Virtual mediastinoscopy for safer and more accurate mediastinal exploration.
OBJECTIVE
Virtual endoscopy can theoretically produce images of hollow organs from computed tomographic scanning by discriminating walls with the air space. We produced virtual images of the mediastinum (ie, virtual mediastinoscopy based on positron emission tomography and computed tomography scanning data to visualize lymph nodes and great vessels similar to cervical mediastinoscopy).


METHODS
Virtual images from 5 patients with positive mediastinal positron emission tomography findings were produced using computer software designed for virtual endoscopy. Visualization of lymph nodes and vessels was done based on positron emission tomography-computed tomography and enhanced computed tomographic scanning data, respectively.


RESULTS
Virtual mediastinoscopy clearly showed three-dimensional relationships between active nodes and surrounding structures. Great vessels, such as the innominate artery and azygos vein, which require assessment during a mediastinoscopy, were visualized in virtual movies. Further, perspective views in the craniocaudal direction based on surgeon-orientation, simulated actual views were obtained during cervical video mediastinoscopy.


CONCLUSIONS
Virtual mediastinoscopy provided realistic images of the mediastinal anatomy, and has the potential to make cervical mediastinoscopy and other mediastinal explorations safer, as well as more accurate.
Shiono
Hiroyuki
H
Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan. hishiro@surg1.med.osaka-u.ac.jp
Okumura
Meinoshin
M
Sawabata
Noriyoshi
N
Utsumi
Tomoki
T
Inoue
Masayoshi
M
Minami
Masato
M
Tomiyama
Noriyuki
N
Matsuda
Hikaru
H
Sawa
Yoshiki
Y
D000368:Aged; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008481:Mediastinoscopy / Q000379:methods*; D008482:Mediastinum / Q000473:pathology*; D008875:Middle Aged; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed