Analysis of Pulmonary Artery Variation Based on 3D Reconstruction of CT Angiograph

doi:10.21203/rs.3.rs-2104022/v1

Download PDF

Research Article

Analysis of Pulmonary Artery Variation Based on 3D Reconstruction of CT Angiograph

https://doi.org/10.21203/rs.3.rs-2104022/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Objective

The purpose of this study is to obtain the pulmonary CT angiographic data for three-dimensional reconstruction, and to analyze the characteristics and variation of the branches of bilateral pulmonary lobes, so as to provide a more intuitive and stereoscopic reference for clinicians in preoperative evaluation and surgical planning. To provide more comprehensive data for clinical anatomy and anatomy teaching.

Method

From August 2016 to December 2018, 420 patients in the thoracic surgery department of the first hospital of Jilin University were selected for 64 channel contrast enhanced CT (Philip ICT 256) examination. Slice thickness is 1.5mm. The obtained DCM documents were analyzed by Mimics 22.0 Software for 3D reconstruction(For example the Fig. 1 and Fig. 2). After reconstruction, the three-dimensional pulmonary artery models were reviewed by chest surgeons and radiologists who were more than attending doctors. At the same time, the two-dimensional image plane, coronary and sagittal plane were used to evaluate the arteries. The characteristics and variations of branches and courses of pulmonary arteries in each lobe of both lungs were analyzed. The subsegmental arterial system was not evaluated.After reconstruction, the three-dimensional model of pulmonary artery was evaluated jointly by chest surgeons and radiologists, and the characteristics and variations of branches and courses of pulmonary artery in each lobe of both lungs were analyzed.

Results

There was a large degree of variation in the left superior pulmonary artery in 420 subjects. The blood supply of 4 arteries in the left upper lobe was 50.5% (n = 212), while that of 2 arteries in the left lower lobe was the most, accounting for 79.5% (n = 334). In the variation of right pulmonary artery, the greater variation of right upper lobe pulmonary artery is the branch supply of right upper lobe mediastinal artery, the majority of which are two arteries, accounting for 77.9% of the subjects. Two arteries were the most common, accounting for 64% (n = 269). There may be 2–4 arteries in the right inferior lobe of the lung, mainly 2 arteries, accounting for 79% (n = 332).

Conclusion

Three dimensional reconstruction of CT angiography of pulmonary artery can clearly observe the branches and distribution of pulmonary artery, and clarify the variation. It has important clinical value for the preoperative assessment of lesions and blood vessels, the formulation of operation plan and the operation of blood vessels during operation.

Pulmonary artery variation

three-dimensional reconstruction

In recent years, the incidence rate of lung cancer has increased rapidly.[1]It has seriously threatened the safety of people. For most of the lung tumors with low degree of malignancy, early detection and early operation can bring good recovery and survival time. For pulmonary surgery, the variation of pulmonary artery is a high risk factor of bleeding risk. Pulmonary artery rupture and hemorrhage are rapid and massive, which can lead to hemorrhagic shock, cardiac arrest, cerebral ischemia and even brain death.[2] Traditional open chest surgery has a wide field of vision and can be operated in a wide range. In case of pulmonary hemorrhage, hemostasis measures such as compression and vascular suture can be carried out quickly to reduce the probability of massive hemorrhage. However, in recent years, with the introduction and wide application of thoracoscopy, a series of studies have shown that thoracoscopic surgery has no significant difference or even better than traditional thoracotomy in the postoperative complications and survival period of early lung tumor. [3 4]Therefore, endoscopic surgery has been widely used in clinical practice. However, during thoracoscopic surgery, the connection between the thoracic cavity and the outside world is small, and the hemostasis related measures such as suture of blood vessels cannot be carried out in time in case of pulmonary artery rupture and hemorrhage. It is necessary to open the chest urgently, delay the rescue time, increase the amount of bleeding, and significantly increase the risk during the operation and the occurrence of postoperative complications. [5]Therefore, before the operation, the patient's pulmonary artery condition should be mastered, or he should have a good knowledge of pulmonary artery variation Knowledge has a significant effect on reducing the risk of pulmonary artery bleeding during operation .

