Application of Three-Dimensional Computed Tomography Bronchography and Angiography Reconstruction in Thoracoscopic Segmentectomy and Segmental Structure Analysis

2020 ◽  
Vol 12 (9) ◽  
pp. 1137-1143
Author(s):  
Chao Yang Pan ◽  
Guoqiu Xu ◽  
Bin Xu ◽  
Wei Gan ◽  
Yunkun Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Safety Margin ◽  
Pulmonary Nodules ◽  
Anatomical Variations ◽  
Surgical Safety ◽  
Segmental Bronchus ◽  
The Individual ◽  
The Right ◽  
Segmental Arteries

In thoracoscopic segmentectomy, accurate preoperative identification of intersegmental vessels, bronchi, and the surgical safety margin is vital. We applied three dimensional computed tomography bronchography and angiography (3D-CTBA) reconstruction to appropriately plan thoracoscopic segmentectomy for Patients with pulmonary nodules. In this study, we evaluated the effectiveness and accuracy of 3D-CTBA reconstruction for the identification of segmental anatomical structures and variation during thoracoscopic segmentectomy.We retrospectively analyzed data of 30 patients who underwent 3D-CTBA reconstruction before thoracoscopic segmentectomy between January and May 2019 in the Department of Thoracic Surgery, First Affiliated Hospital of Nanchang University. We compared the individual target segment arteries, veins, and bronchi identified during surgery with the preoperative 3D-CTBA model to evaluate its effectiveness and accuracy. The accuracy of the preoperative 3D-CTBA model for the identification of target segmental arteries, veins, and bronchi was 99.08% (108/109), 98.39% (122/124), and 100% (118/118), respectively. Through 3DCTBA modeling, we found mediastinal and interlobar types of lingular segmental arteries in six patients, and central veins were not found in seven patients. In addition, we detected rare anatomical variations in two patients; one patient had the right apical segmental bronchus that stemmed solely from the right primary bronchus (tracheal bronchus), and the other had rare right basal segmental variant bronchi and vessels. The 3D-CTBA model can precisely predict segmental bronchi and vessels and identify anatomical structure variations before operation, which can aid surgeons to avoid incorrect operation and improve surgical efficiency. This has important implications for thoracoscopic segmentectomy.

scholarly journals Multiple Primary Cutaneous Melanomas in a Bulgarian Patient: The Possible Role of One Step Melanoma Surgery (OSMS) As the Most Adequate Treatment Approach!

2018 ◽  
Vol 6 (11) ◽  
pp. 2155-2160
Author(s):  
Georgi Tchernev ◽  
Ivanka Temelkova
Keyword(s):  
Safety Margin ◽  
Simultaneous Occurrence ◽  
Radical Excision ◽  
Complete Regression ◽  
Adequate Treatment ◽  
Surgical Safety ◽  
Melanocytic Lesions ◽  
Multiple Primary ◽  
The Individual ◽  
The Right

BACKGROUND: Simultaneous occurrence of multiple primary melanomas is a rare, however possible phenomenon, and it is believed that older, male, white, Atypical Mole Syndrome carriers (sporadic and familial) are part of the possible risk factors for its occurrence. In these patients, it is possible to observe involutional changes or (partial/complete) regression of melanocytic lesions, which are likely to be caused by the generation of a spontaneous immune reaction against specific tumour antigens. CASE REPORT: A 58-year-old male patient is presented with two melanocytic lesions located in the right clavicle (subclavicular area) and left the scapular area that meets clinically and dermatoscopically the requirements for malignant melanoma. The lesions were removed by a radical excision with 0.5 cm surgical safety margin in all directions. During the subsequent histological verification it was established it was melanoma with a tumour thickness of 1 mm that in one case, and the other 2 mm. A week later, according to the recommendations of the current guidelines, a re-excision was performed with a surgical safety margin of 1.5 cm in all directions. Considering the complications that are possible during the parallel removal of a draining lymph node recommended for these tumour thicknesses, the patient definitively refused its detection and removal. CONCLUSION: A rare case of a Bulgarian patient with multiple primary, however partially involutional melanomas existing for over 20 years, is described. The individual recommendations of dermato-oncologists for the patient (according to AJCC) were not in favour of radicality but of a more sparing, individualised approach, appropriate for that patient. Unfortunately, the approach we used, in this case, was inconsistent with the AJCC or OSMS guidelines. The reason for individualising the approach in the case we have described is due to the variability of the recommendations for surgical treatment of melanomas laid down in the AJCC.

scholarly journals Preoperative virtual simulation for synchronous multiple primary lung cancers using three-dimensional computed tomography lung reconstruction: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Weichun Wu ◽  
Yimin Wu ◽  
Gang Shen ◽  
Guofei Zhang
Keyword(s):  
Computed Tomography ◽  
Thoracoscopic Surgery ◽  
Three Dimensional ◽  
Primary Lung Cancer ◽  
Pulmonary Nodules ◽  
Term Survival ◽  
Lung Cancers ◽  
Multiple Primary ◽  
Feasible Alternative

