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目的探讨多层螺旋 CT(MSCT)容积再现技术(VRT)显示肺气肿组织最佳的重组阈值区间,及其作为肺减容术(LVRS)靶区(拟行切除的肺气肿组织)显示手段的价值。方法对56例拟行 LVRS 的肺气肿患者行呼气相肺部扫描,按照 CT 检查时间的先后将患者分为 A 组和 B 组。以-1024～-960 HU、-1024～-910 HU 分别作为 LVRS 手术靶区的重组阈值区间,对 A 组的原始薄层图像行 VRT 重组,并将2种重组阈值的 VRT 图像分别与轴面图像、多平面重组(MPR)图像对比,确定显示 LVRS 靶区的最佳重组阈值区问。B 组根据 A 组选定的重组阈值区间进行 VRT 重组,计数并对比 VRT 与二维图像中直径≥3 cm 的肺大泡在各肺叶的分布,应用配对 t 检验验证2种计数结果。结果 A 组中以-1024～-960 HU 作为肺气肿重组阈值区间的 VRT 图像对 LVRS 手术靶区显示较佳,与相对正常肺组织对比较鲜明,病变的程度、范围与二维图像符合程度高。B 组中 VRT 图像与原始图像分析结果一致,对肺大泡的定位及计数结果与原始图像基本一致,肺右上、右中、右下、左上、左下叶计数对比,二维图像分别显示:(4.22±2.09)、(4.44±2.59)、(2.18±0.92)、(3.54±2.03)和(4.40±2.42)个;VRT 分别显示:(4.12±2.12)、(4.44±2.59)、(2.18±0.87)、(3.50±1.99)和(4.28±2.28)个(t 值分别为1.98、0.00、1.77、1.76、1.81,P 值均>0.05)。结论以-1024～-960 HU 作为肺气肿组织的重组阈值,VRT 成像可以准确显示肺气肿的分布类型,立体直观的显示 LVRS 手术靶区,为术前形态评估和术后效果预测提供了新方法。
Objective To investigate the optimal reconstruction threshold interval for emphysema in MSCT volumetric reconstruction (VRT) and its application as a lung volume reduction target (emphysematous tissue for resection) The value of means. Methods Fifty-six patients with emphysema undergoing LVRS underwent expiratory and pulmonary scintigraphy. Patients were divided into A group and B group according to the CT examination time. Using -1024 ~ -960 HU and -1024 ~ -910 HU as the recombination threshold interval of the LVRS target respectively, the original thin-layer images of group A were subjected to VRT recombination. The reconstructed threshold VRT images were compared with the axial plane Image, multiplanar reconstitution (MPR) images to determine the optimal recombination threshold region for LVRS targets. Group B received VRT recombination according to the recombination threshold interval selected in group A, and counted and compared the distribution of bullae in each lobe with VRT and diameter ≥3 cm in two-dimensional images. Two kinds of counting results were verified by paired t-test. Results The VRT images of -1024 ~ -960 HU in group A as the reconstruction threshold of emphysema showed better target area for LVRS surgery, and had a clear contrast with the normal lung tissue. The extent and extent of the lesion were consistent with the two-dimensional images high. Group B VRT images and the original image analysis of the results of the bullae positioning and counting results are basically the same with the original image, lung right upper right middle right lower left upper left lower lobe count contrast, two-dimensional images show: ( 4.22 ± 2.09, 4.44 ± 2.59, 2.18 ± 0.92, 3.54 ± 2.03 and 4.40 ± 2.42, respectively; VRT showed: 4.12 ± 2.12, 4.44 ± 2.59, 2.18 ± 0.87, ), (3.50 ± 1.99) and (4.28 ± 2.28), respectively (t = 1.98,0.00,1.77,1.76,1.81, P> 0.05). Conclusion -1024 ~ -960 HU is the recombination threshold of emphysematous tissue. VRT imaging can accurately display the distribution type of emphysema. Stereological and visual display of LVRS surgical target area provides preoperative morphological evaluation and postoperative effect prediction new method.