In recent years, 3D reconstruction technology is one of the rapid development of computer technology.[6 7] Medical three-dimensional reconstruction technology is the application of three-dimensional reconstruction technology in the field of medicine. It refers to that people use CT, MRI and other scanning technology to obtain the continuous data of the body structure and store it in the computer, then recognize the image data through relevant software, process the image data, and build a virtual three-dimensional model of human organs. Compared with the two-dimensional image, the reconstructed three-dimensional reconstruction model has the advantages of three-dimensional, intuitive and easier to observe, and can well observe the characteristics and abnormalities of the relevant tissues of the body. CT has the characteristics of thin layer, fast scanning speed, low price and easy access to data. Angiographic technique is to inject contrast medium into the blood vessel so that the vessels can be better observed with different CT values from the surrounding tissues. Through the pulmonary CT angiography, the computer DCM image data are obtained, and the corresponding pulmonary artery model is reconstructed by inputting three-dimensional reconstruction software, which is more convenient and easy to obtain than the study of pulmonary artery anatomical dye perfusion. At the same time, the branch and course of pulmonary artery can be observed clearly, and the variation of pulmonary artery can be analyzed.

The purpose of this study is to obtain CT angiography data of the lung for three-dimensional reconstruction, analyze the characteristics and variation of the branches of bilateral pulmonary lobar arteries, improve the safety of clinicians' operation, and explore the application value of three-dimensional reconstruction technology in pulmonary vascular reconstruction.

The Department of thoracic surgery patients in No.1 Hospital of Jilin University from August 2016 to December 2018 was selected. This study passed the audit of the ethics committee of the first hospital of Jilin University, and the audit batch number was: 2019-069.

Inclusion criteria:

1) Age (≥ 18 years old), age (< 60 years old), sex is not limited.

2) Pulmonary CT angiography was performed in the Department of Radiology, First Hospital of Jilin University. No data were available.

3) There is no lesion or small lesion in both lungs, which does not affect the course of blood vessels.

4) Imaging data without history of thoracic trauma or operation;

4) The two-dimensional data of pulmonary CT angiography were well enhanced and the model was clear for three-dimensional reconstruction.

Exclusion criteria

1) The pulmonary CT angiographic data were incomplete.

2) Pulmonary CT angiography in the outpatient hospital.

3) The pulmonary lesions are larger or there are factors affecting the course of pulmonary artery.

4) Two-dimensional data of pulmonary CT angiography showed no obvious enhancement of arteries, and the model was not clear after three-dimensional reconstruction, which affected observation and statistics.

Standardized operation process

Patients in the radiology department of the No.1 Hospital of Jilin University for pulmonary CT angiography in peripheral intravenous injection of iodinated contrast agent, after 70s for lung CT continuous scan, the CT data were stored in DCM format file. In this study, Mimics 17.0 three-dimensional reconstruction software was used for data reconstruction.

1. Import the image file with Mimics 17.0.

2. The two-dimensional CT angiography images of the lung were reconstructed after the introduction.

3. After that, the target artery is segmented into surrounding tissues by "Thresholding", and then the model is obtained by using "Dynamic Region Growing" and "Calculate 3D".

4. Through Mimics software, two experienced physicians and radiologists at or above the level of thoracic surgery and radiologists simultaneously observed and counted the course and branch variation characteristics of pulmonary vessels, and checked and unified after double entry

Major instruments and equipment.

DISCOVERY TM 64 CT (Philip, ICT 256,German) were used for high resolution (64-spiral) enhanced chest CT, MIMICS 17.0 (Belgium Materialize company) for Three-dimensional reconstruction. Position of patients: head forward, supine position, hands up to head.

