a、右B6a、右B10a 3支支气管的最远级别及最短直径差异无统计学意义(P值均＞0.05),3支支气管重建出级别大于6级(含6级)的比例分别为66.7％、60.0％、65.0％,而当64排组0.625 mm层厚时,上述比例分别为90.0％、90.0％、88.3％.结论 虚拟支气管镜导航软件(DirectPath)使用64排CT扫描0.625 mm层厚的数据可以重建出较好的支气管树,其具备引导常规/超细支气管镜进入肺外周目标支气管的能力.

abstractsObjective To analyze the effectiveness of DirectPath in reconstructing the threedimensional bronchial tree based on different slice thickness computed tomography images and evaluate the ability of DirectPath in guiding a conventional bronchoscope or an ultrathin bronchoscope to the target peripheral bronchus.Methods 60 patients with solitary pulmonary nodules discovered by chest computed tomography scan were selected.Computed tomography of the chest was performed by 8-row or 64-row multidetector.CT images of 30 patients in 8-row multidetector group were recorded to 1.25 mm slices,and CT images of 30 patients in 64-row multidetector group were recorded to 1.25 mm and 0.625 mm slices respectively.All CT data sets were transferred from CDs into the software which could automatically reconstruct the three-dimensional bronchial tree and simulate the bronchoscopic images of the target bronchus.Data of bronchus generation and minimum diameter of right B1a,right B6a,right B10a of each patients in different slice thickness were collected.Results Three-dimensional bronchial trees and virtual bronchoscopic images were successfully reconstructed in all patients.In slice thickness of 1.25 mm,64 row multidetector group reconstructed better in three-dimensional bronchial tree compared with 8-row multidetector group (Z =-2.849,P =0.004),especially in further bronchus generation of right B1a and right B6a.In 64-row multidetector group,further bronchus generation and smaller diameter bronchi in right B1a,right B6a,right B10a were reconstructed in 0.625 mm slices than those in 1.25 mm slices.But there was no statistical differences in the three-dimensional bronchial tree reconstruction between these two slice thicknesses (Z =-1.732,P =0.083).There was also no statistical differences in bronchus generation and minimum diameter among right B1a,right B6a,and right B10a in 1.25 mm slices in 60 patients.The proportion of more than six grades (including six grades) bronchi reconstructed by the software among the three bronchi above was 66.7％,60.0％,and 65.0 ％ respectively,but 90.0％,90.0％,and 88.3 ％ in 0.625 mm slices in 64-row multidetector group.Conclusions DirectPath can reconstruct better three-dimensional bronchial tree in 0.625 mm slices in 64-row multidetector computed tomography.It can guide a conventional bronchoscope or an ultrathin bronchoscope to the peripheral target bronchus.