Sato Masaaki, Nagayama Kazuhiro, Kuwano Hideki, Nitadori Jun-Ichi, Anraku Masaki, Nakajima Jun
Department of Thoracic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
Asian Cardiovasc Thorac Ann. 2017 Feb;25(2):123-130. doi: 10.1177/0218492316689351. Epub 2017 Jan 11.
Background Virtual-assisted lung mapping is a novel bronchoscopic preoperative lung marking technique in which virtual bronchoscopy is used to predict the locations of multiple dye markings. Post-mapping computed tomography is performed to confirm the locations of the actual markings. This study aimed to examine the accuracy of marking locations predicted by virtual bronchoscopy and elucidate the role of post-mapping computed tomography. Methods Automated and manual virtual bronchoscopy was used to predict marking locations. After bronchoscopic dye marking under local anesthesia, computed tomography was performed to confirm the actual marking locations before surgery. Discrepancies between marking locations predicted by the different methods and the actual markings were examined on computed tomography images. Forty-three markings in 11 patients were analyzed. Results The average difference between the predicted and actual marking locations was 30 mm. There was no significant difference between the latest version of the automated virtual bronchoscopy system (30.7 ± 17.2 mm) and manual virtual bronchoscopy (29.8 ± 19.1 mm). The difference was significantly greater in the upper vs. lower lobes (37.1 ± 20.1 vs. 23.0 ± 6.8 mm, for automated virtual bronchoscopy; p < 0.01). Despite this discrepancy, all targeted lesions were successfully resected using 3-dimensional image guidance based on post-mapping computed tomography reflecting the actual marking locations. Conclusions Markings predicted by virtual bronchoscopy were dislocated from the actual markings by an average of 3 cm. However, surgery was accurately performed using post-mapping computed tomography guidance, demonstrating the indispensable role of post-mapping computed tomography in virtual-assisted lung mapping.
虚拟辅助肺标测是一种新型的支气管镜术前肺标记技术，该技术利用虚拟支气管镜来预测多个染料标记的位置。标记后进行计算机断层扫描以确认实际标记的位置。本研究旨在检验虚拟支气管镜预测标记位置的准确性，并阐明标记后计算机断层扫描的作用。方法：使用自动和手动虚拟支气管镜来预测标记位置。在局部麻醉下进行支气管镜染料标记后，在手术前进行计算机断层扫描以确认实际标记位置。在计算机断层扫描图像上检查不同方法预测的标记位置与实际标记之间的差异。对11例患者的43个标记进行了分析。结果：预测标记位置与实际标记位置的平均差异为30毫米。自动虚拟支气管镜系统的最新版本（30.7±17.2毫米）与手动虚拟支气管镜（29.8±19.1毫米）之间无显著差异。上叶与下叶的差异显著更大（自动虚拟支气管镜分别为37.1±20.1与23.0±6.8毫米；p<0.01）。尽管存在这种差异，但基于反映实际标记位置的标记后计算机断层扫描，使用三维图像引导成功切除了所有目标病变。结论：虚拟支气管镜预测的标记与实际标记平均错位3厘米。然而，使用标记后计算机断层扫描引导准确地进行了手术，证明了标记后计算机断层扫描在虚拟辅助肺标测中不可或缺的作用。
