Pre- and Postoperative Imaging of Lung-sparing Thoracic Resection

Surgical approaches to lung cancer resection are rapidly evolving, particularly for early-stage lung cancer. Advances in chest CT technology and increasing use of CT in patient care have led to detection of smaller nodules, many with ground-glass attenuation that do not require lobectomy for resection. Lung-sparing and minimally invasive techniques have been shown to result in improved patient outcomes compared with those of traditional open thoracotomy and are noninferior in terms of cancer recurrence. As more patients undergo these surgeries, it is important for radiologists to be aware of useful information for surgeons before the operation. It is helpful for radiologists to understand the indications for lung-sparing surgery and have a basic understanding of the techniques involved in video-assisted and robotic thoracic operations. Identification of the location and morphology of the tumor, as well as the pulmonary vasculature that feeds and drains the segment of lung containing the tumor is important. Also, the presence of emphysema, pulmonary fibrosis, and incomplete fissures is useful information. In addition, chest imaging is also progressing, with improvements in multiplanar reformations and three-dimensional imaging allowing for more detailed and accurate image-based localization of tumors and visualization of anatomy. Nodule localization for surgery plays an even larger role given the limited ability to palpate nodules during surgery with minimally invasive surgery approaches. Methods can involve imaging and in vivo localization, with transthoracic and bronchoscopic methods used to label a nodule. Finally, radiologists should be aware of postoperative complications and their imaging characteristics, such as suture line granulomas and bronchopleural fistulas. Supplemental material is available for this article. ^©RSNA, 2025.