4<scp>D CT</scp> and lung cancer surgical resectability: A technical innovation

Troupis, John; Pasricha, Sundeep Singh; Narayanan, Harish; Rybicki, Frank J.; Pick, Adrian

doi:10.1111/1754-9485.12161

Cited by 5 publications

(6 citation statements)

References 5 publications

(5 reference statements)

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“…The effect of gravity and body position on ventilation has been investigated using apparent diffusion coefficient (ADC) values measured by hyperpolarized 3 He MRI, which can be a useful indicator of inflation level 20. Based on the observation, ADC values are similar in nondependent (upside) and dependent (downside) regions at volumes of 100% of vital capacity (VC), whereas the dependent–nondependent vertical gradient in ADC values is observed at VC volumes of both 20% and 60% in nonsmokers, indicating that predominant ventilation occurs in the dorsal regions in the supine position 20.…”

Section: Introductionmentioning

confidence: 99%

Continuous quantitative measurement of the main bronchial dimensions and lung density in the lateral position by four-dimensional dynamic-ventilation CT in smokers and COPD patients

Nagatani

Hashimoto

Nitta

et al. 2018

COPD

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PurposeThe purpose of this study was to measure changes in lung density and airway dimension in smokers in the lateral position using four-dimensional dynamic-ventilation computed tomography (CT) during free breathing and to evaluate their correlations with spirometric values.Materials and methodsPreoperative pleural adhesion assessments included dynamic-ventilation CT of 42 smokers (including 22 patients with COPD) in the lateral position, with the unoperated lung beneath (dependent lung). The scanned lungs’ mean lung density (MLD) and the bilateral main bronchi’s luminal areas (Ai) were measured automatically (13–18 continuous image frames, 0.35 seconds/frame). Calculations included cross-correlation coefficients (CCCs) between the MLD and Ai time curves, and correlations between the quantitative measurements and spirometric values were evaluated by using Spearman’s rank coefficient.ResultsThe ΔMLD1.05 (from the peak inspiration frame to the third expiratory frame, 1.05 seconds later) in the nondependent lung negatively correlated with FEV1/FVC (r=−0.417, P<0.01), suggesting that large expiratory movement of the nondependent lung would compensate limited expiratory movement of the dependent lung due to COPD. The ΔAi1.05 negatively correlated with the FEV1/FVC predicted in both the lungs (r=−0.465 and −0.311, P<0.05), suggesting that early expiratory collapses of the main bronchi indicate severe airflow limitation. The CCC correlated with FEV1/FVC in the dependent lung (r=−0.474, P<0.01), suggesting that reduced synchrony between the proximal airway and lung occurs in patients with severe airflow limitation.ConclusionIn COPD patients, in the lateral position, the following abnormal dynamic-ventilation CT findings are associated with airflow limitation: enhanced complementary ventilation in the nondependent lung, early expiratory airway collapses, and reduced synchrony between airway and lung movements in the dependent lung.

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Section: Introductionmentioning

confidence: 99%

Continuous quantitative measurement of the main bronchial dimensions and lung density in the lateral position by four-dimensional dynamic-ventilation CT in smokers and COPD patients

Nagatani

Hashimoto

Nitta

et al. 2018

COPD

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“…There are a few papers that have described the advantages of four-dimensional (4D) dynamic-ventilation CT for observing airway or pulmonary diseases. 1 – 7 However, no published studies have reported quantitative measurements of the lung or airways using dynamic-ventilation CT. This may be due to a lack of software or workstations that can measure 4D-CT data.…”

Section: Introductionmentioning

confidence: 99%

Continuous quantitative measurement of the proximal airway dimensions and lung density on four-dimensional dynamic-ventilation CT in smokers

