Three-dimensional Computed Tomography Angiography Research Articles

The rupture risk of intracranial saccular aneurysm: a case-control study based on a three-dimensional computed tomography angiography model.

Assessing the risk of rupture in intracranial aneurysms is crucial. Advancements in medical imaging now allow for three-dimensional (3D) assessments of aneurysms, providing a more detailed understanding of their morphology and associated risks. This study aimed to compare the 3D morphological parameters of ruptured and unruptured intracranial saccular aneurysms (ISAs) using computed tomography angiography (CTA) and to analyze risk factors linked to ISA rupture. This retrospective case-control study included patients diagnosed with ISAs via CTA, for which data were sourced from both the Emergency Department and Inpatient Unit in The First Affiliated Hospital of Jinan University. The patients were categorized into rupture and unrupture groups. We used 3D-Slicer (version 5.2.2, Slicer Community) to construct morphological models of the ISAs and their parent arteries. These models facilitated assessments of intracranial aneurysmal volume (IAV), aneurysmal surface area (ASA), and maximum sectional area (MSA). Differences in 3D morphological parameters between ruptured and unruptured ISAs were then analyzed. For statistical analysis, we first performed single factor analysis on the data, constructed a receiver operating characteristic (ROC) curve one by one with statistically significant parameters, and screened out ROC curves that met the sample requirements. Second, we performed multiparameter logistic regression analysis to construct a ROC curve model and analyzed its predictive performance. The analysis encompassed 97 patients comprising 97 ISAs diagnosed from March 2016 to March 2022. Significant differences in morphological parameters were observed between the rupture and unrupture groups (P<0.05), including IAV, ASA, MSA, IAV/diameter (IAV/D), IAV/neck width (IAV/N), MSA/diameter (MSA/D), MSA/neck width (MSA/N), ASA/neck width (ASA/N), and ASA/MSA. It was found that the IAV, ASA, and MSA values of the rupture group were larger than those of the unrupture group. Meanwhile, the IAV/D, IAV/N, MSA/D, MSA/N, and ASA/N values were larger in the rupture group, while ASA/MSA and ASA/IAV were smaller. This study underscores the significance of specific morphological indicators, such as ASA/N and ASA/MSA, in predicting the rupture risk of ISAs. The IAV, MSA, and ASA parameters, especially in relation to diameter and neck width, provide crucial insights into the rupture potential of ISAs.

Influence of Perioperative Three-Dimensional Computed Tomography (CT) Angiography and Surgical Clipping for Unruptured Cerebral Aneurysms on Renal Function in Patients with Chronic Kidney Disease

BackgroundSurgical clipping is a valuable treatment option for unruptured intracranial aneurysms in patients with chronic kidney disease (CKD). However, the comprehensive impact of clipping and perioperative three-dimensional computed tomography angiography (3D-CTA) on renal function remains unclear. This study aimed to evaluate the effects of perioperative 3D-CTA and surgical clipping on renal function in patients with CKD. MethodsWe retrospectively analyzed 529 patients who underwent surgical clipping and perioperative 3D-CTA. An estimated glomerular filtration rate (eGFR) < 60 was defined as CKD. Patients were stratified according to their renal function (group 1: eGFR ≥ 60, group 2: 45 ≤ eGFR < 60, group 3: 30 ≤ eGFR < 45, group 4: eGFR < 30 ml/min/1.73 m2), and eGFR was assessed preoperatively and 1 week and several months postoperatively. ResultsOf the 529 patients, 442 did not have CKD and 87 had CKD. Hypertension, hyperlipidemia and hyperuricemia were significantly more common in those with CKD. After the surgery and perioperative series of 3D-CTA, renal function deterioration was not observed in any group, whether in the acute or chronic postoperative period. Notably, eGFR significantly increased in groups 2 (66.7 ± 10.1, p<0.01) and 3 (48.9 ± 9.2, p=0.02) 1 week postoperatively, despite the CKD. ConclusionsSurgical clipping of unruptured intracranial aneurysms and perioperative 3D-CTA with normal-dose contrast media did not impair renal function in patients with CKD. These results could be valuable in determining treatment strategies for those with CKD and intracranial aneurysms.