Statistical method

We used IBM SPSS 19.0 to analysis all the data. T test was used to compare the mean of the two groups and variance analysis was used among the groups. Χ² test was used to compare distribution difference. P < 0.05 indicates statistical difference.

This study included 420 subjects, including 216 males and 204 females. The average age of the subjects were 56.54 ± 10.08 and 56.12 ± 9.55 respectively as Table 1 shows.

Table 1

Basic data of all the subjects
Characters	Sex groups		t	p
Characters	Male (n = 216)	Female (n = 204)	t	p
Age	56.54 ± 10.08	56.12 ± 9.55	0.44	0.66

We performed three-dimensional reconstruction of pulmonary vessels in all subjects based on enhanced CT images of the lungs. The two pulmonary artery variants were found as follows:

1. Variation of left superior pulmonary artery

According to the statistics of three-dimensional reconstruction results, 420 subjects in this study had a large degree of variation in the left superior pulmonary artery. The number of blood supply arteries was 2–7, of which 2 arteries accounted for 1.4% (n = 6), 3 arteries for 25.5% (n = 107), 4 arteries for 50.5% (n = 212), 5 arteries for 21.6% (n = 91), 6 arteries for 0.5% (n = 2), 7 arteries for 0.5%(n = 2)。 Four arteries supply the most blood in the upper left lung, followed by three and five arteries, two and six or seven arteries supply less.

Table 2

Characteristics of left superior pulmonary artery
Number of arteries	groups		Χ²	P
Number of arteries	male	female	Χ²	P
2 arteries(n = 6,1.4%)	0	6	8.146	0.228
3 arteries(n = 107,25.5%)	56	51
4 arteries(n = 212,50.5%)	109	103
5 arteries(n = 91,21.6%)	51	40
6 arteries(n = 2,0.5%)	0	2
7 arteries(n = 2,0.5%)	0	2

2. Left inferior lobar artery variation

The left inferior lobar pulmonary artery is the terminal of left pulmonary artery which continues to extend downward after the left superior lobar pulmonary artery is separated. In this study, the left inferior lobe basilar artery is regarded as an artery. There are 2–4 arteries in the left inferior lobe. The number of different arteries is different in the upper segment of the left inferior lobe. Among the 420 subjects in this study, 79.5% (n = 334) were one superior artery + one basilar artery, 19.5% (n = 82) were two superior arteries + one basilar artery, and 1% (n = 4) were three superior arteries + one basilar artery. It can be seen that the left inferior lobe is mainly composed of one superior inferior lobe artery + one basilar artery trunk, among which 2, 3 or 4 basilar arteries can be distributed to the basal segment of the inferior lobe.

Table 3

Distribution characteristics of left inferior pulmonary artery
Left inferior lobar artery	n	%
2arteries supply blood, --1 upper segment artery	334	79.5%
3 arteries supply blood, --2 upper segment arteries	82	19.5%
4 arteries supply blood, --3 upper segment arteries	4	1%

3. Variation of right superior lobar pulmonary artery

The first artery of the right upper lobe of the lung usually originates from the mediastinal part of the right pulmonary artery, so it is called the mediastinal artery. Its supply artery may have 1–4 branches. One artery, i.e. only one mediastinal artery supplying the upper lobe tip, posterior and anterior segments, accounted for 7.6% (n = 32); two arteries, i.e. one mediastinal artery and one additional artery supplying the upper or lower segments, accounted for 77.9% (n = 327); three arteries, i.e. one mediastinal artery and two additional arteries supplying the upper or lower segments, accounted for 14% (n = 59); four arteries, i.e. one mediastinal artery and three additional arteries 0.5% (n = 2).

