Dreidimensionale Rekonstruktion von zentralen Lungentumoren basierend auf CT-Daten: Erste klinische Erfahrungen

Application and clinical effects in lung bullae resection of CT 3-dimensional reconstruction

BACKGROUND

To investigate the value and clinical effect of computed tomography (CT) 3-dimensional reconstruction technology in lung bullae resection.

METHODS

Ninety-eight patients who underwent thoracoscopic surgical resection of lung bullae in our hospital from February 2019 to February 2023 were selected and divided into 2 groups according to the principle of voluntary participation in the clinical trial, of which 43 cases underwent preoperative spiral CT for thin-layer enhancement or planar CT scanning of lung bullae (control group), and 43 cases were imaged with MimicsMedical 21 software for 3-dimensional reconstruction to develop a surgical plan (observation group). To compare the surgery-related indexes, postoperative complications, pain, and analgesic use between the 2 groups, we measured serum creatine phosphokinase and myoglobin levels.

RESULTS

The amount of surgical bleeding, drainage volume, hospital stay, and postoperative visual analog scale score of the research group were lower than those of the control group (P < .05), and the duration of analgesic medication was shorter than that of the control group (P < .05), and the levels of serum creatine phosphokinase and myoglobin were lower than those of the control group at 1 and 3 days postoperatively, and the differences were statistically significant (P < .05).

CONCLUSION

Preoperative CT 3-dimensional reconstruction technique can clearly show the anatomical structures around the lung bullae and has its application value for precise lung bullae.

Computer-assisted image-based risk analysis and planning in lung surgery - a review

In this paper, we give an overview on current trends in computer-assisted image-based methods for risk analysis and planning in lung surgery and present our own developments with a focus on computed tomography (CT) based algorithms and applications. The methods combine heuristic, knowledge based image processing algorithms for segmentation, quantification and visualization based on CT images of the lung. Impact for lung surgery is discussed regarding risk assessment, quantitative assessment of resection strategies, and surgical guiding. In perspective, we discuss the role of deep-learning based AI methods for further improvements.

Anatomical video-assisted thoracoscopic surgery segmentectomies based on the three-dimensional reformation images

Segmentectomy was first done in 1939 by Churchill and Belsey in 1939. Video-assisted thoracoscopic surgery (VATS) segmentectomies are still more technically challenging than VATS lobectomies. With the increasing rate of early stage lung carcinomas, the thoracoscopic segmentectomies may have a major role in a near future. Four anatomical VATS segmentectomy videos clips were shared in this study. CT three-dimensional reformation could exactly show the small pulmonary nodule's precise position, clarifies the surrounding structures' relationship like the pulmonary artery (PA), pulmonary vein (PV), bronchus (B), fissure, and lymph nodes. Besides, the resection margin, skin incision, surgical approach can also be designed preoperatively. This feasible technique could increase the confidence for thoracic surgeons. Unnecessary explore time waste for locating small pulmonary nodules during the operation can be avoid, so the surgical accuracy can be improved, complications can be prevented, the duration of chest tube and length of hospital stay can be shortened.

Low-dose three-dimensional reconstruction of the femur with unit free-form deformation

PURPOSE

This paper describes a low-dose method for reconstructing three-dimensional models of femur, using a standard shape model (SSM) and two conventional x-ray images.

METHODS

The x-ray images were taken in two orthogonal directions. The x-ray source and sensor configurations were documented. An optimized algorithm was employed to align the x-ray image to the three-dimensional model. A method of direct correspondence building is proposed for linking two-dimensional images with three-dimensional projections of a SSM. The reconstruction method proposed in this paper is based on a SSM, which was adapted for x-ray images of individual bones. The adaption was executed by deforming the template bone shape until its silhouette boundary exactly matched the x-ray image of the individual bone. A silhouette-based unit free-form deformation method was evaluated for its suitability in the adaption of the SSM for x-ray images. Comprehensive experiments were designed and conducted for 35 specimens.

RESULTS

The validity of the low-dose reconstruction method was demonstrated for the femur, with good results for accuracy (mean error of 1.1 mm, root-mean-square error of 2.1 mm), reproducibility (intraobservation coefficient of variation of 1.1%, interobservation coefficient of variation of 1.4%), and time consumption (mean of 5 min for a full femur).

CONCLUSIONS

Once this approach has been validated in vivo, it should be suited to multiple applications of routine clinical and research practices.

Aggressive surgical management in patients with lung metastases originating from colorectal cancer: addressing the controversy

SUMMARY Pulmonary metastasis of stage IV colorectal cancer was long considered to be an incurable disease with an indication for palliative treatment. While technical advances in surgical therapy led to a broad acceptance of surgical resection of solitary lung metastases, the feasibility of removing all pulmonary metastases with a curative intention has now come to the center of attention. Despite the lack of randomized clinical trials giving evidence in support of the value of surgical resection, we postulate an aggressive surgical strategy within a multidisciplinary management framework.

Optimal management of pulmonary metastases from colorectal cancer

The incidence of colorectal cancers is rising worldwide and pulmonary metastases were seen in approximately 10-15% of all patients. Surgical metastasectomy is a widely accepted procedure in selected patients and is considered as the only curative option in patients with secondary pulmonary malignancy. But surgical resection remains controversial due to the lack of randomized trials, comparing pulmonary metastasectomy to control, either medical therapy, or observation. This article will discuss the differentiated therapeutic strategies for patients with pulmonary metastases of colorectal cancer, focusing on surgical resection, patient evaluation, prognostic factors, interdisciplinary therapeutic approaches and current trials.