Neoplastic Extension Across Pulmonary Fissures: Value of Spiral Computed Tomography and Multiplanar Reformations

To assess the value of spiral computed tomography (CT) with multiplanar reformations for detection of neoplastic extension across pulmonary fissures, 51 patients with a lung neoplasm near a fissure underwent spiral CT, followed by multiplanar reformations, and spaced thin-section CT scans through the area of contact between tumor and fissure. The CT studies were evaluated for visibility of fissures and their relationship to the tumor. Imaging findings were compared with surgical results in 31 patients who underwent thoracotomy. Visibility of fissures on multiplanar reformations was either good or acceptable in 47 (92.2%) patients, and poor in four. Surgical findings of neoplastic extension across the major or the minor fissure were present in seven and eight patients, respectively. Thin-section CT scans were 83.3% sensitive in assessing neoplastic involvement of the major fissure, axial CT scans were 57.1% sensitive, and spiral CT multiplanar images were 100% sensitive. In the evaluation of the minor fissure, thin-section CT and axial spiral CT scans were considered inconclusive in six patients whereas multiplanar reformations enabled correct assessment of the fissure/neoplasm relationship in all but one patient. Spiral CT multiplanar images are accurate for detection of transfissural neoplastic extension, and are superior to axial CT scans for evaluation of tumors near the minor fissure.