Table 3

Distribution characteristics of the right superior lobar pulmonary artery
Basilar artery stem from basilar artery	n	%
1 artery supplies blood	32	7.6%
2 arteries supplies blood	327	77.9%
3 arteries supplies blood	59	14.0%
4 arteries supplies blood	2	0.5%

4. Variation of right middle pulmonary artery

The right middle pulmonary artery generally originates from the interlobar segment of the right pulmonary artery, and then extends to the medial and lateral segments of the right middle pulmonary artery. The middle lobe may be supplied by 1–4 arteries: ① one middle lobe artery, namely a large middle lobe artery trunk, divides into medial and lateral arteries, accounting for 30.5% (n = 128) of the number of researchers; ② two middle lobe arteries, namely from the right pulmonary artery, respectively, with the upper branch supplying the medial and the lower branch supplying the lateral segments, accounting for 64% (n = 269); ③ three middle lobe arteries, accounting for 5% (n = 21); ④ 4 middle lobe arteries supply 0.5% (n = 2). As Table 4 shows, it can be seen that 2 arteries are the most common, 1 middle lobe artery is the second, 3 and 4 arteries are less.

Table 4

Variation of right superior lobar pulmonary artery
Number of right middle pulmonary artery		Location of artery
Number of right middle pulmonary artery		Between the mediastinal artery of the upper lobe and the superior artery of the lower lobe	Level of right inferior lobar superior pulmonary artery	Between superior inferior lobar artery and basilar artery trunk	Bifurcation of basilar artery	Under the bifurcation of the basilar artery trunk
1middle lobe artery(n = 128,30.5%)		128(100%)	0(0%)	0(0%)	0(0%)	0(0%)
2 middle lobe arteries(n = 269, 64%)	1	258(96%)	11(4%)	0(0%)	0(0%)	0(0%)
2 middle lobe arteries(n = 269, 64%)	2	6(2.2%)	118(43.9%)	122(45.4%)	21(7.8%)	2(0.7%)
3 middle lobe arteries(n = 21,5%)	1	21(100%)	0(0%)	0(0%)	0(0%)	0(0%)
	2	0(0%)	8(38.1%)	11(52.4%)	2(9.5%)	0(0%)
	3	0(0%)	0(0%)	6(28.6%)	15(71.4%)	0(0%)
4 middle lobe arteries(n = 2, 0.5%)	1	2(100%)	0(0%)	0(0%)	0(0%)	0(0%)
	2	0(0%)	2(100%)	0(0%)	0(0%)	0(0%)
	3	0(0%)	0(0%)	0(0%)	2(100%)	0(0%)
	4	0(0%)	0(0%)	0(0%)	0(0%)	2(100%)

Variation of right inferior lobar pulmonary artery

The right inferior lobar pulmonary artery is formed by the right pulmonary artery extending downward from the middle lobe artery. When the right inferior lobe artery is taken as a main artery, there can be 2–4 arteries in the right inferior lobe. The main difference lies in the number of upper segment arteries. Just like the result of Table 5, one upper segment artery + one basilar artery trunk accounted for 79% (n = 332), two upper segment arteries + one basilar artery trunk accounted for 20.5% (n = 86), three upper segment arteries + one basilar artery trunk accounted for 0.5% (n = 2). Therefore, for the right lower lobe of the lung, the blood supply is mainly from 2 arteries, followed by 3 arteries, and 4 arteries are rare.

Table 5

The vascular characteristics of the right inferior lobar pulmonary artery
Number of arterial blood supply	n	%
2 arteries supply blood(1upper segment artery)	332	79%
3 arteries supply blood(2 upper segment arteries)	86	20.5%
4arteries supply blood(upper segment arteries)	2	0.5%

