Volumetric reconstruction and determination of minimum crosssectional area of the pharynx in patients with cleft lip and palate: comparison between two different softwares

Abstract Objective: The aim of this study was to assess the accuracy of volumetric reconstruction of the pharynx by comparing the volume and minimum crosssectional area (mCSA) determined with open-source applications (ITK-Snap, www.itksnap.org ; SlicerCMF) and commercial software (Dolphin3D, 11.8, Dolphin Imaging & Management Solutions, Chatsworth, CA, USA) previously validated in the literature. Material and Methods: The sample comprised of 35 cone-beam computed tomography (CBCT) scans of patients with unilateral cleft lip and palate, with mean age of 29±15. Three-dimensional volumetric models of the pharynx were reconstructed using semi-automatic segmentation using the applications ITK-Snap (G1) and Dolphin3D (G2). Volumes and minimum cross-sectional areas were determined. Inter- and intra-observer error were calculated using ICC test. Comparison between applications was calculated using the Wilcoxon test. Results: Volumes and minimum crosssectional area were statistically similar between applications. ITK-Snap showed higher pharynx volumes, but lower mCSA. Visual assessment showed that 62.86% matched the region of mCSA in Dolphin3D and SPHARM-PDM. Conclusion: Measurements of volume and mCSA are statistically similar between applications. Therefore, open-source applications may be a viable option to assess upper airway dimensions using CBCT exams.

摘要
研究目的：本研究旨在评估咽部容积重建的准确性，通过比较开源软件（ITK-Snap，www.itksnap.org；SlicerCMF）与商用软件（Dolphin3D 11.8，美国加利福尼亚州查茨沃斯市Dolphin Imaging & Management Solutions公司）的测定结果，该商用软件此前已在学术文献中得到验证。
材料与方法：本研究纳入35例单侧唇腭裂患者的锥形束计算机断层扫描（cone-beam computed tomography, CBCT）影像，患者平均年龄为29±15岁。采用ITK-Snap（G1组）与Dolphin3D（G2组）两款软件，通过半自动分割方法重建咽部三维容积模型，并测定其容积与最小横截面积（minimum cross-sectional area, mCSA）。采用组内相关系数（ICC）检验计算观察者间与观察者内的测量误差，采用Wilcoxon秩和检验比较不同软件间的测量差异。
结果：不同软件测得的咽部容积与最小横截面积均无统计学差异。其中ITK-Snap测得的咽部容积更高，但最小横截面积更低。视觉评估显示，62.86%的最小横截面积区域与Dolphin3D及SPHARM-PDM的测定结果相符。
结论：不同软件间的容积与最小横截面积测量值无统计学差异。因此，开源软件可作为利用CBCT检查评估上气道维度的可行方案。