ArticleJournal of thoracic disease2026
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.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: 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. Methods: 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. Results: 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% Conclusions: 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.
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