Evaluation of Pulmonary Lobe Variations Using Multidetector Row Computed Tomography

Mahmut, Mawlan; Nishitani, Hiromu

doi:10.1097/rct.0b013e3180500d23

Cited by 20 publications

(20 citation statements)

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“…As a result, more than 90% of the patients involved in this study had incomplete fissures. This number is similar to the result (i.e., 95% of subjects have incomplete fissures) reported by Mahmut et al [18]. Typically, the oblique fissures, no matter in the right or the left lung, have an integrity level larger than 60%.…”

Section: Discussionsupporting

confidence: 91%

Pulmonary Fissure Integrity and Collateral Ventilation in COPD Patients

Wang

et al. 2014

PLoS ONE

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PurposeTo investigate whether the integrity (completeness) of pulmonary fissures affects pulmonary function in patients with chronic obstructive pulmonary disease (COPD).Materials and MethodsA dataset consisting of 573 CT exams acquired on different subjects was collected from a COPD study. According to the global initiative for chronic obstructive lung disease (GOLD) criteria, these subjects (examinations) were classified into five different subgroups, namely non-COPD (222 subjects), GOLD-I (83 subjects), GOLD-II (141 subjects), GOLD-III (63 subjects), and GOLD-IV (64 subjects), in terms of disease severity. An available computer tool was used to aid in an objective and efficient quantification of fissure integrity. The correlations between fissure integrity, and pulmonary functions (e.g., FEV1, and FEV1/FVC) and COPD severity were assessed using Pearson and Spearman's correlation coefficients, respectively.ResultsFor the five sub-groups ranging from non-COPD to GOLD-IV, the average integrities of the right oblique fissure (ROF) were 81.8%, 82.4%, 81.8%, 82.8%, and 80.2%, respectively; the average integrities of the right horizontal fissure (RHF) were 62.6%, 61.8%, 62.1%, 62.2%, and 62.3%, respectively; the average integrities of the left oblique fissure (LOF) were 82.0%, 83.2%, 81.7%, 82.0%, and 78.4%, respectively; and the average integrities of all fissures in the entire lung were 78.0%, 78.6%, 78.1%, 78.5%, and 76.4%, respectively. Their Pearson correlation coefficients with FEV1 and FE1/FVC range from 0.027 to 0.248 with p values larger than 0.05. Their Spearman correlation coefficients with COPD severity except GOLD-IV range from −0.013 to −0.073 with p values larger than 0.08.ConclusionThere is no significant difference in fissure integrity for patients with different levels of disease severity, suggesting that the development of COPD does not change the completeness of pulmonary fissures and incomplete fissures alone may not contribute to the collateral ventilation.

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Section: Discussionsupporting

confidence: 91%

Pulmonary Fissure Integrity and Collateral Ventilation in COPD Patients

Wang

et al. 2014

PLoS ONE

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“…However, in this study, 9.1% of HFs were found to be discontinuous in the intermediate region, which might relate to the direction of HFs. In previous studies, among the four types of incomplete interlobar fissures, both ROFs and LOFs were most frequently observed as type 1, whereas HFs were most frequently observed as type 3 or type 4 (4,8). In this study, the results for ROFs and LOFs indicated agreement with these studies, but the results for HFs were different, as similar probabilities were observed for HFs of types 1, 3, and 4.…”

Section: Discussionsupporting

confidence: 87%

“…Based on several studies using high resolution CT (1.5 mm thick section) and thin-section CT (1-2 mm thick sections), the probability of having incomplete fissures can vary as 17.4%-87% for ROFs, 20.4%-86.9% for HFs, and 18.6%-70.4% for LOFs (4,6,8,(11)(12)(13). In this study, incomplete ROFs, HFs, and LOFs exhibited frequencies of 41.3%, 58.2%, and 45.2%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Volumetric thin-section CT: evaluation of pulmonaryinterlobar fissures

