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Introduction
Several studies in the field of pulmonary segmentectomy have investigated the usefulness of preoperative three-dimensional (3D) image simulation. To create a 3D image, contrast-enhanced computed tomography (CT) data is generally necessary. Therefore, preoperative simulation remains difficult among patients who cannot tolerate contrast agent administration due to contrast media allergy, asthma, impaired renal function and others.
Recently, we have reported on the clinical efficacy of a novel simulation system that especially focuses on pulmonary segmentectomy based on high-quality 3D lung modeling from contrast-enhanced CT data using the novel 3D image-processing software REVORAS™ (Ziosoft, Inc., Tokyo, Japan) [1]. The novel algorithms used in the system had substantial capacity to automatically recognize the pulmonary arteries and veins. These algorithms, which are independent of the differences in CT values of vascular structures, also enabled the creation of 3D images from unenhanced CT data with accuracy comparable to that from contrast-enhanced CT data.
The current study aimed to evaluate the anatomical accuracy of a 3D image simulation for thoracoscopic segmentectomy from unenhanced CT data using the new software.
Technique
The 3D image simulation process is described in our previous report [1]. Briefly, digital imaging and communications in medicine data of the high-resolution CT (HRCT) images with a section thickness of 1.25 mm were transferred to a workstation using REVORAS™. Thereafter, 3D images of the pulmonary lobes and bronchovascular image were constructed automatically within a few minutes. After semi-automatic recognition of the target lesion and determination of the segments to be resected, the 3D segmentectomy simulation view was automatically constructed, after which the distance between the tumor and the intersegmental plain was calculated (Supplemental Video).
We retrospectively investigated seven patients with suspected pulmonary malignancy and for whom thoracoscopic segmentectomy was performed in 2020. Our institutional review board approved the study (2020-1252) and waived the need for written informed consent because of the retrospective design. 3D image simulation was performed for each patient using REVORAS™ based on both unenhanced (UE-3D image) and contrast-enhanced CT (CE-3D image) data. We evaluated the...