Yamashiro

Moriya

Tsubakimoto

et al. 2016

COPD

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PurposeFour-dimensional dynamic-ventilation computed tomography (CT) imaging demonstrates continuous movement of the airways and lungs, which cannot be depicted with conventional CT. We aimed to investigate continuous changes in lung density and airway dimensions and to assess the correlation with spirometric values in smokers.Materials and methodsThis retrospective study was approved by the Institutional Review Board, and informed consent was waived. Twenty-one smokers including six patients with COPD underwent four-dimensional dynamic-ventilation CT during free breathing (160 mm in length). The mean lung density (MLD) of the scanned lung and luminal areas (Ai) of fixed points in the trachea and the right proximal bronchi (main bronchus, upper bronchus, bronchus intermedius, and lower bronchus) were continuously measured. Concordance between the time curve of the MLD and that of the airway Ai values was expressed by cross-correlation coefficients. The associations between these quantitative measurements and the forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) values were assessed by Spearman’s rank correlation analysis.ResultsOn the time curve for the MLD, the Δ-MLD1.05 values between the peak inspiratory frame to the later third frame (1.05 seconds later) were strongly correlated with the FEV1/FVC (ρ=0.76, P<0.0001). The cross-correlation coefficients between the airway Ai and MLD values were significantly correlated with the FEV1/FVC (ρ=−0.56 to −0.66, P<0.01), except for the right upper bronchus. This suggested that the synchrony between the airway and lung movement was lost in patients with severe airflow limitation.ConclusionRespiratory changes in the MLD and synchrony between the airway Ai and the MLD measured with dynamic-ventilation CT were correlated with patient’s spirometric values.

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“…[9] A previous study reported on the evaluation of an adhesion in the aorta, and 2 cases in this study where the tumor was in contact with the aorta were found to be evaluated correctly. [10]…”

Section: Discussionmentioning

confidence: 99%

Preoperative evaluation of pleural adhesion in patients with lung tumors using four-dimensional computed tomography performed during natural breathing

Mizuno

Muto

2021

Medicine

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The presence of pleural adhesions increases blood loss, occurrence of pulmonary fistulation due to lung injury, and operative time and may complicate thoracoscopic surgery. Recently, it has been reported that four-dimensional computed tomography (4D-CT) synchronized with breathing predicts pleural adhesion. These studies have been performed by asking the patients to maintain a constant respiratory rhythm at the time of scanning. However, many patients face difficulty in doing so, particularly elderly individuals and patients with respiratory dysfunction. We examined the utility of 4D-CT performed while maintaining a natural breathing pattern, which reduces patient burden, in detecting pleural adhesions.A total of 36 patients with a lung tumor near the pleura underwent 4D-CT during free breathing. The migration distance between the lesion and the nearest point on the chest wall on 4D-CT was measured. A sufficient distance indicated the absence of adhesion in that area. The presence of actual adhesions was evaluated and confirmed by intraoperative thoracoscopic findings.There were 7 cases determined to have adhesion by 4D-CT, and 4 of them had actual adhesions confirmed during surgery. The sensitivity and specificity were 80.0% and 90.3%, respectively. The mean migration distance of tumors was 0.8 ± 0.2 cm in the 5 cases with adhesion and 2.6 ± 1.8 cm in the 31 cases without adhesion (P = .01).These results suggest that 4D-CT is a convenient and useful technique for the preoperative assessment of pleural adhesion.Abbreviations: 4D-CT = four-dimensional computed tomography, CT = computed tomography, VATS = video-assisted thoracoscopic surgery.

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4D CT and lung cancer surgical resectability: A technical innovation

Cited by 5 publications

References 5 publications

Continuous quantitative measurement of the main bronchial dimensions and lung density in the lateral position by four-dimensional dynamic-ventilation CT in smokers and COPD patients

Continuous quantitative measurement of the main bronchial dimensions and lung density in the lateral position by four-dimensional dynamic-ventilation CT in smokers and COPD patients

Continuous quantitative measurement of the proximal airway dimensions and lung density on four-dimensional dynamic-ventilation CT in smokers

Preoperative evaluation of pleural adhesion in patients with lung tumors using four-dimensional computed tomography performed during natural breathing

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