A novel predictor of ischemic complications in the treatment of ruptured middle cerebral artery aneurysms: Neck-branching angle

ObjectiveThe risk factors of procedural cerebral ischemia (CI) in ruptured middle cerebral artery (MCA) aneurysms are unclear. This study proposed the neck-branching angle (NBA), a simple quantitative indicator of the aneurysm neck and branch vessels, and analyzed its usefulness as a predictor of procedural CI in ruptured MCA aneurysms. MethodsWe retrospectively analyzed 128 patients with ruptured saccular MCA aneurysms who underwent surgical or endovascular treatment between January 2014 and June 2021. We defined the NBA as the angle formed by the MCA aneurysm neck and M2 superior or inferior branch vessel line. The superior and inferior NBA were measured on admission via three-dimensional computed tomography angiography on admission. We divided the patients into clipping (106 patients) and coiling (22 patients) groups according to the treatment. Risk factors associated with procedural CI were analyzed in each group. ResultsBoth groups showed that an enlarged superior NBA was a significant risk factor for procedural CI (clipping, P < 0.0005; coiling group, P = 0.007). The receiver operating characteristic curve showed the closed thresholds of the superior NBA with procedural CI in both groups (clipping group, 128.5°, sensitivity and specificity of 0.667 and 0.848, respectively; coiling group, 130.9°, sensitivity and specificity of 1 and 0.889, respectively). ConclusionThe NBA can estimate the procedural risk of ruptured MCA aneurysms. In addition, an enlarged superior NBA is a risk factor for procedural CI in both clipping and coiling techniques.

Assessing anatomical variations of the inferior mesenteric artery via three-dimensional CT angiography and laparoscopic colorectal surgery: a retrospective observational study

To assess the anatomy of the inferior mesenteric artery (IMA) and its branches by reviewing laparoscopic left-sided colorectal cancer surgery videos and comparing them with preoperative three-dimensional computed tomography (3D-CT) angiography, to verify the accuracy of 3D-CT vascular reconstruction techniques. High-definition surgical videos and preoperative imaging data of 200 patients who underwent laparoscopic left-sided colorectal cancer surgery were analysed, and the alignment of the IMA and its branches in relation to the inferior mesenteric vein (IMV) was observed and summarized. The above two methods were used to measure the length of the IMA and its branches. Of 200 patients, 47.0% had the sigmoid arteries (SAs) arise from the common trunk with the superior rectal artery (SRA), and 30.5% had the SAs arise from the common trunk with the left colic artery (LCA). In 3.5% of patients, the SAs arising from both the LCA and SRA. The LCA, SA, and SRA emanated from the same point in 13.5% of patients, and the LCA was absent in 5.5% of patients. The range of D cm (IMA length measured by intraoperative silk thread) and d cm (IMA length measured by 3D-CT vascular reconstruction) in all cases was 1.84–6.62 cm and 1.85–6.52 cm, respectively, and there was a significant difference between them. (p < 0.001). The lengths between the intersection of the LCA and IMV measured intraoperatively were 0.64–4.29 cm, 0.87–4.35 cm, 1.32–4.28 cm and 1.65–3.69 cm in types 1A, 1B, 1C, and 2, respectively, and there was no significant difference between the groups (p = 0.994). There was only a significant difference in the length of the IMA between the 3D-CT vascular reconstruction and intraoperative observation data, which can provide guidance to surgeons in preoperative preparation.

Safe suprapancreatic lymph node dissection for gastric cancer with ectopic common hepatic artery.

Suprapancreatic lymph node dissection for patients with gastric cancer in whom the common hepatic artery is located neither at the suprapancreatic margin nor in front of the portal vein is a more difficult procedure than when the common hepatic artery is in a more typical position. There is an increased risk of injury to the vessels that need to be preserved and inadequate lymph node dissection. Measures that have been reported for use in this situation are preoperative diagnosis with three-dimensional computed tomography angiography, dissection using the portal vain as a guide, and safe exposure of the portal vein with dissection to preserve the nerves at the suprapancreatic margin and in front of the portal vein. We review the literature and report our experience with a patient whose common hepatic artery was not located in the suprapancreatic margin who safely underwent suprapancreatic lymph node dissection using these methods.

