| ObjectiveTo analyze the CT technical requirements for Lung Density software in EBW workstation and its performance of imaging anatomy, so as to explore the methods and values of the software reflected in the diagnosis of pneumonia and pulmonary tuberculosis. Materials and methodsThe clinical trial objects were composed of 88 healthy persons, 44 pneumonia patients and 46 pulmonary tuberculosis patients. The average age was 39.31±7.74, 69.59±16.01 and 44.89±16.06 years old, respectively. Among the 88 healthy persons, 16 cases with unqualified Lung Density images were used for the research of EBW quality assurance and technical requirements. The other 72 cases were used as normal specimens for the image and anatomy study, the contents included lung 3D performance, tracheal diameters, main bronchus length, angles between left and right main bronchus, volume of emphysema and its ratio to lung, emphysema grading, and the morphology, size and distribution of emphysema, et al. In the group of pneumonia and pulmonary tuberculosis patients, the observation focused on the volume of emphysema and its ratio to lung, emphysema grading, and the morphology, size and distribution of emphysema, et al. In the three groups, the red marked areas were all observed on the threshold of-1010 HU,-980 HU,-950 HU,-920 HU,-890 HU and-860 HU, respectively. On the other hand, 6 pneumonia cases and 5 tuberculosis cases with multi focal lesions were comparatively analyzed in Lung Density software. In addition, dynamic changes and histological observation of emphysema districts were observed in 2 rabbits accepted with iodine atomization inhalation, and the influence factors of scanning position on image qualities were simulated observed. The main instruments and reagents included EBW4.5 workstation, siemens SOMATOM definition AS+ CT, children pressurized atomizing inhalation device, HE staining reagents and Leica DM4000 B LED microscopy, et al. Results(1) The quality problems of Lung Density images included incomplete display of lung, false identification and measurement, poor image resolution, were caused by too small scanning range, deviation from the center line more than 3cm, too thick image layer(≥3mm).(2)Histological examination showed obvious emphysematous appearances in the red marked area of rabbit lung. After inhalation with iodine water, the red marked districts changed frequently, and the original larger area tended to be smaller.(3) 3D image of Lung Density could directly display the severity and volume or ratio of emphysema.Under-1024 HU threshold,the gray images clearly showed 4 grade bronchus branching, pleural surface and pulmonary vascular. In 72 healthy persons, the tracheal minimum transverse diameter was 0.95-2.2cm, averaged 1.65 cm or 1.36 cm in male or female. And the sagittal minimum diameter was 0.8cm-2.25 cm, averaged 1.5cm or 1.26 cm in male or female. The average length of right and left main bronchus was 4.98 cm and 2.68 cm in male, 4.61 cm and 2.38 cm in female. The average angle under crest was 81.87° or 78° in male and female. Emphysema areas could be found more common in inside middle or bottom lung in 67 healthy persons, presented like point, flake, and strip or fusion shape. When the threshold was adjusted from-1010 HU to-860 HU, the CT value-volume curve remained unchanged, but the volume and ratio of red marked districts gradually increased.(4) Emphysema tended to be more serious in pneumonia and tuberculosis patients with the growth of age, associated with the expansion of lung volume but more obvious. Observed under multi thresholds, Lung Density image of chronic bronchitis complicated with infection showed scattered red strip or plate shadow, as the threshold increased, the red marked districts always increased dispersedly too. Red marked areas in lobar pneumonia were rare, focal, and usually appeared near hilum with the shapes of points or strips on Lung Density. In bronchial pneumonia, it’s rarely appeared in the lesion areas, but often in other normal lobes, usually changed rapidly a few days later. Among the 46 cases of tuberculosis, the red tag area often appeared like point in the lesions, or like strip in lower lobes of the lung, with minor changes after one month follow-up.(5) Red areas in multifocal pneumonia often showed scattered, easily seen in non diseased lobes, usually larger like flaky. On the other hand, the red areas were easily seen around the focus or concentrated in the diseased lobes with the shapes of spots or strip in multifocal tuberculosis. ConclusionHigh quality Lung Density image could clearly show the anatomy of lung and trachea. In accordance with the reasonable operating procedures, more CT information could be reviewed rapidly on EBW workstation. Some signs, such as the morphology, distribution, size, dynamic changes of the red marked areas could be used for the differential diagnosis of pneumonia with tuberculosis. |
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