Demarcation of arteriopulmonary segments: a novel and effective method for the identification of pulmonary segments

Abstract

Objective: Each pulmonary segment is an anatomical and functional unit. However, it is fundamentally difficult to precisely distinguish every pulmonary segment using the conventional pulmonary intersegmental planes from computed tomography images. Building arteriopulmonary segments is likely to be an effective way to identify pulmonary segments.

Methods: The thoracic computed tomography images of 40 patients were collected. The anatomic structures of interest were extracted in the transverse, sagittal, and coronal planes using the semi-automated segmentation tools provided by Amira software. The intrapulmonary vessels were subsequently segmented and reconstructed. The distributions of the pulmonary arteries, veins, and bronchi were observed. In patients with pulmonary masses, the mass was also reconstructed.

Results: The three-dimensional reconstructed images showed the branches of the pulmonary artery ramified up to their eighth order covering the entire lung as well as evident intersegmental gaps without pulmonary arteries. The segmental artery was closely accompanied by the segmental bronchi in 486 pulmonary segments (90% of total number of segments). The size and spatial location of the pulmonary mass within a pulmonary segment were also clearly visible.

Conclusions: Demarcation of arteriopulmonary segments can be used to precisely distinguish every pulmonary segment and provide its detailed anatomical structure before pulmonary segmentectomy.

Keywords: Lung; arteriopulmonary segment; computed tomography; pulmonary artery; pulmonary mass; segmentectomy.

Figure 1.

Segmentation of the pulmonary (a) bronchi, (b) arteries, (c) veins, (d) gaps between pulmonary segments, and (e, f) the mass in computed tomography images. b, pulmonary bronchi; a, pulmonary arteries; v, pulmonary veins; G, gaps; M, mass.

Figure 2.

Distribution of pulmonary bronchi and pulmonary arteries in the (a–c) transverse plane, (d–f) coronal plane, and (g–i) sagittal plane.

Figure 3.

Branches of the (a) pulmonary artery and (b) pulmonary bronchi.

Figure 4.

(a) The segmental artery was closely accompanied by the segmental bronchi, and (b) the primary branch of the segmental artery entered the adjacent pulmonary segment. a, segmental arteries; b, segmental bronchi; G, gap.

Figure 5.

Different arteriopulmonary segments in the (a, d) anterior view, (b, e) lateral view, and (c, f) posterior view.

Figure 6.

Individual arteriopulmonary segment observed in different directions. a, pulmonary arteries; b, pulmonary bronchi; v, pulmonary veins.

Figure 7.

Lung mass located in (a) the periphery of pulmonary segments, (b) near the edge of adjacent pulmonary segments, and (c) located in two pulmonary segments. M, mass; V, intersegmental vein.