To Draw a Detailed Map for Maxillofacial Fast-Flow Vascular Diseases With the Combination of Color Doppler Ultrasound and Three-Dimensional Computed Tomography Angiography.

Vascular diseases, such as vascular malformations and hemangiomas, are often classified into "fast-flow" and "slow-flow" based on their internal blood velocity. Fast-flow vascular diseases of maxillofacial regions are a kind of complicated and dangerous pathological changes originating from or containing arteries, their treatment is often complex and different from disease to disease, and large amounts of intraoperative blood loss and poor operation field may cause side injury or other problems without a detailed map of the lesion. The authors use the combination of color Doppler ultrasound and three-dimensional computed tomography angiography to diagnose and classify 36 cases of maxillofacial fast-flow vascular diseases, from January 2018 to December 2022 presented in the authors' department. Three-dimensional computed tomography angiography can display the location, type, and blood supply of lesions, whereas color Doppler ultrasound has unique advantages in identifying some special lesions (such as the colorful images of orificium fistulaes and the "Yin-yang sign" of pseudoaneurysms), then projecting and marking them on the body surface, which greatly facilitate the surgical procedure. This cost-effective and noninvasive combination shows significant clinical application value.

Preoperative Evaluation for Carotid Endarterectomy Using CT and MRI Fusion Images Without Contrast Media.

The usefulness of carotid endarterectomy (CEA) for carotid artery stenosis has been established even in the era of endovascular treatment. Digital subtraction angiography (DSA) and three-dimensional computed tomography angiography (3D-CTA) are used for preoperative evaluation of CEA; however, contrast agents cannot be used in patients with renal dysfunction or contrast agent allergy. Since the introduction of a three-dimensional image analysis software, SYNAPSE VINCENT (Fujifilm, Tokyo, Japan) in February 2016, we initially fused cervical CT, carotid three-dimensional time-of-flight magnetic resonance angiography, and carotid plaque imaging using 1.5 T magnetic resonance imaging to evaluate carotid artery stenosis in patients with renal dysfunction. Since then, we have gradually accumulated several cases, and at present, this fusion imaging is our first choice for preoperative evaluation of CEA instead of DSA or 3D-CTA. This evaluation method has many advantages over DSA and 3D-CTA, including the fact that it does not require contrast media. We report its usefulness, limitations, and cautions.

Anatomical and Three-Dimensional Study of the Female Feline Abdominal and Pelvic Vascular System Using Dissections, Computed Tomography Angiography and Magnetic Resonance Angiography.

This study describes the anatomical characteristics of the abdominal and pelvic vascular system of two healthy mature female cats via three-dimensional contrast enhanced computed tomography angiography, non-contrast enhanced magnetic resonance angiography and three-dimensional printing. Volume-rendering computed tomography angiography images were acquired from the ventral aspect using RadiAnt, Amira and OsiriX MD Dicom three-dimensional formats, and three-dimensional printing was obtained and compared with the corresponding computed tomography angiography images. Non-contrast enhanced magnetic resonance angiography was made using the time-of-flight imaging in ventral, oblique and lateral views. In addition, three cadavers with colored latex injection were dissected to facilitate the identification of the vascular structures. Three-dimensional computed tomography angiography showed the main vascular structures, whereas with the time-of-flight blood appeared with a high signal intensity compared with associated abdominal and pelvic tissues. Three-dimensional computed tomography angiography images and time-of-flight sequences provided adequate anatomical details of the main arteries and veins that could be used for future feline anatomical and clinical vascular studies of the abdomen and pelvis.

Iliac vein variation in the sacral promontory on three-dimensional computed tomography angiography: a prospective observational study before laparoscopic sacrocolpopexy

