Incomplete and accessory fissures of the lung evaluated by high-resolution computed tomography

Heřmanová, Zuzana; Čtvrtlík, Filip; Moreno, Herman

doi:10.1016/j.ejrad.2013.12.001

Cited by 26 publications

(29 citation statements)

References 13 publications

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“…On a standard CT scan with 10 mm thick sections, the ratios of avascular zones, lines, and bands were 60%-94%, 1%-18%, and 0%-8%, respectively, for ROFs; 58%-82%, 1%-22%, and 0%-18%, respectively, for LOFs (3,9). sections, the ratios of avascular zones, lines, and bands were 0%, 74%-94%, and 6%-18%, respectively, for ROFs; 0%, 96%-98%, and 2%-4%, respectively, for LOFs (1,3,4,6). In this study, no avascular zone was observed in thin-section axial CT, and 70.2% of ROFs and 94.2% of LOFs were shown as lines, and 83.2% of HFs as bands.…”

Section: Discussionmentioning

confidence: 98%

“…Incomplete interlobar fissures referred to discontinuous fissures or detachment from the hilum or mediastinum. In addition, the lung tissues in the region of discontinuous fissures merged into each other (3)(4)(5). Incompleteness of the interlobar fissures was expressed as a percentage of defects over the entire fissure and categorized into seven grades: grade 0, 0% incomplete (i.e., fully complete fissure); grade 1, 1%-20% incomplete; grade 2, 21%-40% incomplete; grade 3, 41%-60% incomplete; grade 4, 61%-80% incomplete; grade 5, 81%-99% incomplete; and grade 6, 100% incomplete (i.e., fissure is absent) (2,4).…”

Section: Image Evaluationmentioning

confidence: 99%

“…In addition, the lung tissues in the region of discontinuous fissures merged into each other (3)(4)(5). Incompleteness of the interlobar fissures was expressed as a percentage of defects over the entire fissure and categorized into seven grades: grade 0, 0% incomplete (i.e., fully complete fissure); grade 1, 1%-20% incomplete; grade 2, 21%-40% incomplete; grade 3, 41%-60% incomplete; grade 4, 61%-80% incomplete; grade 5, 81%-99% incomplete; and grade 6, 100% incomplete (i.e., fissure is absent) (2,4). The incomplete interlobar fissures were classified into four types (8): type 1, the interlobar fissure was a discontinuous avascular zone; type 2, blood vessels in the adjacent lobes crossed over the interlobar region; type 3, pulmonary blood vessels, especially the pulmonary vein, penetrated the interlobar region; and type 4, the pulmonary vein was observed in the interlobar region and was connected to the vessels in the adjacent lobes (Fig.…”

Section: Image Evaluationmentioning

confidence: 99%

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Volumetric thin-section CT: evaluation of pulmonaryinterlobar fissures

Guan

Han³

et al. 2015

Diagn Interv Radiol

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T he pulmonary interlobar fissures are important landmarks for pulmonary anatomy. They adopt a double membrane structure formed by invagination of the visceral pleura. The interlobar fissures are 1-3 mm thick and consist of the right oblique fissure (ROF), horizontal fissure (HF), and left oblique fissure (LOF) (1, 2). The recognition of pulmonary interlobar fissures and their variations is beneficial for identifying pulmonary lesion locations, evaluating disease progression, selecting surgical operations, and applying endoscopic therapy (3-5). With the constant development of imaging techniques, thin-section computed tomography (CT) can provide more detailed information regarding lung structure with respect to the anatomy (5-7). Multiplanar reformatting (MPR) (8) and maximal intensity projection (MIP) are reconstruction techniques based on a noninvasive methodology that detect pulmonary interlobar fissure variations. The results generated by these techniques highly resemble the results of an autopsy (8). In this study, the pulmonary interlobar fissures and their variations were investigated and analyzed by volumetric thin-section MPR and MIP images. MethodsThe study was approved by the institutional review board and the institutional ethics committee. A retrospective analysis was performed on CT scans of 862 adult subjects ( PURPOSEWe aimed to perform an imaging analysis of interlobar fissures and their variations using thin-section computed tomography (CT). METHODSVolumetric thin-section CT scanning was performed in 208 subjects. Interlobar fissures were observed on axial images, and reconstructed coronal and sagittal images were observed by multiplanar reformatting (MPR). The vessel distributions were verified by maximal intensity projection (MIP). On the axial images, the interlobar fissures were characterized by lines of hyperattenuation, bands of hyperattenuation, avascular zones, and mixed imaging. The interlobar fissures were divided into seven grades according to the percentage of defects over the entire fissure. RESULTSOn the axial images, of all interlobar fissures without avascular zones, 70.2% of the right oblique fissures (ROFs) and 94.2% of the left oblique fissures (LOFs) appeared as lines, and 83.2% of the horizontal fissures (HFs) appeared as bands. All of the interlobar fissures appeared as lines on the coronal and sagittal images. Of all cases, 17.8% showed fully complete interlobar fissures for all three fissures. Incomplete fissures included 41.3% of ROFs, 58.2% of HFs, and 45.2% of LOFs. In ROFs and LOFs, discontinuity was most frequently below 20%, while in HFs discontinuity was most frequently 41%-60%. The most common classification of incomplete interlobar fissures was a discontinuous avascular zone. CONCLUSIONIncomplete interlobar fissures are common variations of interlobar fissures. Techniques including volumetric thin-section CT, MPR, and MIP can assist in the diagnosis of incomplete interlobar fissures.