Abstract Background As the positions and sizes of nodules in synchronous multiple primary lung cancer (SMPLC) patients differ, the development of surgical strategies to maximize long-term survival and preserved postoperative pulmonary function in SMPLC patients for whom surgical resection is an alternative strategy presents challenges. Case presentation We provide a case managed through video-assisted thoracoscopic surgery (VATS) resection using three-dimensional computed tomography lung reconstruction (3D-CTLR) to reconstruct lobes containing pulmonary nodules to preoperatively simulate and intraoperatively guide the extent and method of resection. Conclusion The successful attempt demonstrates a technically simplified, feasible alternative to preoperative plans utilizing less invasive VATS to manage SMPLC.

scholarly journals Surgically Relevant Bony Anatomical Variations in Paraclinoid Aneurysms-Three-Dimensional Multi-Detector Row Computed Tomography-Based Study

2017 ◽  
Vol 08 (03) ◽  
pp. 330-334 ◽  
Author(s):  
K. Suprasanna ◽  
Ashvini Kumar
Keyword(s):  
Computed Tomography ◽  
Cerebral Angiography ◽  
Three Dimensional ◽  
Anatomical Variations ◽  
Type I ◽  
Anterior Clinoid Process ◽  
Multiplanar Reconstructions ◽  
Paraclinoid Aneurysm ◽  
Paraclinoid Aneurysms ◽  
Caroticoclinoid Foramen

ABSTRACT Objective: To evaluate the proportion of surgically relevant anatomical variations such as caroticoclinoid foramen, interclinoid osseous bridge, and anterior clinoid pneumatization in patients with paraclinoid aneurysms based on computed tomography (CT) cerebral angiography studies. Materials and Methods: Fifty-four CT cerebral angiography studies showing paraclinoid aneurysms involving the cavernous, clinoid, and supraclinoid internal carotid artery (ICA) were retrospectively evaluated. Source images were processed for three-dimensional reconstructions to evaluate the presence and type of caroticoclinoid foramen, interclinoid osseous bridge, and multiplanar reconstructions with bone algorithm to study the type of pneumatization. Results: The study included 30 female and 24 male patients with mean age of 45.61 (10.47) years. Among the 108 sides studied in 54 patients, caroticoclinoid foramen was seen in 24 cases (22.22%), interclinoid osseous bridge was seen unilaterally in 1 case (0.9%), and pneumatization of anterior clinoid process occurred in 12 cases (11.11%). Incomplete caroticoclinoid foramen (11 cases) and Type I pneumatization (7 cases) were seen to be predominant subtypes. There was no statistically significant gender difference in the occurrence of caroticoclinoid foramen and anterior clinoid pneumatization. Seventy-four aneurysms were detected in 54 patients. Based on their location, 46 aneurysms involved supraclinoid ICA, 18 aneurysms in the clinoid segment, and 10 aneurysms in the cavernous segment. Caroticoclinoid foramen was most prevalent in clinoid aneurysms with 12 cases occurring in the clinoid segment. Conclusion: Notable proportions of caroticoclinoid foramen and pneumatization occur in cases of paraclinoid aneurysm. Radiological reports should emphasize on these surgically relevant bony anatomical variations.

scholarly journals Application of 3D Computed Tomography Reconstruction Images to Assess the Thickness and Dimensions of the Posterior Palatal Seal Area

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Soeun Lim ◽  
Seoung-Jin Hong ◽  
Joo-Young Ohe ◽  
Janghyun Paek
Keyword(s):  
Computed Tomography ◽  
3D Model ◽  
Three Dimensional ◽  
Ct Images ◽  
Anterior Border ◽  
Lateral Direction ◽  
Mean Dimension ◽  
The Mean ◽  
The Right ◽  
Palatal Mucosa

Few studies have been reported on the scientific measurements of the thickness and dimensions of the posterior palatal seal (PPS) area. The purpose of this study is to measure and analyze the thickness of palatal mucosa by using a three-dimensional (3D) model reconstructed with computed tomography (CT) images and to present objective values by identifying the PPS area. The CT images were reconstructed as a 3D model by separating the maxillary palate mucosa and teeth. Each reconstructed model was analyzed and the thickness was measured at 93 crossing points of each divided plane. The dimension of the PPS area was measured and the right and left dimensions of the PPS area were compared. The thickness of the palatal mucosa was thicker toward the posterior area. The thickness increased in the lateral direction and decreased again. In the PPS area, the mean dimension between the rearmost of anterior border and the most posterior line was 2.19 mm and the mean dimension between the forefront of anterior border and the most posterior line was 5.19 mm in the right side and 5.16 mm in the left side. The mean dimension from the center of the palate to the right most forward point was 6.85 mm, and the left was 7.36 mm. The new measurement method of palatal mucosal thickness is noninvasive, accurate, and easy to store and study, so it can be used effectively in planning and manufacturing the maxillary complete denture in the digital workflows.

scholarly journals Three-dimensional visualisation of the internal anatomy of the sparrowhawk (Accipiter nisus) forelimb using contrast-enhanced micro-computed tomography