Introduction and HypothesisVenous injury may occur during exposure of the anterior longitudinal ligament at the anterior sacral promontory (SP). We aimed to quantitatively measure the extent of the vascular window (VW) in front of the SP in patients with internal iliac vein (IIV) variations using preoperative three-dimensional computed tomography angiography (3DCTA). We hypothesized that patients with IIV variations would have a narrow VW.MethodsThis prospective observational study included patients scheduled for laparoscopic sacrocolpopexy (LSC) between July 2022 and April 2023 who underwent preoperative 3DCTA. The primary endpoint was the VW measurement in the standard and variant IIV groups using 3DCTA before LSC. The secondary endpoint was the difference between the two IIV groups adjusted for age, body mass index, hypertension, and diabetes using an analysis of covariance (ANCOVA) model. Multiple regression analysis was performed to analyze the effect of factors on the distance from the SP to great vascular bifurcations.ResultsThere were 20 cases of IIV variation (20.2%). VW was 28.8 ± 12.4 mm in the variant group and 39.6 ± 12.6 mm in the standard group (p = 0.001). In the ANCOVA model, IIV variations affected VW (coefficient, –11.8; 95% confidence interval [CI], –18.4 to –5.08, p < 0.001). Multivariate analysis revealed that the aorta–SP distance decreased with age (coefficient, −0.44; 95% CI, −0.77 to −0.11, p = 0.009).ConclusionsOne in five women has a vascular variant at the SP that restricts the “safe” zone of fixation to < 3 cm.

Initial Treatment of Subarachnoid Hemorrhage

The re-rupture of a subarachnoid hemorrhage(SAH)due to a ruptured cerebral aneurysm is a poor prognostic factor, and initial treatment to prevent re-rupture is important in the acute phase of SAH. Prevention of re-rupture is performed by reducing blood pressure, by sedation, and by analgesia until the patient undergoes radical surgery. It is recommended that the systolic blood pressure be lowered to below 120-140 mmHg. When SAH is suspected, a head CT scan should be obtained after the initial treatment. If the SAH is not clearly visible on CT but is strongly suspected, MRI should be performed. Once a SAH is diagnosed, three-dimensional CT angiography should be performed to search for cerebral aneurysms. SAHs may also cause breathing and circulation problems due to neurogenic pulmonary edema and Takotsubo cardiomyopathy. Clipping is more curative than coil embolization, but coil embolization has been shown to have better long-term survival and independence rates than clipping for aneurysms that can be treated with either technique. Ideally, ruptured cerebral aneurysms should be treated at institutions that offer both clipping and coil embolization, and the choice of treatment should be based on a comprehensive assessment of the patient's age; the severity, location, size and shape of the aneurysm; the clipping and coil embolization techniques of the treating physician; and the wishes of the patient and family.

Simulation of the occipital transtentorial approach incorporating visualization of the cerebellar tentorium using three-dimensional computed tomography angiography and gadolinium-enhanced T1-weighted magnetic resonance imaging: technical note

The occipital transtentorial approach (OTA) is one of the useful approaches to the lesions of the pineal region, dorsal brainstem, and supracerebellar region. However, a wide operative field is sometimes difficult to obtain due to the tentorial sinus and bridging veins. This study evaluated the usefulness of preoperative simulation of OTA, specifically including the cerebellar tentorium in 9 patients. All patients underwent computed tomography angiography and venography and gadolinium-enhanced three-dimensional T1-weighted magnetic resonance images (Gd-3D-T1WI). The images were fused, and the cerebellar tentorium, vessels, and tumor were manually extracted from Gd-3D-T1WI to obtain the simulation images. Visualization of the cerebellar tentorium could discriminate between bridging veins from the occipital lobe and cerebellum, and recognize the site of bridging to the tentorial sinus and variants which may interfere with the tentorial incision. Simulation of the tentorial incision was also possible based on the relationships between the tumor, tentorial sinus, bridging vein, and cerebellar tentorium. The simulation suggested that safe tentorial incision was difficult in two sides because of the crossed tentorial sinus draining the left basal vein and draining veins from the glioblastoma. The OTA was performed in eight cases, and no difficulty was experienced in the tentorial incision in all cases. The simulation findings of the bridging vein and tentorial sinus were consistent with the intraoperative findings. Preoperative simulation including the cerebellar tentorium is useful for determining the optimum and safe side and required extent of the tentorial incision necessary for tumor resection with the OTA.

Optimizing contrast protocol for bone-subtraction CT angiography of intracranial arteries in normal dogs using 160-slice CT.

