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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2024; 72(07): 557-567
DOI: 10.1055/s-0044-1786195
Original Thoracic

Pulmonary Arterial Anatomical Patterns: A Classification Scheme Based on Lobectomy and 3D-CTBA

Zhuolin Xie‡   *
1   Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
,
Xinyu Zhu‡   *
1   Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
,
Feifei Li‡   *
2   Department of Radiology, Xinghai Hospital of Suzhou Industry ParkSuzhou, Suzhou, Jiangsu, China
,
Jun Zhao
1   Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
,
Chang Li
1   Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Abstract

Purpose Preoperative evaluation of pulmonary vascular and tracheal routes and variations is of great importance to the surgeon. Three-dimensional computed tomography bronchography and angiography (3D-CTBA) has evolved in recent years with the optimization of 3D reconstruction techniques and artificial intelligence. We aim to apply CT angiography and Exoview 3D reconstruction technology to assess patients' pulmonary arterial tree and its anatomical variants and to try to summarize a set of anatomical typing of the pulmonary arterial tree that is relatively easy and conducive to promoting teaching based on surgical habits of lobectomy.

Methods A total of 358 patients hospitalized in the Department of Thoracic Surgery of the First Affiliated Hospital of Soochow University between July 2020 and August 2021 were included in this study. We carefully analyzed the site of emanation, alignment, and number of branches of the pulmonary artery according to a uniform classification method in conjunction with the two-dimensional CT images and transformed them into 3D reconstruction models.

Results Different types of pulmonary artery were observed in 358 cases. We evaluated the complete pulmonary artery tree and counted the number and frequency of major arteries of the pulmonary based on the surgical habits of anatomical lobectomy.

Conclusion The 3D-CTBA technique enables us to adequately assess the anatomy of the pulmonary arteries. Moreover, we provide a practical classification scheme of pulmonary arterial anatomical patterns based on lobectomy and 3D-CTBA. Our data can be used by clinicians in the teaching of pulmonary artery anatomy and the preoperative preparation for anatomical lobectomy.

Keywords

anatomy - pulmonary arteries/veins - surgery - complications - imaging (all modalities) - computed tomography

Authors' Contribution

Data collection: Z.X., X.Z., F.L.; design of the study: X.Z., J.Z., C.L.; imaging reconstruction and data analysis: Z.X., X.Z., F.L.; drafting the manuscript: Z.X., X.Z.; critical revision of the manuscript: J.Z., C.L. Z.X., X.Z., and F.L. have contributed equally to this work.


* These authors contributed equally to the study.




Publication History

Received: 04 November 2023

Accepted: 26 March 2024

Article published online:
02 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Akiba T, Marushima H, Takagi M. et al. Preoperative evaluation of a tracheal bronchus by three-dimensional 64-row multidetector-row computed tomography (MDCT) bronchography and angiography: report of a case. Surg Today 2008; 38 (09) 841-843
    CrossrefPubMedGoogle Scholar
  • 2 Wu WB, Xu XF, Wen W. et al. Three-dimensional computed tomography bronchography and angiography in the preoperative evaluation of thoracoscopic segmentectomy and subsegmentectomy. J Thorac Dis 2016; 8 (Suppl. 09) S710-S715
    PubMedGoogle Scholar
  • 3 Xue L, Fan H, Shi W. et al. Preoperative 3-dimensional computed tomography lung simulation before video-assisted thoracoscopic anatomic segmentectomy for ground glass opacity in lung. J Thorac Dis 2018; 10 (12) 6598-6605
    CrossrefPubMedGoogle Scholar
  • 4 Xu G, Chen C, Zheng W, Zhu Y, Chen H, Cai B. Application of the IQQA-3D imaging interpretation and analysis system in uniportal video-assisted thoracoscopic anatomical segmentectomy: a series study. J Thorac Dis 2019; 11 (05) 2058-2066
    CrossrefPubMedGoogle Scholar
  • 5 Eguchi T, Takasuna K, Kitazawa A. et al. Three-dimensional imaging navigation during a lung segmentectomy using an iPad. Eur J Cardiothorac Surg 2012; 41 (04) 893-897
    CrossrefPubMedGoogle Scholar
  • 6 Shimizu K, Nakano T, Kamiyoshihara M, Takeyoshi I. Segmentectomy guided by three-dimensional computed tomography angiography and bronchography. Interact Cardiovasc Thorac Surg 2012; 15 (02) 194-196
    CrossrefPubMedGoogle Scholar
  • 7 Fukuhara K, Akashi A, Nakane S, Tomita E. Preoperative assessment of the pulmonary artery by three-dimensional computed tomography before video-assisted thoracic surgery lobectomy. Eur J Cardiothorac Surg 2008; 34 (04) 875-877
    CrossrefPubMedGoogle Scholar
  • 8 Zhang M, Liu D, Wu W, Zhang H, Mao N. Preoperative 3D-CT bronchography and angiography facilitates single-direction uniportal thoracoscopic anatomic lobectomy. Ann Transl Med 2019; 7 (20) 526
    CrossrefPubMedGoogle Scholar
  • 9 Cui Z, Ding C, Li C. et al. Preoperative evaluation of the segmental artery by three-dimensional image reconstruction vs. thin-section multi-detector computed tomography. J Thorac Dis 2020; 12 (08) 4196-4204
    CrossrefPubMedGoogle Scholar
  • 10 Cory RA, Valentine EJ. Varying patterns of the lobar branches of the pulmonary artery. A study of 524 lungs and lobes seen at operation of 426 patients. Thorax 1959; 14 (04) 267-280
    CrossrefPubMedGoogle Scholar
  • 11 Fourdrain A, De Dominicis F, Blanchard C. et al. Three-dimensional CT angiography of anatomic variations in the pulmonary arterial tree. Surg Radiol Anat 2018; 40 (01) 45-53
    CrossrefPubMedGoogle Scholar
  • 12 Murota M, Yamamoto Y, Satoh K. et al. An analysis of anatomical variations of the left pulmonary artery of the interlobar portion for lung resection by three-dimensional CT pulmonary angiography and thin-section images. Jpn J Radiol 2020; 38 (12) 1158-1168
    CrossrefPubMedGoogle Scholar
  • 13 Nagashima T, Shimizu K, Ohtaki Y. et al. An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography. Gen Thorac Cardiovasc Surg 2015; 63 (06) 354-360
    CrossrefPubMedGoogle Scholar
  • 14 Nagashima T, Shimizu K, Ohtaki Y. et al. Analysis of variation in bronchovascular pattern of the right middle and lower lobes of the lung using three-dimensional CT angiography and bronchography. Gen Thorac Cardiovasc Surg 2017; 65 (06) 343-349
    CrossrefPubMedGoogle Scholar
  • 15 Gao C, Xu WZ, Li ZH, Chen L. Analysis of bronchial and vascular patterns in left upper lobes to explore the genesis of mediastinal lingular artery and its influence on pulmonary anatomical variation. J Cardiothorac Surg 2021; 16 (01) 306
    CrossrefPubMedGoogle Scholar
  • 16 Kawai N, Kawaguchi T, Yasukawa M, Tojo T. Lobectomy for a mediastinal basal pulmonary artery. Gen Thorac Cardiovasc Surg 2017; 65 (07) 422-424
    CrossrefPubMedGoogle Scholar
  • 17 Nakamura A, Okumura Y, Hashimoto M. et al. Right lower lobectomy for an aberrant mediastinal inferior lobar artery. Ann Thorac Surg 2020; 109 (06) e415-e417
    CrossrefPubMedGoogle Scholar