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Kerley A-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3D-CT lung segmentation analysis

PURPOSE: Kerley A-lines are generally apparent in patients with pulmonary edema or lymphangitic carcinomatosis. There are two main thoughts regarding the etiology of Kerley A-lines, but no general agreement. Specifically, the lines are caused by thickened interlobular septa or dilated anastomotic ly...

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Autores principales: Tsuchiya, Nanae, Tsubakimoto, Maho, Nishie, Akihiro, Murayama, Sadayuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Singapore 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977263/
https://www.ncbi.nlm.nih.gov/pubmed/34750736
http://dx.doi.org/10.1007/s11604-021-01215-4
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author Tsuchiya, Nanae
Tsubakimoto, Maho
Nishie, Akihiro
Murayama, Sadayuki
author_facet Tsuchiya, Nanae
Tsubakimoto, Maho
Nishie, Akihiro
Murayama, Sadayuki
author_sort Tsuchiya, Nanae
collection PubMed
description PURPOSE: Kerley A-lines are generally apparent in patients with pulmonary edema or lymphangitic carcinomatosis. There are two main thoughts regarding the etiology of Kerley A-lines, but no general agreement. Specifically, the lines are caused by thickened interlobular septa or dilated anastomotic lymphatics. Our purpose was to determine the anatomic structure represented as Kerley A-lines using 3D-CT lung segmentation analysis. MATERIALS AND METHODS: We reviewed 139 charts of patients with lymphangitic carcinomatosis of the lung who had CT and X-ray exams with a maximum interval of 7 days. The presence of Kerley A-lines on X-ray was assessed by a radiologist. The A-lines on X-ray were defined as follows: dense; fine (< 1 mm thick); ≥ 2 cm in length, radiating from the hilum; no bifurcation; and not adjacent to the pleura. For cases with Kerley A-lines on X-ray, three radiologists agreed that the lines on CT corresponded with Kerley A-lines. The incidence of A-lines and the characteristics of the lines were investigated. The septal lines between lung segments were identified using a 3D-CT lung segmentation analysis workstation. The percentage of agreement between the A-lines on CT and lung segmental lines was assessed. RESULTS: On chest X-ray, 37 Kerley A-lines (right, 16; left, 21) were identified in the 22 cases (16%). Of these, 4 lungs with 12 lines were excluded from analysis due to technical reasons. Nineteen of the 25 lines (76%) corresponded to the septal lines on CT. Of these, 11 lines matched with automatically segmented lines (intersegmental septa, 4; intersubsegmental septa, 7) by the workstation. Two lines (8%) represented fissures. Four lines corresponded to the bronchial wall/artery (3 lines, 12%) or vein (1 line, 4%). CONCLUSION: Kerley A-lines primarily represented thickened and continued interlobular septal lines that corresponded to the septa between lung segments and subsegments. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11604-021-01215-4.
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spelling pubmed-89772632022-04-07 Kerley A-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3D-CT lung segmentation analysis Tsuchiya, Nanae Tsubakimoto, Maho Nishie, Akihiro Murayama, Sadayuki Jpn J Radiol Original Article PURPOSE: Kerley A-lines are generally apparent in patients with pulmonary edema or lymphangitic carcinomatosis. There are two main thoughts regarding the etiology of Kerley A-lines, but no general agreement. Specifically, the lines are caused by thickened interlobular septa or dilated anastomotic lymphatics. Our purpose was to determine the anatomic structure represented as Kerley A-lines using 3D-CT lung segmentation analysis. MATERIALS AND METHODS: We reviewed 139 charts of patients with lymphangitic carcinomatosis of the lung who had CT and X-ray exams with a maximum interval of 7 days. The presence of Kerley A-lines on X-ray was assessed by a radiologist. The A-lines on X-ray were defined as follows: dense; fine (< 1 mm thick); ≥ 2 cm in length, radiating from the hilum; no bifurcation; and not adjacent to the pleura. For cases with Kerley A-lines on X-ray, three radiologists agreed that the lines on CT corresponded with Kerley A-lines. The incidence of A-lines and the characteristics of the lines were investigated. The septal lines between lung segments were identified using a 3D-CT lung segmentation analysis workstation. The percentage of agreement between the A-lines on CT and lung segmental lines was assessed. RESULTS: On chest X-ray, 37 Kerley A-lines (right, 16; left, 21) were identified in the 22 cases (16%). Of these, 4 lungs with 12 lines were excluded from analysis due to technical reasons. Nineteen of the 25 lines (76%) corresponded to the septal lines on CT. Of these, 11 lines matched with automatically segmented lines (intersegmental septa, 4; intersubsegmental septa, 7) by the workstation. Two lines (8%) represented fissures. Four lines corresponded to the bronchial wall/artery (3 lines, 12%) or vein (1 line, 4%). CONCLUSION: Kerley A-lines primarily represented thickened and continued interlobular septal lines that corresponded to the septa between lung segments and subsegments. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11604-021-01215-4. Springer Singapore 2021-11-09 2022 /pmc/articles/PMC8977263/ /pubmed/34750736 http://dx.doi.org/10.1007/s11604-021-01215-4 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Tsuchiya, Nanae
Tsubakimoto, Maho
Nishie, Akihiro
Murayama, Sadayuki
Kerley A-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3D-CT lung segmentation analysis
title Kerley A-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3D-CT lung segmentation analysis
title_full Kerley A-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3D-CT lung segmentation analysis
title_fullStr Kerley A-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3D-CT lung segmentation analysis
title_full_unstemmed Kerley A-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3D-CT lung segmentation analysis
title_short Kerley A-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3D-CT lung segmentation analysis
title_sort kerley a-lines represent thickened septal plates between lung segments in patients with lymphangitic carcinomatosis: confirmation using 3d-ct lung segmentation analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8977263/
https://www.ncbi.nlm.nih.gov/pubmed/34750736
http://dx.doi.org/10.1007/s11604-021-01215-4
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