Bone-subtraction computed tomography angiography (CTA) (BSCTA) is a new technique designed to overcome the limitation of three-dimensional CTA, where the vessels surrounded by bone and calcification can be obscured. An optimal contrast CT protocol for intracranial artery visualization with BSCTA has yet to be established in dogs. The purpose of this study was to determine the optimal contrast protocol of CTA for visualizing intracranial artery using an automatic bone-subtraction technique in dogs. Brain CTA was performed four times for each of nine healthy beagle dogs to cover all the contrast protocols: two different contrast iodine concentrations (300 and 370mgI/mL) and two different contrast media injection rates (2 and 4mL/s). Bone removal post-processing was performed automatically by subtracting the non-enhanced CT data from the contrast CT data using a dedicated workstation. The bone-subtracted intracranial vessels were analysed for quantitative and qualitative evaluation. Quantitative evaluation showed significantly higher CT attenuation values for the group with a 370mgI/mL iodine content at a rate of 4mL/s than the two groups with a 300mgI/mL iodine content at the rates of 2 and 4mL/s (p<0.001). Qualitative assessment revealed significantly higher mean scores for the 370mgI/mL groups than the 300mgI/mL groups and significantly higher mean scores for the 4mL/s groups than the 2mL/s groups (p<0.05). The optimal contrast protocol for BSCTA suggests that high iodine material concentration and high injection rate should be used for strong arterial attenuation and great visualization of the intracranial arterial structure in dogs.

Navigation of femoral and popliteal artery around the knee with CT angiography: implications for surgical interventions.

Uncertainty about the exact position of the femoral and popliteal arteries in the medial thigh and posterior knee might increase vascular complications in surgical procedures. This study aimed to document femoral and popliteal arteries in the medial thigh and around the knee to assist surgeons in developing safer surgical approaches. The study included 120 patients-180 lower limbs-who underwent CT angiography (CTA) of the lower extremity. The distance from the femoral artery to the anterior border, midsagittal axis, and posterior border of the femur and the popliteal artery to the medial, lateral, and midpoint posterior cortex of the proximal tibia was measured in two- and three-dimensional CTA images. The femoral artery was found to be on average 236.93 ± 29.61mm, 195.34 ± 26.12mm, and 146.28 ± 33.18mm away from the adductor tubercle at the anterior, midsagittal axis, and posterior borders of the femur, correspondingly. The popliteal artery was to be located on average 5.40 ± 2.50 mm posterior to the midpoint of the plateau tibia at the joint line. Considering the mentioned femoral/popliteal artery distances to the femur and proximal tibia would direct surgeons to the safe zones for more accurate surgical approaches in the medial thigh and around the knee when performing osteotomies, knee arthroplasty, arthroscopy, and trauma surgeries, to reduce possible vascular damages. IV.

Double inferior vena cava, an uncommon but relevant anatomical anomaly in surgery for lower rectal cancer: a report of two cases

BackgroundDouble inferior vena cava (DIVC) is rare and usually detected incidentally. DIVC may be associated with several anatomical variants of the retroperitoneal and pelvic veins. These variants can pose a clinical problem during colorectal surgery. We present two patients with lower rectal cancer who also had a DIVC.Case presentationCase 1 was a 72-year-old man with advanced lower rectal cancer (T3N0M0) who underwent robot-assisted low anterior resection after neoadjuvant therapy. A DIVC was detected on preoperative computed tomography (CT). During the operation, a presacral vein was injured while mobilizing the rectum and hemostasis could not be achieved. We converted to open surgery and packed the pelvic cavity for hemostasis. Retrospective analysis suggested the injured vein arose from an interiliac vein of the presacral pelvic venous plexus. Case 2 was a 50-year-old woman with lower rectal cancer (T3N0M0), immune thrombocytopenic purpura, and a DIVC. Although preoperative three-dimensional CT angiography showed no obvious pelvic vein abnormalities, a short course of preoperative radiotherapy was delivered to avoid lateral pelvic lymph node dissection. Chemotherapy was deferred owing to her thrombocytopenic disease. Laparoscopic abdominoperineal resection was performed meticulously to minimize bleeding and achieve rapid hemostasis. No intraoperative complications occurred.ConclusionDIVC is often accompanied by venous malformations that may pose a problem when mobilizing the mesorectum from the retroperitoneum. Preoperative assessment of pelvic vessel anatomy using three-dimensional CT is essential in patients with a DIVC who undergo rectal surgery.