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3039 ◽  
Author(s):  
Fernanda Bribiesca-Contreras ◽  
William I. Sellers
Keyword(s):  
Computed Tomography ◽  
3D Model ◽  
Three Dimensional ◽  
Biomechanical Analysis ◽  
X Ray ◽  
Accipiter Nisus ◽  
Contrast Enhanced ◽  
Muscle Geometry ◽  
The Individual ◽  
Non Destructive

BackgroundGross dissection is a widespread method for studying animal anatomy, despite being highly destructive and time-consuming. X-ray computed tomography (CT) has been shown to be a non-destructive alternative for studying anatomical structures. However, in the past it has been limited to only being able to visualise mineralised tissues. In recent years, morphologists have started to use traditional X-ray contrast agents to allow the visualisation of soft tissue elements in the CT context. The aim of this project is to assess the ability of contrast-enhanced micro-CT (μCT) to construct a three-dimensional (3D) model of the musculoskeletal system of the bird wing and to quantify muscle geometry and any systematic changes due to shrinkage. We expect that this reconstruction can be used as an anatomical guide to the sparrowhawk wing musculature and form the basis of further biomechanical analysis of flight.MethodsA 3% iodine-buffered formalin solution with a 25-day staining period was used to visualise the wing myology of the sparrowhawk (Accipiter nisus). μCT scans of the wing were taken over the staining period until full penetration of the forelimb musculature by iodine was reached. A 3D model was reconstructed by manually segmenting out the individual elements of the avian wing using 3D visualisation software.ResultsDifferent patterns of contrast were observed over the duration of the staining treatment with the best results occurring after 25 days of staining. Staining made it possible to visualise and identify different elements of the soft tissue of the wing. Finally, a 3D reconstruction of the musculoskeletal system of the sparrowhawk wing is presented and numerical data of muscle geometry is compared to values obtained by dissection.DiscussionContrast-enhanced μCT allows the visualisation and identification of the wing myology of birds, including the smaller muscles in the hand, and provides a non-destructive way for quantifying muscle volume with an accuracy of 96.2%. By combining contrast-enhanced μCT with 3D visualisation techniques, it is possible to study the individual muscles of the forelimb in their original position and 3D design, which can be the basis of further biomechanical analysis. Because the stain can be washed out post analysis, this technique provides a means of obtaining quantitative muscle data from museum specimens non-destructively.

scholarly journals Anatomical variations of intra-sphenoid sinus septations in a sample of Kashmiri population: a non-contrast computed tomography study

2019 ◽  
Vol 7 (5) ◽  
pp. 1445
Author(s):  
Abdul Haseeb Wani ◽  
Yassar Shiekh ◽  
Arshed Hussain Parry ◽  
Zahid Qayoom
Keyword(s):  
Computed Tomography ◽  
Skull Base ◽  
Sphenoid Sinus ◽  
Anatomical Variations ◽  
Carotid Canal ◽  
Preoperative Ct ◽  
Kashmiri Population ◽  
Glandular Structures ◽  
The Right ◽  
Age Range

Background: The sphenoid sinus shows multitude of variations in pneumatization, size and pattern of septations leading to differences in its segmentation. Pre-operative knowledge of their attachment especially to posterolateral bony walls covering vital structures is of utmost importance for a safe trans-sphenoidal approach for various surgical procedures involving skull base. Non-contrast computed tomography (NCCT) with its ability to provide multiplanar reformations (MPR) with sharp algorithms is now a reference standard for visualization of these intra-sphenoid sinus septations preoperatively. The objective of this study was to determine the number and attachment of intra-sphenoid sinus septations in a Kashmiri population sample.Methods: NCCT head images of 591 patients in the age range of 16 to 75 years were analyzed retrospectively. Individuals with age less than 16 years, previous surgery involving skull base/sphenoid sinus, trauma causing hem sinus/fractures around skull base or having space occupying lesions around skull base/sphenoid sinus were excluded from the study. On the CT workstation multi-planar coronal, sagittal and axial reconstructions were performed and subsequently examined.Results: The age range was 16 to 75 years with mean age of 43.56 years of which 453 (76.6%) were males and 138 (23.4%) were females. Single intra-sphenoid septation was the most common anatomic variant in present study (79.7%) being complete in 71.7% and partial or incomplete in 8% of the examined subjects. Double septa were found in 11% inpresent study and more than 2 septae in 3.4%. After sellar attachment (51%) the next most common site of attachment was to the carotid canal (29.5%) (23% to left ICA and 6.5% to the right ICA).Conclusions: Intricate knowledge about sphenoid sinus, its pneumatization and anatomical variations in intra-sphenoid sinus septations and its relationship with the surrounding vital structures is of utmost importance before performing any endoscopic/open surgery involving skull base via trans-sphenoidal approach. The present study shows that a significant percentage of septal attachment to the carotid canal makes main sphenoidal septum as not so reliable landmark for endoscopic procedures as used to be in the pre-imaging era. Thus, preoperative CT is mandatory to avoid injuries to para-sellar neurovascular and glandular structures.

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