Incomplete pulmonary fissures evaluated by volumetric thin-section CT: Semi-quantitative evaluation for small fissure gaps identification, description of prevalence and severity of fissural defects

Koenigkam-Santos, Marcel; Paula, Wagner Diniz de; Owsijewitsch, Michael; Wielpütz, Mark O.; Gompelmann, Daniela; Schlemmer, Heinz Peter; Kauczor, Hans Ulrich; Puderbach, Michael

doi:10.1016/j.ejrad.2013.08.029

Cited by 34 publications

(32 citation statements)

References 27 publications

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“…In this study, incomplete ROFs, HFs, and LOFs exhibited frequencies of 41.3%, 58.2%, and 45.2%, respectively. HFs are the most frequently observed incomplete fissures (5). Incompleteness has more often been observed in LOFs than in ROFs, and the incomplete regions of interlobar fissures are most often located medially, near the hilar region, or mediastinal region (12), which is in agreement with the present study.…”

Section: Discussionsupporting

confidence: 91%

“…However, previous valuable studies have investigated the clinical significance of the pulmonary interlobar fissures, including the location of pulmonary lesions, distribution of pleural effusion, dissemination of inflammation and tumors, selection of surgical operations, endoscopic therapy for severe emphysema, and the differential diagnosis between normal and pathological structures (5,6).…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

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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“…For assessment on CT, the authors usually state criteria for incomplete fissures, with several using four types accord-ing to the varying presence of vessels, including the situation when a fissure is simply missing. Data from various CT methods were mostly obtained from hundreds of patients 1,[12][13][14][15][16][17][18][19][20][21][22][23] . Only Frija et al 12 used healthy volunteers.…”

Section: Prevalence Of Incomplete Fissuresmentioning

confidence: 99%

Prevalence of incomplete interlobar fissures of the lung

Sedláčková¹,

Čtvrtlík²,

Moreno³

2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Some patients benefit from accurate integrity assessment of pulmonary fissures. There are a number of methods for the assessment of incomplete interlobar fissures: imaging techniques, endobronchial methods measuring collateral air flow, a perioperative view, and autopsies used in research into pulmonary anatomy. Methods and Results. We performed a computerized advanced search for primary evidence in the PubMed (Public/ Publisher MEDLINE) and Google Scholar electronic databases using the following terms: incomplete and fissure. The search was not restricted to the English literature, nor limited by publication time. The bibliographic search was then extended to the "Related Articles" links and to the list of literature references of each article. Conclusion. Publications have consistently shown that interlobar fissures exhibit high variability and that preoperative or at least detailed perioperative assessment can influence the effect of treatment.

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“…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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Incomplete pulmonary fissures evaluated by volumetric thin-section CT: Semi-quantitative evaluation for small fissure gaps identification, description of prevalence and severity of fissural defects

Cited by 34 publications

References 27 publications

Volumetric thin-section CT: evaluation of pulmonaryinterlobar fissures

Volumetric thin-section CT: evaluation of pulmonaryinterlobar fissures

Prevalence of incomplete interlobar fissures of the lung

Emphysema: Imaging for Endoscopic Lung Volume Reduction

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