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Identification of anatomical types of segmental bronchi in left superior and lingular lobes using multi-slice CT

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Abstract

Purpose

The objectives of this study were to evaluate various branching patterns of segmental bronchi in the left superior and lingular lobes and to survey the anatomical diversity and sex-related differences of these branches in a large sample of the study population.

Materials and methods

Overall, 10,000 participants (5428 males, and 4572 females, mean age 50 ± 13.5 years [SD] years; age range: 3–91 years) who underwent multi-slice CT (MSCT) scans between September 2019 and December 2021 were retrospectively included. Using the syngo.via post-processing workstation, the data were applied to generate three-dimensional (3D) and virtual bronchoscopy (VB) simulations of a bronchial tree. The reconstructed images were then interpreted to identify and categorize distinct bronchial patterns in the left superior and lingular lobes. Cross-tabulation analysis and the Pearson Chi-square (χ2) test were used to calculate the constituent ratios of bronchial branch types and determine their significance between male and female groups.

Results

Our results revealed mainly four distinct types for the left superior lobe (LSL) bronchial tree, i.e., (B1 + 2, B3, 76.13%); (B1 + 2 + 3, 17.32%); (B1 + 3, B2, 5.74%); (B1a + B3, B1b + B2, 0.81%) and two types for the left lingular lobe (LLL) bronchial tree, i.e., (B4, B5, 91.05%); (B4, B5, B*, 8.95%). There were no significant sex-related differences in the proportion of bronchial branches in LLL (P > 0.05). However, sex-related differences were significant in the proportion of bronchial branches in LSL (P < 0.05).

Conclusion

The current study has validated the presence of segmental bronchial variations in the left superior and lingular lobes. These findings may have a crucial effect on the diagnosis of symptomatic patients, as well as in carrying out procedures such as lung resections, endotracheal intubation, and bronchoscopies.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Abbreviations

3D:

Three dimensional

2D:

Two dimensional

VB:

Virtual bronchoscopy

LSL:

Left superior lobe

LLL:

Left lingular lobe

B1:

Apical segmental bronchus

B2:

Posterior segmental bronchus

B3:

Anterior segmental bronchus

B4:

Superior lingular segmental bronchus

B5:

Inferior lingular segmental bronchus

B*:

Extra segmental bronchus

B1 + 2:

Common stem of apical and posterior segmental bronchus

B1 + 3:

Common stem of apical and anterior segmental bronchus

B2 + 3:

Common stem of anterior and posterior segmental bronchus

References

  1. Beder S, Küpeli E, Karnak D, Kayacan O (2008) Tracheobronchial variations in turkish population. Clin Anat 21:531–538. https://doi.org/10.1002/ca.20667

    Article  PubMed  Google Scholar 

  2. Boyden EA, Hartmann JF (1946) An analysis of variations in the bronchopulmonary segments of the left upper lobes of fifty lungs. Am J Anat 79:321–360. https://doi.org/10.1002/aja.1000790302

    Article  CAS  PubMed  Google Scholar 

  3. Boyden EA (1955) Segmental anatomy of the lungs a study of the patterns of the segmental bronchi and related pulmonary vessels. McGraw-Hill, New York. https://doi.org/10.1148/66.6.895b

    Book  Google Scholar 

  4. Chassagnon G, Morel B, Carpentier E, Le Pointe HD, Sirinelli D (2016) Tracheobronchial branching abnormalities: lobe-based classification scheme. Radiographics 36:358–373. https://doi.org/10.1148/rg.2016150115

    Article  PubMed  Google Scholar 

  5. D’Antoni AV (2016) Gray’s anatomy, the anatomical basis of clinical practice, forty-first edition, by susan standring, editor-in-chief, elsevier limited. Clin Anat 29:264–265. https://doi.org/10.1002/ca.22677

    Article  Google Scholar 

  6. Dalrymple NC, Prasad SR, Freckleton MW, Chintapalli KN (2005) Introduction to the language of three-dimensional imaging with multidetector CT. Radiographics 25:1409–1428. https://doi.org/10.1148/rg.255055044

    Article  PubMed  Google Scholar 

  7. Fetita CI, Prêteux F, Beigelman AC, Grenier P (2004) Pulmonary airways: 3-D reconstruction from multislice CT and clinical investigation. IEEE Trans Med Imaging 23:1353–1364. https://doi.org/10.1109/TMI.2004.826945

    Article  PubMed  Google Scholar 

  8. Gariani J, Martin SP, Botsikas D, Becker CD, Montet X (2018) Evaluating the effect of increased pitch, iterative reconstruction and dual source CT on dose reduction and image quality. Br J of Radiol 91(1088):20170443. https://doi.org/10.1259/bjr.20170443

    Article  Google Scholar 

  9. Ghaye B, Szapiro D, Fanchamps JM, Dondelinger RF (2001) Congenital bronchial abnormalities revisited. Radiographics 21:105–119. https://doi.org/10.1148/radiographics.21.1.g01ja06105

