The Application Of Multi-slice Spiral CT Angiography In The Anatomy Of Pulmonary Artery Of Right Upper Lobe

Background and objective:With the high detection of early lung tumors, anatomical segmentectomy with video-assisted thoracoscope has become a hot topic. The complexity of the bronchi and pulmonary vessels anatomy demands thoracic surgeons be familiar with lung anatomy in order to secure the safety of the operation. At present, studies on pulmonary bronchovascular anatomy are mainly restricted to sectional anatomical specimens and sectional imaging specimens. Meanwhile three dimensional anatomical studies on pulmonary bronchovascular, especially in live pulmonary arteries are comparatively less. In recent years, with the extensive clinical application of multi-slice spiral CT (computed tomography) angiography and its rapid post-processing technologies of volume scanning and rendering, studies on anatomical structures of living pulmonary arteries come true.With the help of multi-slice spiral CT angiography and volume rendering technology, the branch pattern of the right upper lobe pulmonary arteries and the segmental arteries are studied in large quantities. It not only helps to position the right upper lobe diseases precisely, but also provide valuable imaging anatomical information for interventional radiology therapy and pulmonary segmental and video-assisted thoracoscopic subsegmental resection, meanwhile vascular injury and bleeding during operation are decreased and the operation process is shorten.Methods:Total 124 cases who have been excluded pulmonary embolism and whose branches are well displayed are selected from the patients with suspected pulmonary embolism who underwent multi-slice spiral CT angiography. The mean age is 42.1 years old ranging from 7 to 80 years old. Input the raw data of the pulmonary arteries angiography into the post-processing workstations, then reconstruct their volume rendering pictures and regulate the window width and window level to make the branches displayed well.According to Boyden’s nomenclature, two physicians who are familiar with the pulmonary artery anatomy analysised the branches of the right upper lobe, then classified them, summarized the origins of subsegmental arteries. All pictures meet the need of analysising the anatomy.Results:According to the differentiation of starting position and distribution range, the right upper pulmonary arteries are divided into anterior trunk or superior, inferior anterior trunk, ascending artery, anterior ascending artery, posterior anterior artery with Boyden’s nomenclature.The pulmonary artery of right upper lobe have seven branch types:"anterior trunk+posterior ascending artery" type accounts for 54.0%; "anterior trunk+posterior ascending artery+posterior ascending artery" type accounts for 12.9%; "superior anterior trunk+posterior anterior trunk+posterior ascending artery" type accounts for 12.1%; "anterior trunk+ascending artery" type accounts for 8.1%; "anterior trunk" type accounts for 4.0%; "anterior trunk+anterior ascending artery" type accounts for only 1.6%.Summarizing the branch types above mentioned, two-branches type of the right upper pulmonary arteries is the most, and occupies 76.7% which include 4 branch types, such as "anterior trunk+posterior ascending artery" type, "anterior trunk+ ascending artery" type, "superior anterior trunk+inferior anterior trunk" type, "anterior trunk+anterior ascending artery" type. The second is the three-branches type with 25.0%, and it includes "anterior trunk+posterior ascending artery+anterior ascending artery" type and "superior anterior trunk+inferior anterior trunk+posterior ascending artery" type. One-branch is the least which occupies only 7.3%, and it is "anterior trunk" type.Anterior trunks and superior, inferior anterior trunks are respectively accounting for 83.9%,16.1%. The posterior ascending arteries which accounts for 66.1% are the majority of the interlobe arteries, followed by ascending arteries which accounts for 8.1% and anterior ascending arteries which accounts for 1.6%. There are also 14 cases,accounting for 11.3% with no interlobe artery.The segmental arteries of the right upper pulmonary arteries are in complex resources, especially the posterior segmental arteries. But in them one branch are all the most whose proportion are more than half.Conclusion:The anatomical structure of the right upper pulmonary arteries are rather complex. And they can displayed by multi-slice spiral CT angiography accompanied with VR technology truly and visually, which help to anatomy teaching and instruct the thoracic surgeries and their accuracy.