Guan

Han³

et al. 2015

Diagn Interv Radiol

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T he pulmonary interlobar fissures are important landmarks for pulmonary anatomy. They adopt a double membrane structure formed by invagination of the visceral pleura. The interlobar fissures are 1-3 mm thick and consist of the right oblique fissure (ROF), horizontal fissure (HF), and left oblique fissure (LOF) (1, 2). The recognition of pulmonary interlobar fissures and their variations is beneficial for identifying pulmonary lesion locations, evaluating disease progression, selecting surgical operations, and applying endoscopic therapy (3-5). With the constant development of imaging techniques, thin-section computed tomography (CT) can provide more detailed information regarding lung structure with respect to the anatomy (5-7). Multiplanar reformatting (MPR) (8) and maximal intensity projection (MIP) are reconstruction techniques based on a noninvasive methodology that detect pulmonary interlobar fissure variations. The results generated by these techniques highly resemble the results of an autopsy (8). In this study, the pulmonary interlobar fissures and their variations were investigated and analyzed by volumetric thin-section MPR and MIP images. MethodsThe study was approved by the institutional review board and the institutional ethics committee. A retrospective analysis was performed on CT scans of 862 adult subjects ( PURPOSEWe aimed to perform an imaging analysis of interlobar fissures and their variations using thin-section computed tomography (CT). METHODSVolumetric thin-section CT scanning was performed in 208 subjects. Interlobar fissures were observed on axial images, and reconstructed coronal and sagittal images were observed by multiplanar reformatting (MPR). The vessel distributions were verified by maximal intensity projection (MIP). On the axial images, the interlobar fissures were characterized by lines of hyperattenuation, bands of hyperattenuation, avascular zones, and mixed imaging. The interlobar fissures were divided into seven grades according to the percentage of defects over the entire fissure. RESULTSOn the axial images, of all interlobar fissures without avascular zones, 70.2% of the right oblique fissures (ROFs) and 94.2% of the left oblique fissures (LOFs) appeared as lines, and 83.2% of the horizontal fissures (HFs) appeared as bands. All of the interlobar fissures appeared as lines on the coronal and sagittal images. Of all cases, 17.8% showed fully complete interlobar fissures for all three fissures. Incomplete fissures included 41.3% of ROFs, 58.2% of HFs, and 45.2% of LOFs. In ROFs and LOFs, discontinuity was most frequently below 20%, while in HFs discontinuity was most frequently 41%-60%. The most common classification of incomplete interlobar fissures was a discontinuous avascular zone. CONCLUSIONIncomplete interlobar fissures are common variations of interlobar fissures. Techniques including volumetric thin-section CT, MPR, and MIP can assist in the diagnosis of incomplete interlobar fissures.

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“…[4][5][6][7][8][9] The existence of incomplete fissures may reduce barriers that prevent the spread of diseases, such as pneumonia, and could also affect the distribution pattern of pleural effusion. Air leaks after lobectomies represent but one type of complication in lung cancer patients with incomplete fissures.…”

Section: Introductionmentioning

confidence: 99%

Computerized assessment of pulmonary fissure integrity using high resolution CT

Fuhrman

Durick

et al. 2010

Medical Physics

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Purpose: Knowledge of pulmonary interlobar fissure integrity is of interest in a number of clinical and investigational applications. The authors developed and tested a high resolution CT based automated computerized scheme for this purpose. Methods: The fissure integrity assessment scheme consists of the following steps: ͑1͒ Fissure detection, ͑2͒ individual fissure identification, ͑3͒ fissure type determination, ͑4͒ "complete" interlobe surface estimation, and ͑5͒ fissure integrity estimation. For evaluation purposes, 50 anonymized chest CT examinations were ascertained and the complete and "incomplete" regions of the fissures of interest were manually marked by two experienced radiologists. After applying the scheme to the same examinations, differences among fissure percent completeness estimates based on the radiologists' manual markings and the automated computerized scheme were computed and compared. Results: Average differences in estimated fissure percent completeness ͑integrity͒ between the results of the computerized scheme and that based on each of the two radiologists' markings were 6.88% Ϯ 5.86%, 9.57% Ϯ 7.77%, and 4.19% Ϯ 5.64% for the right major fissures, the right minor fissures, and the left major fissures, respectively. The differences between results based on radiologists' markings for the same fissures were 4.27% Ϯ 3.32%, 7.02% Ϯ 5.54%, and 4.23% Ϯ 4.93%, respectively. The difference among the three matched measurement sets for each fissure were statistically significant ͑Friedman's test, p Յ 0.005͒ but paired comparisons showed that much of the observed difference was related to inter-reader differences rather than reader-computerized scheme differences. Computerized estimates were correlated with each of the radiologist's estimates ͑Spear-man, p Ͻ 0.0001͒. Conclusions: While variability between readers-based estimates of fissure integrity was smaller than differences between the computerized scheme and each of the readers, the result reported here are quite encouraging in that the magnitude of these differences were in the same magnitude, demonstrating the feasibility of using a computerized scheme for this purpose.

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Evaluation of Pulmonary Lobe Variations Using Multidetector Row Computed Tomography

Abstract: The incidence of incomplete lobulation observed by multidetector CT in this study is remarkably lower than that reported in previous CT studies but is comparable with that reported from autopsy results. It is important to perform multidirectional observation using MPR.

Cited by 20 publications

References 6 publications

Pulmonary Fissure Integrity and Collateral Ventilation in COPD Patients

Pulmonary Fissure Integrity and Collateral Ventilation in COPD Patients

Volumetric thin-section CT: evaluation of pulmonaryinterlobar fissures

Computerized assessment of pulmonary fissure integrity using high resolution CT

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