    Article  CAS  PubMed  Google Scholar 

  10. Hammond E, Chan KS, Ames JC, Stoyles N, Sloan CM, Guo J, Newell JD, Hofman EA, Sieren JC (2018) Impact of advanced detector technology and iterative reconstruction on low-dose quantitative assessment of lung computed tomography density in a biological lung model. Med Phys 45:3657–3670. https://doi.org/10.1002/mp.13057

    Article  Google Scholar 

  11. Horton KM, Horton MR, Fishman EK (2007) Advanced visualization of airways with 64-MDCT: 3D mapping and virtual bronchoscopy. Am J Roentgenol 189:1387–1396. https://doi.org/10.2214/AJR.07.2824

    Article  Google Scholar 

  12. Huang M, Wang T, Wang X, Zhao X (2019) An anatomical study of the right bronchial tree using multi-detector computed tomography. Surg Radiol Anat 41:335–338. https://doi.org/10.1007/s00276-019-02199-7

    Article  PubMed  Google Scholar 

  13. Keenan RJ, Landreneau RJ, Maley RH, Singh D, Macherey R, Bartley S, Santucci T (2004) Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg 78:228–233. https://doi.org/10.1016/j.athoracsur.2004.01.024

    Article  PubMed  Google Scholar 

  14. Kiraly AP, Helferty JP, Hoffman EA, McLennan G, Higgins WE (2004) Three-dimensional path planning for virtual bronchoscopy. IEEE Trans Med Imaging 23:1365–1379. https://doi.org/10.1109/TMI.2004.829332

    Article  CAS  PubMed  Google Scholar 

  15. Krause GR, Lubert M (1951) The anatomy of the bronchopulmonary segments: clinical applications. Radiology 56:333–354. https://doi.org/10.1148/56.3.333

    Article  CAS  PubMed  Google Scholar 

  16. Lee KS, Bae WK, Lee BH, Kim IY, Choi EW, Lee BH (1991) Bronchovascular anatomy of the upper lobes: evaluation with thin-section CT. Radiology 181:765–772. https://doi.org/10.1148/radiology.181.3.1947094

    Article  CAS  PubMed  Google Scholar 

  17. Leroux BT (1962) The bronchial anatomy of the left upper lobe. J Thorac Cardiovasc Surg 44:216–224. https://doi.org/10.1016/s0022-5223(19)32975-7

    Article  CAS  Google Scholar 

  18. Li Y, Xia L (2020) Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. Am J of Roentgenol 214:1280–1286. https://doi.org/10.2214/AJR.20.22954

    Article  Google Scholar 

  19. Ma X, Ma Y, Wang S (1997) Analysis of 270 cases of bronchial variation in lung segment. Chin J Pract Intern Med 10:593–596

    Google Scholar 

  20. Mehran RJ (2018) Fundamental and practical aspects of airway anatomy: from glottis to segmental bronchus. Thorac Cardiovasc Surg 28:117–125. https://doi.org/10.1016/j.thorsurg.2018.02.003

    Article  Google Scholar 

  21. Mori K, Ema S, Kitasaka T, Mekada Y, Ide I, Murase H, Suenaga Y, Takabatake H, Mori M, Natori H (2005) Automated nomenclature of bronchial branches extracted from CT images and its application to biopsy path planning in virtual bronchoscopy. Lect Notes Comput Sci 3750:854–861. https://doi.org/10.1007/11566489_105

    Article  Google Scholar 

  22. Naidich DP, Zinn WL, Ettenger NA, McCauley DI, Garay SM (1988) Basilar segmental bronchi: thin-section CT evaluation. Radiology 169:11–16. https://doi.org/10.1148/radiology.169.1.3420245

    Article  CAS  PubMed  Google Scholar 

  23. Perhomaa M, Lähde S, Rossi O, Suramo I (1997) Helical CT in evaluation of the bronchial tree. Acta Radiol 38:83–91. https://doi.org/10.3109/02841859709171247

    Article  CAS  PubMed  Google Scholar 

  24. Pitel M, Boyden EA (1953) Variations in the bronchovascular patterns of the left lower lobe of fifty lungs. J Thorac Surg 26:633–653. https://doi.org/10.1016/s0096-5588(20)30791-1

    Article  CAS  PubMed  Google Scholar 

  25. Reck M, Rabe KF (2017) Precision diagnosis and treatment for advanced non–small-cell lung cancer. N Engl J Med 377:849–861. https://doi.org/10.1056/nejmra1703413

    Article  CAS  PubMed  Google Scholar 

  26. Room C (1950) Nomenclature of broncho-pulmonary anatomy; an international nomenclature accepted by the Thoracic Society. Thorax 5:222–228. https://doi.org/10.1136/thx.5.3.222

