简介

这e-Anatomy单元针对使用正常CT扫描进行的胸部解剖（肺，胸膜，心脏，主动脉，胸腔淋巴结及其他相关的解剖结构）。  

它主要帮助放射科医生进行日常操作，重点特别放在肺段解剖学，用于肺癌的治疗前阶段分类的国际肺癌研究协会淋巴结分区，或者用于经导管主动脉瓣置换和胸主动脉瘤跟进的胸主动脉测量。但这单元也可有助了解胸腔的放射解剖结构，尤其是医学生，放射学，肺病学，放射肿瘤学或胸外科住院医师。

材料与方法

胸部计算机断层扫描是由法国Imaios的放射科医生Dr.Antoine Micheau对43岁正常男性患者进行的，使用的是Siemens Somatom Definition Edge，其技术指标如下：

注射碘化造影剂（Omnipaque碘海醇 350mg I/mL），并使用心电图信号

我们使用了从实质和纵隔窗口截取的图像，结合额（冠状）面和矢状面进行了多平面重建。

我们创建了3D胸部图像，包括一般解剖结构，表面解剖结构，胸骨，胸肌，气管和支气管，肺，胸腔血管，胸主动脉，肺动脉，肺静脉和上腔静脉。

Dr Antoine Micheau使用解剖学术语2（Terminologia Anatomica 2）来标注解剖标签。

在标记过程中，我们发现了一些不可避免的解剖变化，请参照下方。

Anatomical variants and notes from the author about the anatomical labeling of the thorax CT:

• In the lower lobe of the left lung, there is an inconstant subsuperior pulmonary segment that is seen in approximately 30% of individuals, located between the superior and basal segments of the lower lobe. For pedagogical purposes, we included it in the superior segment of right lower lung, but we termed his bronchus as subpsuperior bronchus (S*), and his artery as subsuperior artery (A*).
• The lower lobe of the right lung has two superior segmental bronchi, with separate origins from the right inferior lobar bronchus.
• In the lower left lobe, it is not clear if there is a common basal anteromedial segment, or if these segments are separated (this is the option we chose for labeling, but consequently, the anterior segment appears to be slightly lateral and the lateral segment appears to be slightly posterior….).
• Segmental and subsegmental pulmonary arteries are generally parallel to segmental and subsegmental bronchi and run alongside them. This is in contrast to the course of most pulmonary veins, which run independently of bronchi within interlobular septa. In this module, the segmental arteries were named according to the bronchopulmonary segments that they feed, following the Terminologia Anatomica 2 (we just added the terms interlobar arteries, used in daily practice). However, the proximal portions of the arteries can run independently of their respective bronchi for short segments. Frequently, there are also accessory arteries from neighboring segments, particularly in the right upper lobe. Segmental and subsegmental pulmonary arteries vary considerably in the location of their origins, in whether they arise as common trunks with other arteries or as separate arteries, and in their number. Here are the variations encountered in this e-Anatomy module:

        - There is an additional segmental middle lobar artery, draining the upper lateral part of middle lobe, and connected directly to the left lower lobe artery.
        - There are two separate superior and subsuperior segmental arteries in the right lung.
        - There are at least 3 separate superior segmental arteries in the left lung.

• In our case, the brachiocephalic artery shares a common origin with the left common carotid artery forming a bovine arch, most common variant of the aortic arch (near 15% population).
• For the measurements of aortic diameters, we put colored lines as overlay on axial, coronal, sagittal and 3VR, however these landmarks are inevitably imprecise because the measurements of the diameters of the aorta must imperatively be measured on multiplanar reconstructions perpendicular to the aorta (blood flow) and not directly on axial, coronal or frontal images.
• Some structures like the phrenic nerve along with the pericardiacophrenic artery and vein, or some lymph nodes of the thorax cannot be clearly seen on this CT. But for educational purposes, we put anatomical labels on the presumed place of these structures.
• The IASLC lymph node map provides a reproducible and consistent set of definitions for the discussion of regional lymphadenopathy in patients with lung cancer. However, because of its comprehensiveness and text-based presentation, it may be challenging to grasp, remember, and apply during daily practice especially on thorax CTs. More importantly, ambiguities may emerge when its definitions are rigorously applied during interpretation of CT images. That’s why we used the article of El-Sherief et al. (Radiographics) for the delimitations of the thoracic lymph node area. The main changes concern the lower boundary of station 1 (thoracic inlet with sagittal oblique plane preferred to the clavicles) and the lower boundary of the station 4 (it should be on the right side of the inferior border of the azygos vein, and on the left side of the superior border of the left main pulmonary artery, but the result is unclear for the precarinal space that is included in station 4 during daily practice.