In this study, the variation rate of left superior pulmonary artery system was the highest in both pulmonary arteries. Cory and Valentine[8] assessed the anatomical variation of pulmonary artery tree in 426 patients between 1955 and 1959. 513 patients underwent anatomical pneumonectomy. They analyzed 524 pulmonary lobes or pulmonary arterial and vascular systems in detail. They observed 29 variant types of arteries through 107 resections of the left upper lobe of the lung. They believed that there were almost no real arterial types in the left upper lobe of the lung and that there were 2–7 vessels in the number of arteries, just like the result of Table 2, we found 43 types of arteries in 200 cases of three-dimensional reconstruction of left superior pulmonary artery. The total number of types 3, 5, 10 and 13 accounted for 42.5% (n = 85), which was similar to the results of Cory and Valentine's study. There were almost no real arterial types in left superior pulmonary lobe. Maciejewski[9] studied 100 pairs of stained, injected or corroded cast lungs in 1900 and described the characteristics of the left superior pulmonary artery. He believed that the left superior pulmonary artery was mostly supplied by four arteries (49%). Just like the result of Table 3, our results were consistent with that (50.5%). Fourdrain[10] Through three-dimensional reconstruction of the arteries by CT angiography in 44 patients who underwent surgery, it was found that the lingual segmental artery was supplied by two common arteries (77.3%), which was different from our results (61.5%) and by two separate lingual arteries (37%). We also observed three lingual arteries (n = 3). We observed that the lingual artery (24%) with mediastinal origin (originating from the anterolateral wall of the first artery in the left upper lobe of the lung) was more common than Fourdrain (15.9%). This lingual artery was the only source of the lingual segment (11%) than Fourdrain (2.3%).

The arterial system of the left inferior lobe is simpler than that of the left upper lobe. Cory and Valentine[8] found four main types of arteries in the left lower lobe of the lung. The main types of arteries were one apical segment artery and two common trunk basilar arteries. Eight types of arteries were observed in the left lower lobe. We observed that four basilar arteries (n = 2) could be separated from the left lower lobe basilar artery trunk, and extended from the upper lingual artery to the basilar artery (n = 1).

Fourdrain[10] observed the presence of one superior segment artery (65.9%), two superior segments (27.3%) and three superior segments (6.8%) and the occurrence rate of one superior segment artery (79.5%) was more common than Fourdrain. The occurrence rate of two (19.5%) and three (1%) superior arteries was lower than that of Fourdrain. For basilar artery, we observed two common trunks of basilar artery (anterolateral trunk and posterolateral trunk) accounting for 52.5%, which was similar to the result of Fourdrain (50%). The occurrence rate of three basilar arteries (17%) was less common than that of Fourdrain (50%).

We chose to use the terms Cabrol and Corner for the right superior lobe arterial system. The first artery of the right pulmonary artery is usually called the mediastinal artery of the right upper lobe. It has a strict mediastinal origin. The main reason is that the right pulmonary artery originates from the left ventricle, which leads to a longer walking path in the mediastinum. The French Encyclopedia of Surgery describes the anatomical structure of the right pulmonary artery tree as follows: one mediastinal artery, one or two middle lobe arteries, the upper and basal segments of the right lower lobe (the right lower lobe is divided into four segments). Murota[11] used three-dimensional reconstruction of pulmonary artery tree and MPR imaging to make the recognition rate of pulmonary artery branches of right superior pulmonary artery 97.2% and 99.7% respectively.

In our study, there were 24 types of arteries in the right upper lobe of the lung. Because two types of arteries accounted for 78%, i.e. one mediastinal artery and one dorsal mediastinal artery, the main difference between different types of arteries was the different segments of the branches of the mediastinal artery. In addition to the mediastinal artery, 78% (n = 156) had one additional artery, which was similar to the result of Fourdrain (70.5%). In addition, there were two or three additional arteries. We found that the superior lobe artery originating from the dorsal side of the plane of the right middle lobe could supply both anterior, posterior or bifurcated segments simultaneously. We also observed the co-trunking of the superior right lower lobe artery with this artery.