    Article  Google Scholar 

  27. Rosell J, Cabras P (2013) A three-stage method for the 3D reconstruction of the tracheobronchial tree from CT scans. Comput Med Imaging Graph 37:430–437. https://doi.org/10.1016/j.compmedimag.2013.07.003

    Article  PubMed  Google Scholar 

  28. Salvolini L, Bichi SE, Costarelli L, DeNicola M (2000) Clinical applications of 2D and 3D CT imaging of the airways—a review. Eur J Radiol 34:9–25. https://doi.org/10.1016/S0720-048X(00)00155-8

    Article  CAS  PubMed  Google Scholar 

  29. Scannell JG (1949) Bronchographic anatomy of the lungs. Surg Clin North Am 29:573–581

    Article  CAS  PubMed  Google Scholar 

  30. Sealy WC, Connally SR, Dalton ML (1993) Naming the bronchopulmonary segments and the development of pulmonary surgery. Ann Thorac Surg 55:184–188. https://doi.org/10.1016/0003-4975(93)90507-E

    Article  CAS  PubMed  Google Scholar 

  31. Ugalde P, Camargo J, de Deslauriers J (2007) Lobes, fissures, and bronchopulmonary segments. Thorac Surg 17:587–599. https://doi.org/10.1016/j.thorsurg.2006.12.008

    Article  Google Scholar 

  32. Wahidi MM, Shojaee S, Lamb CR, Ost D, Maldonado F, Eapen G, Carof DA, Stevens MP, Ouellette DR, Lilly C, Gardner DD, Glisinski K, Pennington K, Alalawi R (2020) The use of bronchoscopy during the coronavirus disease 2019 pandemic: CHEST/ AABIP guideline and expert panel report. Chest 158:1268–1281. https://doi.org/10.1016/j.chest.2020.04.036

    Article  CAS  PubMed  Google Scholar 

  33. Wang T, Meng M, Huang M, Zhao X (2018) Variations of right bronchial tree: a study with multi-detector CT. Surg Radiol Anat 40:955–958. https://doi.org/10.1007/s00276-018-2033-1

    Article  PubMed  Google Scholar 

  34. Wu WB, Xu XF, Wen W, Xu J, Zhu Q, Chen L (2016) Thoracoscopic pulmonary sub-subsegmentectomy based on three-dimensional images. Ann Thorac Surg 102:389–391. https://doi.org/10.1016/j.athoracsur.2016.04.048

    Article  Google Scholar 

  35. Yang Q, Xie B, Hu M, Sun X, Huang X, Guo M (2016) Thoracoscopic anatomic pulmonary segmentectomy: a 3-dimensional guided imaging system for lung operations. Interact Cardiovasc Thorac Surg 23:183–189. https://doi.org/10.1093/icvts/ivw085

    Article  PubMed  Google Scholar 

  36. Zhao X, Ju Y, Liu C, Li J, Huang M, Sun J, Wang T (2009) Bronchial anatomy of left lung: a study of multi-detector row CT. Surg Radiol Anat 31:85–91. https://doi.org/10.1007/s00276-008-0404-8

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was supported by Major Scientific and Technological Innovation Projects in Shandong Province, China (2019JZZY020106, 2015ZDXX0201A02).

Author information

Authors and Affiliations

  1. Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Digital Human and Clinical Anatomy, Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, 44#, Wenhua Xi Road, Jinan, 250012, Shandong, China

    Saeed Javed, Yixuan Mei, Dian Wan, Hailan Liu & Shuwei Liu

  2. Department of Medical Imaging, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250021, Shandong, China

    Yi Zhang & Cheng Liu

  3. Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, 250014, China

    Yi Zhang

  4. Chengdu Institute of Biological Products, Chengdu, 610041, Sichuan, China

    Dian Wan

  5. Department of Medical Imaging, Dongying People’s Hospital, Dongying, 257091, China

    Yixuan Mei

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Contributions

SJ: project development, study concepts and design, literature research, clinical studies, data collection, data analysis, manuscript preparation, manuscript editing. YZ: project development, literature research, clinical studies, manuscript editing. DW: study concepts and design, clinical studies, data collection, data analysis. YM: study concepts and design, clinical studies, data collection, data analysis, statistical analysis. HL: study concepts and design, clinical studies, data collection, data analysis. CL: project development, study concepts and design, literature research, manuscript editing. SL: project development, study concepts and design, literature research, manuscript editing.

Corresponding author

Correspondence to Shuwei Liu.

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The authors have no conflict of interest to declare.

Ethical approval

All procedures followed were as per the protocol of the work center and ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. This work was approved by the Ethics Committee of the School of Basic Medicine of Shandong University (No. ECSBMSSDU2018-1-050).

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Javed, S., Mei, Y., Zhang, Y. et al. Identification of anatomical types of segmental bronchi in left superior and lingular lobes using multi-slice CT. Surg Radiol Anat 45, 1461–1470 (2023). https://doi.org/10.1007/s00276-023-03208-6

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