Soder Stephan A, Perin Fabiola A, Felicetti José Carlos, Camargo José de Jesus P, Camargo Spencer M, Hochhegger Bruno, Teixeira Paulo José Zimermann
Health Sciences Postgraduation Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
Division of Thoracic Surgery, Pavilhão Pereira Filho, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
J Thorac Dis. 2022 Jan;14(1):54-63. doi: 10.21037/jtd-21-1359.
Bronchoscopic lung volume reduction (BLVR) is a potential treatment for patients with severe emphysema, performed through the placement of unidirectional endobronchial valves (EBVs). Their benefits are only achieved in patients that significantly reduce lobar volume, and it is mandatory that the fissures are complete. Fissure evaluation is preferably done by computed tomography, but little is known if its evaluation corresponds to the anatomical findings. The aim of this study is to evaluate the accuracy of thoracic radiologists in the identification of complete fissures by multidetector computed tomography (MDCT) using maximum intensity projection (MIP) technique, compared with direct anatomical evaluation.
Prospective study, conducted in a single institution. Patients submitted to thoracic surgery had their fissures classified as complete or incomplete by thoracic surgeons and their preoperative chest scans evaluated by three radiologists, blinded for surgical evaluation. With the intraoperative categorization as a reference, the accuracy and concordance of the three thoracic radiologists' evaluation were calculated. The most experienced radiologist evaluated the fissures at two different moments to estimate the intra-observer agreement.
There were included 67 patients, being 37 (55%) males, with a mean age of 64 years. The accuracy of radiological identification of complete fissures ranged from 76.8% for left posterior oblique fissure to 85.1% for left anterior oblique fissure, with the best performance achieved by the most experienced radiologist. The concordance of the radiological evaluation for fissure integrity compared to the surgical assessment (k) was 0.53-0.68. Intra-observer agreement ranged from 0.74 to 0.87.
The evaluation of the fissure integrity by MDCT analysis using MIP technique by thoracic radiologists had high accuracy among the thoracic radiologists.
支气管镜肺减容术（BLVR）是一种针对重度肺气肿患者的潜在治疗方法，通过放置单向支气管内瓣膜（EBV）来实施。其益处仅在肺叶体积显著减小的患者中才能实现，并且必须保证肺裂完整。肺裂评估最好通过计算机断层扫描进行，但对于其评估结果与解剖学发现是否相符却知之甚少。本研究的目的是评估胸部放射科医生使用最大密度投影（MIP）技术通过多排螺旋计算机断层扫描（MDCT）识别完整肺裂的准确性，并与直接解剖学评估进行比较。
在单一机构进行的前瞻性研究。接受胸外科手术的患者，其肺裂由胸外科医生分类为完整或不完整，术前胸部扫描由三名放射科医生进行评估，且他们对手术评估不知情。以术中分类为参考，计算三名胸部放射科医生评估的准确性和一致性。经验最丰富的放射科医生在两个不同时间评估肺裂以估计观察者内一致性。
纳入67例患者，其中男性37例（55%），平均年龄64岁。放射学识别完整肺裂的准确性范围从左后斜裂的76.8%到左前斜裂的85.1%，经验最丰富的放射科医生表现最佳。与手术评估相比，肺裂完整性的放射学评估一致性（k）为0.53 - 0.68。观察者内一致性范围为0.74至0.87。
胸部放射科医生使用MIP技术通过MDCT分析评估肺裂完整性在胸部放射科医生中具有较高的准确性。
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