Right middle lobe pulmonary artery

The supply of the right middle lobe artery was relatively fixed, similar to that described by Fourdrain and Corey and Valentine, with two segmental middle lobe arteries or a common middle lobe artery. Cory and Valentine found five types of arteries in the right middle lobe of the lung, of which 49% (n = 25) were supplied by two middle lobe arteries and 45% (n = 23) were supplied by one single middle lobe artery. Six types of arteries were observed in the middle lobe of the right lung. Two middle lobe arteries (64%) were more frequently supplied than Cory and Fourdrain (54.5%). The supply of one middle lobe artery (30.5%) was less than that of Cory and Fourdrain (45.5%). We also observed three middle lobe arteries (n = 10) and the middle lobe arteries (n = 1) from the basilar artery, which were consistent with the findings of Cory and Valentine.

5.5 Right inferior pulmonary artery

The right inferior pulmonary lobe artery is divided into upper segment artery and basilar artery. Cory and Valentine found six types of arteries. We observed seven types of arteries. The difference between right inferior pulmonary artery types was the number of vessels in the upper and basilar arteries. In our study with Cory and Valentine, the vasculature of the right lower lobe is similar, in most cases, to a superior inferior lobe artery and a basilar artery trunk (two or three basilar arteries separated). It is difficult to compare the vasculature of basal segments in different anatomical studies. Maciejewski[12 13]and others described the "dense" division of the four segmental arteries and the gradual "dendritic" division of the arteries supplying the basal segments. Cory and Valentine[8] describe only basal segmental arteries divided into two or three branches. We observed that 37% (n = 74) and 38% (n = 76) of the right inferior lobe basilar artery trunk were divided into anterior internal basilar artery trunk and posterolateral basilar artery trunk, which was similar to the results of Fourdrain's study. We observed that dense or progressive dendritic division accounted for 16.5% (n = 33). At the same time, we also found that there were arteries extending from the superior segment to the basal segment (n = 9); the superior inferior segment artery and the superior segment artery located on the back of the middle lobe artery plane (n = 8); we first observed that there were additional posterior segment arteries (n = 9) at the bifurcation of the basal trunk, which were divided into four types of basilar artery. When there are more than two upper segment arteries in the right lower lobe, the second upper segment arteries emit more than the bifurcation of the basal trunk (51.2%).

Although we try to minimize the errors through standardized operation and strict physician observation, there are still some limitations in our research: 1. The study of single-center samples may lack the representativeness of corresponding multi-centers; 2. The small number of samples leads to the enlargement of corresponding errors. So further research is still needed.

Three-dimensional reconstruction of pulmonary artery CT angiography can more clearly observe the branches and distribution characteristics of pulmonary artery, clarify the variation, and play a good navigation role in preoperative evaluation, surgical planning and intraoperative vascular management. Among the lobes of both lungs, the left superior lobe artery has the most variation and complexity.

Ethical Approval

This study was approved by the ethics committee of the first hospital of Jilin University. And we have got the exemption from Informed Consent from the Ethics Committee of the First Hospital of Jilin University. We certify that the study was performed in accordance with the 1964 declaration of HELSINKI and later amendments.

Consent for publication

Not applicable

Competing interests

All authors disclosed no relevant relationships.

Authors' contributions

Xiaochao Ma contributed to the conception of the study; performed the experiment; performed the data analyses and wrote the manuscript. Tianyu Lu, Da Qin, Hongfei Cai, Ze Tang, Yue Yang contributed significantly to analysis and manuscript preparation; Youbin Cui，Rui Wang helped perform the analysis with constructive discussions.

Funding

Application of 3D Simulation Technology in Diagnosis and Treatment of Thoracic Diseases. 20130604050TC. Science and Technology Department of Jilin Province.

Availability of data and materials

The datasets generated and analysed during the current study are not publicly available due to privacy, but are available from the corresponding author on reasonable request.

