Original article: general thoracic
Use of three-dimensional computed tomographic angiography of pulmonary vessels for lung resections

https://doi.org/10.1016/S0003-4975(02)04375-8Get rights and content

Abstract

Background

Identification and appropriate treatment of the pulmonary artery (PA) is a key to successful anatomic resection of the lung. Preoperative identification of branching pattern of the PA seems to make pulmonary resection easier and safer especially when there is severe adhesion or incomplete fissure between the lobes. With the development of the multidetector row spiral computed tomography (MDCT), three-dimensional (3D) CT angiography can be obtained easily and can provide very useful information about various organs. We studied the usefulness of 3D-CT pulmonary angiography (3D-CTPA) in evaluating the PA branching pattern before anatomic pulmonary resection.

Methods

Fourteen patients with primary lung cancer undergoing anatomic pulmonary resections were the subjects of this study. The 3D-CTPA images were obtained using MDCT. The obtained images of the PA branching pattern were compared with intraoperative findings in each case at the time of thoracotomy.

Results

MDCT scanning required approximately 15 seconds per patient during a single respiratory pause and the 3D images were processed within 10 minutes after scannning. According to intraoperative findings, 98% (84 of 86) of PA branches were revealed to be successfully identified on preoperative 3D-CTPA. Two missed branches on 3D-CTPA were small vessels, which were less than 1.5 mm in actual diameter. Pulmonary vessels were clearly identified even when contrast medium was not administered intravenously.

Conclusions

Obtaining 3D-CTPA using MDCT is noninvasive yet it provides precise preoperative information regarding pulmonary vessels. This technique is a far less invasive and an easier investigation than conventional pulmonary angiography. The 3D-CTPA navigation may have the potential to increase the safety of surgical procedure and to reduce surgical morbidity in anatomic lung resection.

Section snippets

Patients and methods

Fourteen patients who underwent anatomic resection for primary lung cancer between February and September 2001 were included in this study. The 3D-CTPA images were obtained using an MDCT scanner (Somatom Plus 4-VZ; Siemens Medical System, Erlangen, Germany). Iodinated contrast medium was administered intravenously from the upper limb at a rate of 3.0 mL/s with a total dose of 100 mL by a mechanical injector. Images of the arterial phase were obtained by commencing the scanning when the injected

Scanning time

MDCT scanning required approximately 15 seconds per patient during a single respiratory pause, and the 3D images of pulmonary vessels were processed within 5 to 10 minutes after scanning.

Quality of images

PA branches were clearly identified at the subsegmental or more peripheral levels (Fig 1). Wearing special glasses offered more comprehensible 3D images. The reconstructed 3D-CTPA image of the PA could be rotated 360 degrees in any direction on the display screen. Although both PA and PV are visible in this 3D

Comment

Anatomic pulmonary resection such as lobectomy and segmentectomy is a common and basic procedure to treat various pulmonary tumors. Identification and appropriate treatment of the PA branches is a particularly important key to successful anatomic pulmonary resection although there are a multitude of anatomic variations in the PA branching pattern [2]. Because no one pattern for either the right or the left PA can be described as standard the thoracic surgeon must be mindful of the high degree

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