An increase in micro-vessels beneath the pleural surface on computed tomography as a preoperative predictor of pleural adhesions: a prospective study

Abstract Purpose Pleural adhesions, which may be present in varying degrees and involve blood vessels, often complicate thoracic surgery. The blood flow within pleural adhesions can be identified on computed tomography (CT) as micro-vessels beneath the pleural surface (MVBP). We conducted a prospective study to assess if MVBP can be detected on preoperative CT to predict intraoperative pleural adhesions. Methods This prospective study investigated the preoperative CT images of patients scheduled to undergo surgery for lung tumors. MVBP was defined as positive when lung vessels were identified below the pleura on CT. MVBP was evaluated for each lung segment, and intraoperative findings of pleural adhesions on the segments were then recorded. Results This study included 173 patients, with 1532 segments evaluated. Pleural adhesions were found in 51 patients and confirmed in 92 segments. The number of segments evaluated preoperatively as MVBP-positive was 134 (9%), of which 36 (26.9%) had pleural adhesions. Multivariable analysis identified that MVBP was an independent significant predictor (odds ratio = 2.29, 95% confidence interval 1.09–4.80, P = 0.028) of pleural adhesions on a per-patient basis. Conclusions MVBP is a valuable predictor of pleural adhesions. The method is useful in clinical practice because it does not require additional examinations and is easy to assess.