Acknowledgements

Not applicable

Torre LA, Siegel RL, Jemal A. Lung Cancer Statistics. Advances in experimental medicine and biology 2016;893:1-19 doi: 10.1007/978-3-319-24223-1_1[published Online First: Epub Date]|.
Bussières JS. Iatrogenic pulmonary artery rupture. Current opinion in anaesthesiology 2007;20(1):48-52 doi: 10.1097/ACO.0b013e32801158a9[published Online First: Epub Date]|.
Qin J, Ren Y, Ma D. A comparative study of thoracoscopic and open surgery of congenital diaphragmatic hernia in neonates. 2019;14(1):118 doi: 10.1186/s13019-019-0938-3[published Online First: Epub Date]|.
Gu Z, Chen C, Wang Y, et al. Video-assisted thoracoscopic surgery versus open surgery for Stage I thymic epithelial tumours: a propensity score-matched study. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2018;54(6):1037-44 doi: 10.1093/ejcts/ezy239[published Online First: Epub Date]|.
Takahashi Y, Miyajima M, Tada M, et al. Outcomes of completion lobectomy long after segmentectomy. Journal of cardiothoracic surgery 2019;14(1):116 doi: 10.1186/s13019-019-0941-8[published Online First: Epub Date]|.
Nyberg EL, Farris AL, Hung BP, et al. 3D-Printing Technologies for Craniofacial Rehabilitation, Reconstruction, and Regeneration. 2017;45(1):45-57 doi: 10.1007/s10439-016-1668-5[published Online First: Epub Date]|.
Cai H, Wang R, Li Y, et al. Role of 3D reconstruction in the evaluation of patients with lower segment oesophageal cancer. Journal of thoracic disease 2018;10(7):3940-47 doi: 10.21037/jtd.2018.06.119[published Online First: Epub Date]|.
Cory RA, Valentine EJ. Varying patterns of the lobar branches of the pulmonary artery. A study of 524 lungs and lobes seen at operation of 426 patients. Thorax 1959;14:267-80 doi: 10.1136/thx.14.4.267[published Online First: Epub Date]|.
Maciejewski R, Kutnik B. Branches of the left pulmonary artery vascularizing the left upper pulmonary lobe. Acta anatomica 1990;138(3):224-9 doi: 10.1159/000146944[published Online First: Epub Date]|.
Fourdrain A, De Dominicis F, Blanchard C, et al. Three-dimensional CT angiography of anatomic variations in the pulmonary arterial tree. Surgical and radiologic anatomy : SRA 2018;40(1):45-53 doi: 10.1007/s00276-017-1914-z[published Online First: Epub Date]|.
Murota M, Yamamoto Y, Satoh K, et al. Preoperative Evaluation of the Right Upper Lobe Pulmonary Artery by 3D-CT Pulmonary Angiography vs. Thin-Section Multiplanar Reconstruction Images Obtained by Contrast-Enhanced Multidetector-Row CT. Acta medica Okayama 2015;69(6):327-32 doi: 10.18926/amo/53906[published Online First: Epub Date]|.
Maciejewski R. Branches of the left pulmonary artery supplying the basal segments of the lung. Acta anatomica 1991;140(3):284-6 doi: 10.1159/000147070[published Online First: Epub Date]|.
Maciejewski R. Branches of the right pulmonary artery supplying the basal segments of the lung. Acta anatomica 1992;145(3):244-7 doi: 10.1159/000147373[published Online First: Epub Date]|.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Analysis of Pulmonary Artery Variation Based on 3D Reconstruction of CT Angiograph

Status:

Version 1

Abstract

Objective

Method

Results

Conclusion

Figures

Introduction

Methods

Result

1. Variation of left superior pulmonary artery

2. Left inferior lobar artery variation

3. Variation of right superior lobar pulmonary artery

4. Variation of right middle pulmonary artery

Variation of right inferior lobar pulmonary artery

Discussion

Right middle lobe pulmonary artery

5.5 Right inferior pulmonary artery

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1