title: The efficacy of 320-detector row computed tomography for the assessment of preoperative pulmonary vasculature of candidates for pulmonary segmentectomy.
abstract: OBJECTIVE
  The purpose of this study was to compare the efficacy of 320-detector row computed tomography (CT) with that of 64-detector row CT for three-dimensional assessment of pulmonary vasculature of candidates for pulmonary segmentectomy.
  
  
  METHODS
  We included 32 patients who underwent both 320- and 64-detector CT before pulmonary segmentectomy, which was performed by cutting the pulmonary artery and bronchi of the affected segment followed by dissection of the intersegmental plane along the intersegmental vein. Before the operation, three-dimensional pulmonary vasculature images were obtained for each patient, and the arteries and intersegmental veins of the affected segments were identified. Two thoracic surgeons independently assessed the vessels with visual scoring systems, and kappa analysis was used to determine interobserver agreement. The Wilcoxon signed-rank test was used to compare the visual scores for the assessment of the visualization capabilities of the two methods. In addition, the final determination of pulmonary vasculature at a given site was made by consensus from thoracic surgeons during operation, and receiver operating characteristic analysis was performed to compare their efficacy of pulmonary vasculature assessment. Sensitivity, specificity and accuracy of either method were also compared by means of McNemar's test.
  
  
  RESULTS
  Of the 32 cases, there were no operative complications, but 1 patient died of postoperative idiopathic interstitial pneumonia. Visualization scores for the pulmonary vessels were significantly higher for 320- than those for 64-detector CT (P < 0.0001 for the affected arteries and P < 0.0001 for the intersegmental veins). As for pulmonary vasculature assessment, the areas under the curve showed no statistically significant differences in between the two methods, while the specificity and accuracy of intersegemental vein assessment were significantly better for 320- than those for 64-detector row CT (P < 0.05). Interobserver agreement for the assessment yielded by either method was almost perfect for all cases.
  
  
  CONCLUSIONS
  Three hundred and twenty-detector row CT is more useful than conventional 64-detector row CT for preoperative three-dimensional assessment of pulmonary vasculature, especially when we identify the intersegmental veins, in candidates for pulmonary segmentectomy.
authors.affiliation: Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Tane
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Ohno
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hokka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ogawa
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Tauchi
authors.forename: Wataru
authors.initials: W
authors.lastname: Nishio
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshimura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Maniwa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002289:Carcinoma, Non-Small-Cell Lung / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008175:Lung Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010690:Phlebography / Q000379:methods*; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D016896:Treatment Outcome
keywords: Computed tomography; Pulmonary artery; Pulmonary vein; Segmentectomy; Surgery