Revisited Surgical Anatomy of the Left Colonic Angle for Tailored Carcinologic Colectomy: A Review.

Although several types of surgical procedure have been advocated to date, the optimal resection of the left colonic angle in cancer treatment remains controversial. Located at the border of the transverse and descending colons, the anatomy of the left colonic angle is complex and characterized by numerous anatomic variations. Recent advances in preoperative (three-dimensional CT angiography with colonography) and/or intraoperative (indocyanine green staining) imaging have allowed for a better identification of these variations. We performed a methodological review of studies assessing the anatomical variations of the left colic artery. While the left colonic angle is classically vascularized by branches of the superior and inferior mesenteric arteries, an accessory middle colonic artery has been identified from 6 % to 36% of cases, respectively, leading to their classification of five types. In the absence of a left colic artery, this artery becomes predominant. In parallel to the variations in the venous drainage of the left colonic angle, which has been classified into four types, new lymphatic drainage routes have also been identified via this accessory artery and the inferior mesenteric vein. Collectively, these newly obtained findings plead for preoperative identification in cases of cancer of the left colonic angle and a surgical strategy adapted to these anatomical variations.

Robot-assisted thoracoscopic right upper lobectomy with displaced B3 and absence of minor fissure: a case report.

B3 downward-shifting is a rare bronchial anomaly characterized by abnormal pulmonary arteries associated with downward displacement of B3 and complete fusion between the right upper and middle lobes. We report a case of robot-assisted thoracoscopic right upper lobectomy in a patient with lung cancer with B3 downward-shifting. An 81-year-old male was diagnosed with non-small cell lung cancer in S3 of the right upper lung. Preoperative three-dimensional computed tomography angiography revealed a B3 bronchus derived from the middle lobe bronchus and an anterior segmental pulmonary artery variation. Robot-assisted thoracoscopic surgery right upper lobectomy with ND2a-1 was performed via four-port incisions and an assist incision. No interlobar fissure was observed between the right upper and middle lobes. After dissecting B1+2, the displaced B3 root was dissected. The displaced A3a was difficult to dissect because of an extremely severe complete fissure. Therefore, we dissected the bronchus preceding from the cranial side. To confirm a minor fissure, indocyanine green was administered intravenously, and the interlobar boundary was identified as the line separating the dark and green lung parenchyma. The boundary was divided using mechanical staples. No surgical complications occurred. Using three-dimensional reconstruction imaging and systemic indocyanine green administration, we successfully performed a right upper lobectomy through robot-assisted thoracic surgery.

Drainage pattern of the splenic flexure vein and its accompanying arteries using three-dimensional computed tomography angiography: a single-centre study of 600 patients.

The splenic flexure has variable vascular anatomy, and the details of the venous forms are not known. In this study, we report the flow pattern of the splenic flexure vein (SFV) and the positional relationship between the SFV and arteries such as the accessory middle colic artery (AMCA). This was a single-centre study using preoperative enhanced CT colonography images of 600 colorectal surgery patients. CT images were reconstructed into 3D angiography. SFV was defined as a vein flowing centrally from the marginal vein of the splenic flexure visible on CT. AMCA was defined as the artery feeding the left side of the transverse colon, separate from the left branch of the middle colic artery. The SFV returned to the inferior mesenteric vein (IMV) in 494 cases (82.3%), the superior mesenteric vein in 51 cases (8.5%) and the splenic vein in seven cases (1.2%). The AMCA was present in 244 cases (40.7%). The AMCA branched from the superior mesenteric artery or its branches in 227 cases (93.0% of cases with existing AMCA). In the 552 cases in which the SFV returned to the IMV, superior mesenteric vein or splenic vein, the left colic artery was the most frequent artery accompanying the SFV (42.2%), followed by the AMCA (38.1%) and the left branch of the middle colic artery (14.3%). The most common flow pattern of the vein in the splenic flexure is from the SFV to IMV. The SFV is frequently accompanied by the left colic artery or AMCA.

An analysis of the left top pulmonary vein and comparison with the right top pulmonary vein for lung resection by three-dimensional CT angiography and thin-section images

PurposeThe right top pulmonary vein (RTPV) is defined as an anomalous branch of the right superior PV (SPV) draining into the PV or left atrium (LA). Several previous reports have described the RTPV, but only a few have mentioned the left top PV (LTPV). The present study aimed to evaluate the branching patterns of the RTPV and LTPV using thin-section CT images and three-dimensional CT angiography (3D-CTA).Materials and methodsThis study included 1437 consecutive patients for evaluation of the right side and 1454 consecutive patients for the left side who were suspected of lung cancer and underwent CTA. We assessed the presence of each RTPV and LTPV and their branching patterns on the CTA images. When the RTPV or LTPV was identified, the maximum short-axis diameter was measured.ResultsRTPV was found in 9.1% (131/1437), whereas LTPV was found in 2.9% (42/1454) of the patients. RTPV was also observed in 17.1% (7/41) of LTPV cases, except for one case in which the right side could not be evaluated. The most common RTPV inflow site was the right inferior PV (IPV) in 64.9% (85/131) of the patients, whereas that of the LTPV was the left IPV in 100.0% (42/42) of the patients. The mean diameter of the RTPV and LTPV was 3.3 mm (range, 1.3–7.5 mm) and 2.4 mm (range, 0.9–6.3 mm), respectively (P < 0.01).ConclusionThe top PV branching pattern variations can be evaluated using thin-section CT and 3D-CTA images. RTPV is not a rare finding, and LTPV should also be identified in lung cancer cases scheduled for resection.

Displaced bronchus and anomalous pulmonary vein passing dorsal to the pulmonary artery in a patient who underwent right upper lobectomy for lung cancer with lymph node metastases: a case report

BackgroundTracheobronchial anomalies are extremely rare and are often associated with pulmonary arteriovenous anatomical anomalies. An anomalous right upper vein segment that passes between the pulmonary artery (PA) and bronchus is a rare vascular abnormality. We report a case of a displaced superior posterior branch (B2) that was independent of the superior apical/anterior branch (B1 + 3) accompanied by anomalous right superior pulmonary vein (SPV) anatomy in a patient who underwent right upper lobectomy for lung cancer with lymph node metastases.Case presentationA 73-year-old asymptomatic woman was shown to have an abnormal shadow on chest radiography performed during medical checkup and visited our hospital for further evaluation. The patient was diagnosed with primary lung adenocarcinoma (c-T1cN1M0, stage IIB) involving the right superior posterior segment (S2) with an abnormally displaced B2 and an anomalous upper vein segment that was observed to run dorsal to the PA and anterior to the right upper bronchus. We performed right upper lobectomy and systematic hilar and mediastinal nodal dissection via video-assisted thoracoscopic surgery. Intraoperative findings revealed a displaced B2 bronchus independent from the B1 + 3 and an anomalous SPV, which was consistent with preoperative imaging findings.ConclusionPreoperative bronchoscopy and three-dimensional computed tomography angiography (3D-CTA) are essential to confirm bronchial bifurcation and vascular abnormalities to aid with meticulous surgical planning to select the optimal operative technique.

Evaluation of the Usefulness of Variable-speed Injection Method in Neck to Lower-extremity Three-dimensional Computed Tomography Angiography

The purpose of this study was to investigate the contrast effect of arteries and the distribution of contrast medium along the z-axis in three-dimensional computed tomography angiography from neck to lower extremity (neck-lower-extremity 3D-CTA) using the F variable-speed injection method. The subjects were 112 patients who underwent neck-lower-extremity 3D-CTA. In the fixed-speed injection method, contrast medium was injected at the same rate for 35 s. In the variable-speed injection method, contrast medium was injected for 35 s at varying rates. CT values were measured in the common carotid artery (CCA), ascending aorta (AAo), abdominal aorta (AA), superficial femoral artery (SFA), popliteal artery (PA), anterior tibial artery (ATA), and dorsalis pedis artery (DPA). We normalized the CT values of each artery for each patient, defined the contrast uniformity, and compared them. We also performed a four-level visual evaluation. A significant difference was found in the PA, ATA, and DPA, with the variable-speed injection method showing a higher CT value than the fixed-speed injection method (p<0.01). There were no significant differences in the CCA, AAo, AA, and SFA. Similarly, the variable-speed injection method scored significantly higher in the visual evaluation. The variable-speed injection method is useful in neck-lower-extremity 3D-CTA.