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Vol.48 No.3 contents | Japanese/English |
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- Original Article -
The Physical Relationship of Structures in the Mediastinal Space as a Basis for Interpretation of Radiograms of Regional Mediastinal Lymph Node Stations
Yuko Tanaka1, Takeshi Johkoh2, Shun-ichi Watanabe3, Masahiko Kusumoto4, Yoshinobu Sato5, Ryosuke Tsuchiya31Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Japan, 2Division of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Japan, 3Division of Thoracic Surgery, 4Division of Radiology, National Cancer Center Hospital, Japan, 5Division of Image Analysis, Department of Medical Engineering, Osaka University Graduate School of Medicine, Japan
Objective. To comprehend the physical relationship between individual basic structures in the mediastinal space and discuss the physical relationship of regional mediastinal lymph node stations from CT images. Materials and Methods. We observed the physical relationship between basic structures in the mediastinal space in 201 patients who underwent total lung CT scan because of suspicion of nodal cell or diffuse pneumonia in Osaka University Hospital, from the beginning of April 2005 to the middle of September 2005, and 7 patients who underwent a preoperative total lung CT scan in the National Cancer Center Hospital, from the middle of May 2005 to the middle of August 2005. We used the "General Rules for Clinical and Pathological Records of Lung Cancer (6th Edition)" for classifying regional lymph node stations. Results. Comparing 2 adjoining basal axial slices, it was clear that there were differences among individuals in the hierarchical relation of basal axial slices and there fell into 4 types as follows: the upper rim of the brachiocephalic (left innominate) vein where it ascends to the left, crossing anterior to the trachea at its middle (79%) and the upper margin of the aortic arch (21%), the upper margin of the azygos vein (61%) and the lower margin of the aortic arch (39%), the upper margin of the azygos vein (96%) and the upper margin of the left pulmonary artery (4%), and the upper margin of the right pulmonary artery (70%) and the tracheal bifurcation (30%). The frequency of the structure of appearing on the upper playing was shown in parentheses. From these differences, it became clear that borders on axial slices which were used to divide stations #2-#4 and #6 were different from the depiction in the General Rules, and the images of each lymph node station also different. Conclusion. The result revealed that the physical relationships between anatomic landmarks in the mediastinal space for classifying regional mediastinal lymph node stations differ considerably in individuals, and the border lines of stations #2-#4, #6 different from the depiction in the General Rules. We should take those relationships into account for accurate diagnosis, treatment and three-dimensional display of regional mediastinal lymph node stations.
key words: Lung cancer, Mediastinal lymph node dissection, CT, Chest
Received: August 9, 2006
Accepted: March 4, 2008
JJLC 48 (3): 176-184, 2008
