Anatomy of the lung revisited by 3D-CT imaging

Abstract

The anatomy of the lung was originally described based on data acquired from cadaveric studies and surgical findings. Over time, computed tomography (CT) and three-dimensional (3D) imaging techniques have been developed, allowing for reconstruction and understanding of lung anatomy in a more intuitive way. The wide adoption of 3D-CT imaging technology has led to a variety of anatomical studies performed not only by anatomists but also by surgeons and radiologists. Such studies have led to new or modified classification systems, shed light on lung anatomy from a useful surgical viewpoint, and enabled us to analyze lung anatomy with a focus on particular anatomical features. 3D images also allow for enhanced pre- and intra-operative simulation, improved surgical safety, enhanced educational utility, and the capacity to perform large-scale anatomical studies in shorter time frames. We will review here the key features of 3D-CT imaging of the lung, along with representative anatomical studies regarding (I) general lung anatomy, (II) anatomy of the right and left lobes, and (III) features of interlobar vessels. The current surge of 3D imaging analysis shows that the field is growing, with the technology continuing to improve. Future studies using these new and innovative methodologies will continue to refine our understanding of lung anatomy while enhancing our ability to perform safe and effective surgical resections.

Effect of preoperative three-dimensional modeling on uniportal video-assisted thoracoscopic bronchial sleeve resection and early postoperative outcomes

“…However, these images are not always sufficient to fully recognize the spatial relationships between anatomical structures. [ 22 ] Three-dimensional lung modeling facilitates surgeons' rapid and intuitive recognition of anatomy and associated bronchovascular anomalies. [ 23 ] Sardari Nia et al[ 24 ] argued that preoperative 3D modeling would allow for a detailed anatomical delineation of the tumor, enabling surgeons to perform anatomical radical resections instead of pneumonectomy.…”

Evolution of Three-Dimensional Computed Tomography Imaging in Thoracic Surgery

“…After that, many thoracic surgeons confirmed the usefulness of this technique, mainly in minimally invasive surgery, such as multiportal VATS, uniportal VATS, and RATS [ 20 , 21 , 22 , 23 ]. Regarding the current surge of 3D imaging analyses, Nakazawa and his colleague reviewed the lung anatomy using 3D CT imaging [ 24 ]. The lung anatomy has been studied in detail by cadaveric and surgical confirmation, and several critical limitations were reported, such as postmortem modifications and difficulties procuring numerous cases.…”

“…Second, the accuracy of vascular and bronchial depiction depends on the quality of preoperative CT. Pulmonary vessels with small diameters tend not to be delineated when constructed in 3D and need to be recognized by thoracic surgeons [ 12 , 24 , 64 ]. Third, because each lobe is segmented and reconstructed in the process of generating RPM images, all lobes are completely separated on the RPM.…”