Elsevier

JTCVS Techniques

Volume 16, December 2022, Pages 132-138
JTCVS Techniques

Thoracic: Lung Cancer
The intersegmental pulmonary vein is not always located on the intersegmental plane of the lung: Evaluation with 3-dimensional volume-rendering image reconstruction

https://doi.org/10.1016/j.xjtc.2022.09.002Get rights and content
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open access

Abstract

Objective

To clarify whether intersegmental pulmonary veins are always located on the intersegmental plane and determine the division from which blood flows into them.

Methods

We analyzed representative intersegmental veins located between the upper/lingular and superior/basal division of the lungs using preoperative chest computed tomography (CT) DICOM data from 22 patients who underwent lobectomy or segmentectomy during 2020. The location and blood flow of V3a+b and V6b+c were assessed using REVORAS (Ziosoft), a novel volume-rendering 3-dimensional (3D) image reconstruction software dedicated to lung segmentectomy.

Results

The V3a+b was in the upper division and on the intersegmental plane between the upper and lingular divisions of the left lung in 11 patients (50%) each. A main root of V3a+b was not found in the lingular division, but some peripheral flow in the V3a+b was derived from it in 14 patients (64%). The V6b+c was found in the superior division of the right lower lobe in 13 patients (59%) and the left lower lobe in 10 patients (45%), and on the intersegmental plane between the superior and basal division of the right lower lobe in 6 patients (27%) and the left lower lobe in 10 patients (45%). A main root of V6b+c was imperceptible in the basal division. Some peripheral blood flow was derived from the basal division in 6 patients (27%) with V6b+c veins located in the right lower lobe and in 8 patients (36%) with V6b+c veins located in the left lower lobe.

Conclusions

Precise evaluation of intersegmental veins using preoperative volume-rendering 3D reconstructed CT images provides useful anatomic information for separating intersegmental pulmonary parenchyma.

Key Words

intersegmental pulmonary vein
segmentectomy
blood flow
reconstruction

Abbreviations and Acronyms

3D
three-dimensional
CT
computed tomography
HU
Hounsfield unit

Cited by (0)

This study was supported by grants from the Japan Society for the Promotion of Science, Japan (KAKENHI 20K09177).