Zhang Chen, Bruggink Robin, Baan Frank, Bronkhorst Ewald, Maal Thomas, He Hong, Ongkosuwito Edwin M
The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands.
PeerJ. 2019 Jan 28;7:e6246. doi: 10.7717/peerj.6246. eCollection 2019.
Three-dimensional (3D) modeling of the nasal airway space is becoming increasingly important for assessment in breathing disorders. Processing cone beam computed tomography (CBCT) scans of this region is complicated, however, by the intricate anatomy of the sinuses compared to the simpler nasopharynx. A gold standard for these measures also is lacking. Previous work has shown that software programs can vary in accuracy and reproducibility outcomes of these measurements. This study reports the reproducibility and accuracy of an algorithm, airway segmentor (AS), designed for nasal airway space analysis using a 3D printed anthropomorphic nasal airway model.
To test reproducibility, two examiners independently used AS to edit and segment 10 nasal airway CBCT scans. The intra- and inter-examiner reproducibility of the nasal airway volume was evaluated using paired -tests and intraclass correlation coefficients. For accuracy testing, the CBCT data for pairs of nasal cavities were 3D printed to form hollow shell models. The water-equivalent method was used to calculate the inner volume as the gold standard, and the models were then embedded into a dry human skull as a phantom and subjected to CBCT. AS, along with the software programs MIMICS 19.0 and INVIVO 5, was applied to calculate the inner volume of the models from the CBCT scan of the phantom. The accuracy was reported as a percentage of the gold standard.
The intra-examiner reproducibility was high, and the inter-examiner reproducibility was clinically acceptable. AS and MIMICS presented accurate volume calculations, while INVIVO 5 significantly overestimated the mockup of the nasal airway volume.
With the aid of a 3D printing technique, the new algorithm AS was found to be a clinically reliable and accurate tool for the segmentation and reconstruction of the nasal airway space.
鼻气道空间的三维（3D）建模对于呼吸障碍的评估日益重要。然而，与相对简单的鼻咽部相比，鼻窦复杂的解剖结构使得对该区域的锥形束计算机断层扫描（CBCT）图像进行处理变得复杂。目前也缺乏这些测量的金标准。先前的研究表明，不同软件程序在这些测量的准确性和可重复性结果上存在差异。本研究报告了一种用于鼻气道空间分析的算法——气道分割器（AS），使用3D打印的拟人化鼻气道模型时的可重复性和准确性。
为测试可重复性，两名检查者独立使用AS编辑并分割10例鼻气道CBCT扫描图像。使用配对t检验和组内相关系数评估鼻气道容积的检查者内和检查者间可重复性。为进行准确性测试，将成对鼻腔的CBCT数据进行3D打印以形成空心壳模型。采用水当量法计算内部容积作为金标准，然后将模型嵌入干燥的人体颅骨作为体模并进行CBCT扫描。应用AS以及MIMICS 19.0和INVIVO 5软件程序从体模的CBCT扫描图像计算模型的内部容积。准确性以相对于金标准的百分比表示。
检查者内可重复性高，检查者间可重复性在临床上可接受。AS和MIMICS的容积计算准确，而INVIVO 5显著高估了鼻气道容积的模型。
借助3D打印技术，新算法AS被发现是一种用于鼻气道空间分割和重建的临床可靠且准确的工具。
