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

Youjun Deng; Songhua Cai; Chujian Huang; Wenyi Liu; Longde Du; Chunguang Wang; Ran Jia; Shengcheng Lin; Xin Yu; Xiangyang Yu; Yikun Yang; Chenglin Yang; Hongbo Zhao; Zhe Wang; Lixu Wang; Kai Ma; Zhentao Yu; Xiaotong Guo

doi:10.3389/fonc.2022.1028467

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

Front Oncol. 2022 Nov 21:12:1028467. doi: 10.3389/fonc.2022.1028467. eCollection 2022.

Authors

Youjun Deng¹, Songhua Cai¹, Chujian Huang¹, Wenyi Liu¹, Longde Du¹, Chunguang Wang¹, Ran Jia¹, Shengcheng Lin¹, Xin Yu¹, Xiangyang Yu¹, Yikun Yang¹, Chenglin Yang¹, Hongbo Zhao¹, Zhe Wang¹, Lixu Wang¹, Kai Ma¹, Zhentao Yu¹, Xiaotong Guo¹

Affiliation

¹ National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.

Abstract

Background: With 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 methods: A 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.

Results: The 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.

Conclusions: The 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.

Keywords: CT; NSCLC; VATS; anatomical variation; pulmonary; segmentectomy; three-dimensional.