6．画像診断

Medical Diagnostic Imaging

近年の画像技術の進歩は著しく，胸部外科領域においても三次元（3D）イメージによる手術支援などの革新的技術が臨床応用されている．本稿では，胸部外科領域における最新の画像解析および画像手術支援技術の知見について述べる．

Significant advancements in medical imaging technology have been made over the years. Currently, several commercial post-processing software solutions―such as Synapse Vinsent and Ziostation―are available to facilitate the creation of photorealistic three-dimensional （3D） images. Three-dimensional lung reconstruction with virtual modeling offers the opportunity to visualize tumors within the target segment or lobe and to confirm the bronchovascular anatomy, thereby enabling optimal surgical planning. Cross reality （XR）―which includes virtual reality （VR）, augmented reality （AR）, and mixed reality （MR）―enables surgeons to interact with computer-generated environments based on reality. In thoracic surgery, XR tools support anatomical assessment, surgical training through lifelike procedural simulations, preoperative planning, and intraoperative guidance. Lung perfusion scintigraphy with single photon emission computed tomography （SPECT-CT） allows for quantification of lobar perfusion during preoperative assessment of lung cancer candidates and provides a more accurate prediction of postoperative residual pulmonary function. Fractional flow reserve computed tomography （FFRCT） analysis is a non-invasive diagnostic tool used to determine the physiological impact of coronary artery disease （CAD） in patients with symptoms suggestive of CAD. The FFRCT has been demonstrated to reduce the necessity for invasive coronary angiography that shows no significant CAD. Coronary computed tomography angiography （CCTA） is a highly sensitive method of evaluating vascular anatomy, coronary plaque, calcification and stenosis. The pericoronary fat attenuation index （FAI）, a new imaging biomarker derived from CCTA, assesses vascular inflammation by detecting respective gradients in coronary perivascular adipose tissue attenuation. Several studies have shown that elevated pericoronary FAI is associated with vascular inflammation and increased risk of cardiac events.