| Objective:To analyze the characteristic and variability of bilateral pulmonary artery by pulmonary CT angiography three-dimensional reconstruction.To explore the value of three-dimensional reconstruction for pulmonary artery reconstruction.Materials and methods:We select 420 patients from the Department of Thoracic Surgery,First Hospital of Jilin University from 2016.08 to 2018.12.No lesions or lesions in the lungs do not affect the artery orientation and observation.the one whose lesions greatly affect the artery orientation or the angiographic artery is not obvious,which lead to unclear reconstruction model is eliminated.According to our standardization procedure,a 64-channel,contrast-enhanced CT(Philip Model ICT 256)examination was performed,using a syringe to inject the contrast material(Vision Parker,GE Healthcare Ireland)at a rate of 1.5 ml/s(total volume 100 ml).The slice thickness was 1.5mm.The imaging DCM file data was acquired and imported into the 3D reconstruction software Mimics 22.0 for 3D reconstruction.The reconstructed 3D model of the pulmonary artery was reviewed by over attending physician thoracic surgeon and radiologist,and combined with 2D images of axial,coronal and sagittal plane.the characteristic and variation of the branch and direction of the pulmonary arteries in each lung are analyzed.The sub-segment artery system is not evaluated.Result:A total of 420 subjects(mean age 56.36±9.88)were enrolled in the study,including 216 males with an average age of 56.54±10.08 years and 204 females with an average age of 56.12±9.55 years.There was no significant difference between the two groups,(P>0.05).1.The pulmonary artery variation in the left upper lobe can be divided into 43 types,of which the total number of type 3,type 5,type 10 and type 13 accounts for 42.6%(n=179),and the number of other types are less.The left upper lobe is 50.5%(n=212)with 4 arteries,the secondary is 3 arteries 25.5%(n=107)and 5 arteries 21.6%(n=91),2 and 6,7 arteries are less.The presence of apico-posterior artery is 57.6%(n=242).There were 1-3 lingular arteries in the lingular segment.One lingual artery 61.4%(n=258)is the most,and the proportion of beginning in the plane of left lower lobe upper artery is 45.0%(n=116).The two lingual arteries are 37.2%(n=156),and the first lingual artery is mostly 42.9%(n=67)beginning in the front lower side of the left first pulmonary artery and 35.3% in the left lower lobe upper artery plane(n=55);The second lingual artery is 33.3%(n=52)beginning between the level of lower lobe upper artery plane and basal arterial trunk bifurcation plane.And 50%(n=78)near the basal collateral bifurcation.beginning at basal arterial trunk bifurcation plane.In addition,we also observed that the artery which beginning from the lingual artery go to the basal segment(n=2).2,left pulmonary lobe pulmonary artery variability can be divided into 8 types,2 arteries supply,that is,1 upper artery accounted for 79.5%(n=334);3 arteries supply,that is,2 upper arteries accounted for 19.5%(n=82).It can be seen that the left lower lobe is mainly supplied by two arteries,that is,one superior inferior artery and one basal artery.The basilar artery trunk is divided into two trunks,accounting for 82.1%(n=345),of which 64.1%(n=221)is divided into anteromedial basilar artery and posterior-lateral basilar artery;and of which 35.3%(n=122)is divided into anterior,medial,lateral basilar trunk and posterior basilar artery alone.The three basilar arteries are accounting for 16.9%(n=71),of which 64.8%(n=46)is divided into anteromedial basilar artery common trunk,external basilar artery and posterior basilar artery.In addition,it can be seen that the upper artery sends out an artery extending to the base(n=40),and the upper artery is emitted by a branch artery after the bifurcation(n=4).3,the right upper lobe pulmonary artery variability can be divided into 24 types,the larger variation is the branch supply of the mediastinal artery of the right upper lobe.The probability of one artery is 7.6%(n=32),the probability of two arteries is 77.9%(n=327),the probability of three arteries is 14%(n=59),and the probability of four arteries is 0.5%(n=2).The sum of Types 1,3 and 4 accounted for 66.7%(n=280).When two or more arteries of the right upper lobe are supplied,the existence probability