Anatomical variation analysis of left upper pulmonary blood vessels and bronchi based on three-dimensional reconstruction of chest CT

Abstract

BackgroundWith its growing popularity and potential outcome, preoperative three-dimensional reconstruction of chest computed tomography (CT) has been widely used in video-assisted thoracic surgery (VATS) segmentectomy for treating non-small cell lung cancer (NSCLC). This study aimed to summarize the experience of anatomical variation analysis of left upper pulmonary blood vessels and bronchi based on the three-dimensional reconstruction of chest CT.Materials and methodsA total of 103 patients with early-stage NSCLC were chosen to undergo VATS segmentectomy based on preoperative three-dimensional reconstruction of chest CT in our institute from September 2019 to July 2022. Data such as clinical characteristics and variations in blood vessels and bronchi were reviewed in this study.ResultsThe branches of the left lingular pulmonary artery may mutate into the LS1 + 2 + 3. A1 + 2 has four subtypes. The distribution of variation is relatively balanced, and the most common variation is type I (35/103, 33.9%). Most lingular arteries originate from the oblique cleft side of the lingular bronchus (79/103,76.7%). Most V(1 + 2)c* are small developments (70/103, 68.0%). The venous return of the proper segment mainly depends on V(1 + 2)b + c. The variation in the left upper lobe bronchus is complex. The most common variant is the bifurcation type (type A to G, 92/103, 89.3%) and bifurcation type A (62/103, 60.2%). The posterior apical segment artery of the left upper lobe is not accompanied by its bronchus.ConclusionsThe variation types of blood vessels and bronchus in the upper lobe of the left lung are complex. Preoperative CT-based three-dimensional reconstruction of pulmonary arteries, veins, and bronchi is of great significance. It can help understand the variations, accurately locate lesions before the surgery, and effectively plan surgeries.

Analysis of variations in the bronchovascular pattern of the lingular segment to explore the correlations between the lingular segment artery and left superior division veins

“…However, there are only a few reports that have comprehensively summarized and classified the bronchovascular pattern of LS using 3D-CTBA. In this study, we analyzed the bronchovascular patterns of the LS and emphasized the differences between our results and those of previous reports (8)(9)(10)(11)(12)(13)(14)(15)(16).…”

“…In our clinical practice, the anatomical variation of the lingular segment bronchus (LSB) does not accordant with the previous reports (9,10). Moreover, the more detailed classification and occurrence probability of the branching patterns of LSA has been rarely involved in previous studies (11)(12)(13)(14)(15)(16). The present study aimed to analyze the bronchovascular pattern of the LS by using data derived from 3D-CTBA and provided a new perspective to understand pulmonary anatomical variations in LS.…”

An atlas of anatomical variants of subsegmental pulmonary arteries and recognition error analysis

“…In some publications (13)(14)(15), absent basal segmental arteries such as A 7 or A 9 were reported but not well defined. For A 7 absent, we found it extremely rare and did not encounter any case with a suspicious absent A 7 yet. A 9 was suspected to be absent in a couple of cases, while they were finally ruled out using the existence of intersegmental veins (V 8 b and V 9 b).…”

“…On the subsegmental level, the top 10 errors are RA 4 b, LA 9 , RA 7 b, RA 1 ai, RA 9 , LA 8 a, LA 8 a+bii, RA 8 a, LA 3 a, and RA 9 a, with error rates ranging from 21 -4% (Supplementary Table 6). On the segmental level, RA 4 , LA 8 , RA 9 , RA 8 , LA 9 , LA 4 , and RA 7 showed error rates ≥ 10% (Table 8). At the lobular level, the recognition accuracy for the right upper lobe is 84%, right middle lobe 77%, right lower lobe 50%, left upper lobe 82%, and left lower lobe 67% (Table 7).…”

“…Three-dimensional (3-D) reconstruction tool has been utilized in various surgical planning processes with the time efficiency as its primary pitfall (6). Thanks to the emergence of automated 3-D reconstruction algorithms (5,(7)(8)(9)(10), we are able to visualize anatomic variants in a more intuitive way. We hereby present a comprehensive pulmonary artery atlas to aid lobectomy and segmentectomy.…”