Murota Makiko, Norikane Takashi, Ishimura Mariko, Yamamoto Yuka, Mitamura Katsuya, Takami Yasukage, Manabe Yuri, Satoh Katashi, Yokota Naoya, Nishiyama Yoshihiro
Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
Department of Radiology, Diagnostic Imaging Center, Utazu Hospital, Utazu-cho, Kagawa, Japan.
Jpn J Radiol. 2025 Feb;43(2):219-224. doi: 10.1007/s11604-024-01670-9. Epub 2024 Oct 9.
Understanding pulmonary artery (PA) branches and their variations is crucial for successful lung resection. We aimed to evaluate the segmental PA branching pattern of the left upper lobe (LUL) using thin-section computed tomography (TSCT) images and 3D-CT angiography (3D-CTA).
This study included 108 patients who underwent CTA and left upper lobectomy. The segmental PA branching pattern of the LUL was meticulously identified by two thoracic radiologists using 3D-CTA and TSCT images. The lingular artery branches from the left PA (LPA) were classified into mediastinal type (pars mediastinalis: PM), interlobar type (pars interlobaris: PI), and PI originating from the lower portion (PI'), specifically from A8. The intraoperative findings of the PA branches of the LUL were compared with the preoperatively obtained 3D-CTA and TSCT images in each patient's case.
The median (range) number of LPA branches of the LUL was 4.36 (3-8). The most common number of A1 + 2 branches was two, seen in 34 cases (31.5%). One or more branches of A1 + 2c directly originating from the LPA were found in 63 cases (58.3%). The number of branches of A3 was single in 85 cases and the most frequent (78.7%). Instances where one or more branches of A3a directly originated from the LPA were found in seven cases (6.5%). A1 + 2 and A3 origins were separate and independent in 40 cases (37.0%). As the branching pattern of the lingular artery, PI/PI' was most frequent (61.1%). PI´ was observed in 26 cases (24.1%). Inter-observer agreement for A1 + 2, A1 + 2c, A3, A3a, and lingular artery branching patterns was moderate to substantial (κ = 0.53-0.72). Preoperative 3D-CTA and TSCT images identified 99.8% of LPA branches compared to intraoperative findings, except one.
The segmental PA branching pattern of the LUL can be evaluated using TSCT and 3D-CTA images, providing precise preoperative information.
了解肺动脉（PA）分支及其变异情况对于成功进行肺切除手术至关重要。我们旨在利用薄层计算机断层扫描（TSCT）图像和三维CT血管造影（3D-CTA）评估左上叶（LUL）的节段性PA分支模式。
本研究纳入了108例行CTA检查及左上叶切除术的患者。两名胸部放射科医生使用3D-CTA和TSCT图像仔细识别LUL的节段性PA分支模式。舌动脉自左肺动脉（LPA）发出的分支分为纵隔型（纵隔部：PM）、叶间型（叶间部：PI）以及起源于较低部位（PI'），具体为起源于A8的PI'。将每位患者LUL的PA分支术中所见与术前获得的3D-CTA和TSCT图像进行比较。
LUL的LPA分支数量中位数（范围）为4.36（3 - 8）。A1 + 2分支数量最常见为两个，见于34例（31.5%）。63例（58.3%）发现有一个或多个A1 + 2c分支直接起源于LPA。A3分支数量为单个的有85例，最为常见（78.7%）。7例（6.5%）发现有一个或多个A3a分支直接起源于LPA。40例（37.0%）中A1 + 2和A3的起源是分开且独立的。作为舌动脉的分支模式，PI/PI'最为常见（61.1%）。26例（24.1%）观察到PI'。观察者间对A1 + 2、A1 + 2c、A3、A3a以及舌动脉分支模式的一致性为中度到高度（κ = 0.53 - 0.72）。与术中所见相比，术前3D-CTA和TSCT图像识别出了99.