of an artery beginning at the dorsal of right middle lobe artery plane is 90%(n=378),and this artery can supply the posterior,anterior,or posterior-anterior segment.We also observe that the right superior lobe artery and the lower lobe superior artery are co-dried on the dorsal side of the medial lobe artery plane(n=17);anterior artery occurred between the mediastinal artery and the artery of beginning at the dorsal of right middle lobe artery plane(n=46).4,the most common artery blood supply of right middle lobe is two middle lobe arteries 64%(n=269);the secondary one is one middle lobe artery,accounting for 30.5%(n=128);three middle lobe arteries 5%(n=21)and four middle lobe arteries 0.5%(n=2)are less.The variation of middle lobe artery can be divided into 6 types,2,4,and 6 are all 3 middle lobe arteries,but there are differences in the beginning position of the middle lobe artery.When there are two middle lobe arteries,the first middle lobe artery is located between the upper lobe mediastinal artery and the upper artery of the lower lobe,accounting for 95.9%(n=258)The second artery is located in the upper segment of the lower lobe plane,accounting for 43.9%(n=118).the lower lobe upper artery and basilar artery trunk furcation,accounting for 45.4%(n=122).The probability of 3 middle lobe arteries is 5%(n=21).The supply of 4 middle lobe arteries accounted for 0.5%(n=2).At the same time,we also observed the middle lobe artery(n=2)beginning from the basilar artery and the near the medial basilar artery(n=6).5,the right lower lobe can have 2-4 arteries for blood supply.Mainly is 2 arteries,accounting for 79%(n=332),3 arteries,accounting for 20.5%(n=86),and 4 arteries,accounting for 0.5%(n=2)are less,the main difference is the number of upper artery.There are seven artery types in the right lower lobe,the main difference is the number of upper artery and the number of basilar artery from the basilar artery trunk.The sum of Types 1,2,and 4 accounts for 79%(n=332).Mainly is one upper artery and one basilar artery trunk.There are 2-4 basilar arteries in the right lower lobe.The two basilar arteries accounted for 41.4%(n=174),of which the most common type is anteromedial trunk and posterior-lateral trunk,accounting for 89.1%(n=155).The three basilar arteries accounted for 38.1%(n=160),of which posterior-lateral basilar artery trunk,interior basilar artery,anterior basilar artery,accounting for 57.5%(n=92)and the anterior-lateral basilar trunk,internal basilar artery,posterior basilar artery,accounting for 27.5%(n=44),Both types are the most common.Four basilar arteries accounted for 20.5%(n=86),of which progressive or one-time manner divided into internal,anterior,external,and posterior basilar artery,accounting for 80.2%(n=69).When there are two upper arteries in the right lower lobe,the position of the first upper artery is generally fixed,which is distant from the bifurcation of basilar artery trunk.The second upper artery,beginning at the bifurcation plane of the basilar artery trunk 51.2%(n=44)is more common.at the same time,we also observe that the upper artery sends out an artery extending to the base(n=19),and an additional posterior segmental artery(n=19),beginning at the bifurcation plane of the basilar artery trunk,in the type of four basilar arteries.conclusion:1.Three-dimensional reconstruction of pulmonary angiography can clearly observe the branching and distribution characteristics of pulmonary arteries,and clarify the variation.It has important clinical value for preoperative evaluation of lesion and blood vessel position,surgical plan formulation,and intraoperative operation of blood vessels.2.In the lobes of both lungs,the mutation rate of the left upper lobe artery is the highest.3.The presence probability of the apicoposterior segmental artery in left lung upper lobe is 57.6%(n=242).The left lower lobe basilar artery is mainly in the anteromedial/posterior-lateral type.4.In the upper right lobe,there is a case the trunk of upper lobe artery,beginning at middle lobe artery plane,and lower lobe upper artery.The right middle lobe artery beginning under the upper segment artery of the inferior lobe is more common.The basilar artery of the right lower lobe is mainly composed of 2 and 3 branches. |
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