Prediction and intraoperative validation of pulmonary interlobar fissure development based on high-resolution thin-slice computed tomography and multiplanar reconstruction three-dimensional reconstruction technology: a prospective study.
肺叶间裂发育情况是影响胸腔镜肺切除术复杂程度及手术策略选择的重要解剖学因素。术前准确评估叶间裂完整程度有助于制定手术方案并降低术中风险。本前瞻性诊断准确性研究旨在评估高分辨率薄层计算机断层扫描（HRCT）联合多平面重建（MPR）三维（3D）技术预测肺叶间裂发育情况的准确性，并通过术中验证探讨其预测性能的区域差异。共纳入2023年9月至2024年4月期间接受单侧肺部手术的447例患者。术前，三名放射科医师独立使用HRCT和MPR图像对手术侧叶间裂发育情况进行评分（分为5个节段：右水平裂、右斜裂上/下段、左斜裂上/下段），以平均评分作为术前结果。术中，三名胸外科医师独立评估叶间裂的实际状况，记录平均评分作为术中结果。采用符合率、相差1级以内比例及Kappa系数分析术前与术中评分的一致性。术前与术中评分的总体符合率为55.42%，88.67%的病例评分差异在1级以内（Kappa=0.48，P<0.01），提示中等程度一致性。亚组分析显示，左肺的预测准确性高于右肺：符合率为59.54%对52.87%，相差1级以内比例为90.24%对84.48%（左肺Kappa=0.556；右肺Kappa=0.437，均P<0.01）。在具体节段中，左斜裂下段的符合率（60.93%）和Kappa值（0.563）最高，而右水平裂的符合率（52.59%）和Kappa值（0.414）最低。HRCT联合MPR三维重建技术可有效预测肺叶间裂的发育情况，且左肺的准确性优于右肺。这些发现为胸外科术前规划提供了有价值的参考，尤其是在评估右水平裂等复杂叶间裂节段方面。
Pulmonary interlobar fissure development is an important anatomical factor influencing the complexity of thoracoscopic pulmonary resection and surgical strategy selection. Accurate preoperative assessment of fissure completeness may facilitate operative planning and reduce intraoperative risks. This prospective diagnostic accuracy study aimed to evaluate the accuracy of high-resolution thin-slice computed tomography (HRCT) combined with multiplanar reconstruction (MPR) three-dimensional (3D) technology in predicting the development of pulmonary interlobar fissures, and to explore regional differences in predictive performance through intraoperative validation. A total of 447 patients who underwent unilateral pulmonary surgery between September 2023 and April 2024 were enrolled. Preoperatively, three radiologists independently scored the development of operative-side interlobar fissures (divided into 5 segments: right horizontal fissure, upper/lower segments of right oblique fissure, and upper/lower segments of left oblique fissure) using HRCT and MPR images, with the average score as the preoperative result. Intraoperatively, three thoracic surgeons independently assessed the actual condition of the fissures, and the average score was recorded as the intraoperative result. The consistency between preoperative and intraoperative scores was analyzed using concordance rate, proportion of differences within 1 grade, and Kappa coefficient. The overall concordance rate between preoperative and intraoperative scores was 55.42%, with 88.67% of cases showing a score difference within 1 grade (Kappa =0.48, P<0.01), indicating moderate agreement. Subgroup analysis revealed that the left lung had higher predictive accuracy than the right lung: the concordance rate was 59.54% 52.87%, and the proportion of differences within 1 grade was 90.24% 84.48% (left lung Kappa =0.556; right lung Kappa =0.437, both P<0.01). Among specific segments, the lower segment of the left oblique fissure exhibited the highest concordance rate (60.93%) and Kappa value (0.563), while the right horizontal fissure had the lowest concordance rate (52.59%) and Kappa value (0.414). HRCT and MPR 3D reconstruction technology can effectively predict the development of pulmonary interlobar fissures, with superior accuracy in the left lung compared to the right lung. These findings provide valuable reference for preoperative planning of thoracic surgery, particularly in assessing complex fissure segments such as the right horizontal fissure.
Xiuxin Mo, Hongbing Zhang, Chengcheng Chen, Jun Chen. Prediction and intraoperative validation of pulmonary interlobar fissure development based on high-resolution thin-slice computed tomography and multiplanar reconstruction three-dimensional reconstruction technology: a prospective study.. Journal of thoracic disease. 2026; doi:10.21037/jtd-2026-0778.
Xiuxin Mo, Hongbing Zhang, Chengcheng Chen, Jun Chen (2026). Prediction and intraoperative validation of pulmonary interlobar fissure development based on high-resolution thin-slice computed tomography and multiplanar reconstruction three-dimensional reconstruction technology: a prospective study.. Journal of thoracic disease. https://doi.org/10.21037/jtd-2026-0778
Xiuxin Mo, Hongbing Zhang, Chengcheng Chen, Jun Chen. Prediction and intraoperative validation of pulmonary interlobar fissure development based on high-resolution thin-slice computed tomography and multiplanar reconstruction three-dimensional reconstruction technology: a prospective study.[J]. Journal of thoracic disease, 2026 doi:10.21037/jtd-2026-0778.
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