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Section: Discussionmentioning

confidence: 98%

Section: Image Evaluationmentioning

confidence: 99%

Section: Image Evaluationmentioning

confidence: 99%

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Volumetric thin-section CT: evaluation of pulmonaryinterlobar fissures

Guan

Han³

et al. 2015

Diagn Interv Radiol

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“…Contradicting these findings, an analysis of 250 CT images with a by far higher portion of intact fissures showed the left fissure to be incomplete in only 24.4 % of cases (thus appearing continuous in three quarters of all patients), and the right fissure incomplete in 35 % of cases. [57].. There is a consensus regarding at least the horizontal fissure, which very frequently appears to be uninterrupted, as well as regarding the perihilar region, which is more difficult to evaluate and is where parenchymal bridges tend to form.…”

Section: Fissure Analysis: the Interlobular Fissuresmentioning

confidence: 99%

“…There is a consensus regarding at least the horizontal fissure, which very frequently appears to be uninterrupted, as well as regarding the perihilar region, which is more difficult to evaluate and is where parenchymal bridges tend to form. The clinical significance of "small" parenchymal bridges (appearing in approximately one third of patients [58]) as well as accessory fissures (appearing in 16 % of patients, primarily in the superior lobes [57]) on CV has not been clarified. Collateral ventilation can also be measured through bronchoscopy using a balloon catheter.…”

Section: Fissure Analysis: the Interlobular Fissuresmentioning

confidence: 99%

Emphysema: Imaging for Endoscopic Lung Volume Reduction

Storbeck

Schröder

Oldigs

et al. 2015

Fortschr Röntgenstr

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!Chronic obstructive pulmonary disease (COPD) is characterized by two entities, the more airway-predominant type ("bronchitis") on the one hand, and emphysema-predominant type on the other. Imaging via high-resolution computed tomography plays an important role in phenotyping COPD. For patients with advanced lung emphysema, new endoscopic lung volume reduction therapies (ELVR) have been developed. Proper selection of suitable patients requires thinsection reconstruction of volumetric CT image data sets also in coronal and sagittal orientation are required. In the current manuscript we will describe emphysema subtypes (centrilobular, paraseptal, panlobular), options for quantifying emphysema and this importance of regional distribution (homogeneous or heterogeneous, target area) as this is crucial for patient selection. Analysis of the interlobular fissures is obligatory despite the lack of standardization, as incomplete fissures indicate collateral ventilation (CV) via parenchymal bridges, which is an important criterion in choosing endoscopic methods of LVR. Every radiologist should be familiar with modern LVR therapies such as valves and coils, and furthermore should know what a lung doctor expects from radiologic evaluation (before and after ELVR). Finally we present a checklist as a quick reference for all steps concerning imaging for ELVR.

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The prevalence of the azygos lobe: A meta‐analysis of 1,033,083 subjects

et al. 2021

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The azygos lobe (AL) is an accessory lobe of the right lung with prevalence between 0.4 and 1.2%. The aim of the present review is to provide a better estimate of the frequency of the AL and to examine its relationships with other variables such as population, diagnostic methods, and co-occurring illnesses. Studies published between 1899 and October 2020 were searched through three electronic databases; Google Scholar, PubMed, and JSTOR. Titles, abstracts, and full texts of the retrieved entries were screened to determine their appropriateness for inclusion. A total of 88 studies relating to 1,033,083 subjects met the inclusion criteria. A random-effects meta-analysis yielded an overall prevalence of 0.30% (95% CI: 0.0024-0.0035, I 2 = 97.9%). Linear regression and subgroup analysis revealed a negative correlation (ρ = À0.540, p <0.001) between AL prevalence and sample size; studies with smaller sample sizes had higher prevalences. The AL prevalence in individuals with congenital pulmonary defects, 5.2% (95% CI: 0.0018-0.0086, I 2 = 0%), was 17 times higher than the overall prevalence (z = 6.65, p <0.001), suggesting associations with other abnormalities and possibly a genetic predisposition. In addition to an evidence-based synthesis of AL prevalence, this study demonstrates publication bias and small-study effects in the anatomy literature. Awareness of the AL is crucial for radiologists when they interpret unusual radiological findings and for surgeons when they operate in the region.

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Incomplete and accessory fissures of the lung evaluated by high-resolution computed tomography

Cited by 26 publications

References 13 publications

Volumetric thin-section CT: evaluation of pulmonaryinterlobar fissures

Volumetric thin-section CT: evaluation of pulmonaryinterlobar fissures

Emphysema: Imaging for Endoscopic Lung Volume Reduction

The prevalence of the azygos lobe: A meta‐analysis of 1,033,083 subjects

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