Simone Michele, Mutter Didier, Rubino Francesco, Dutson Erik, Roy Catherine, Soler Luc, Marescaux Jacques
IRCAD/European Institute of Telesurgery, Université Louis Pasteur, 1 Place de l'Hopital, 67091 Strasbourg, France.
Ann Surg. 2004 Jul;240(1):82-8. doi: 10.1097/01.sla.0000129493.22157.b7.
Our goal was to evaluate the clinical reliability of a new software system employing 3-dimensional (3D) virtual anatomic reconstruction and intraluminal virtual exploration for detection of choledocholithiasis and preoperative visualization of the biliary anatomy.
Virtual reality systems have been proposed for gastroscopy, bronchoscopy, and colonoscopy, as well as for the 3D reconstruction of liver anatomy and hepatic lesions. The impact of these systems in preoperative diagnostics has not been established due to the lack of large clinical series evaluating their reliability.
From November 2000 to July 2002, all patients presenting to our Institute with suspected choledocholithiasis were prospectively included in the study. All patients underwent conventional magnetic resonance cholangiopancreatography (MRCP) and either intraoperative cholangiogram (IOC) or endoscopic retrograde cholangiopancreatography (ERCP). The digital data from MRCP were incorporated into an original virtual reality software system to generate a 3D reconstruction. All 3D reconstructions were evaluated by a surgeon and a computer software engineer who were blind to the results of the IOC or ERCP. Sensitivity and specificity were then calculated based on the results of either the IOC or ERCP.
Sixty-five patients were enrolled in the study. The average time required to reconstruct the images into navigable virtual reality was 7.5 minutes (range, 4-13.5). The 3D virtual cholangioscopy had sensitivity and specificity rates of 71% and 91%, respectively, compared with 61% and 86% of the standard MRCP.
: The 3D virtual cholangioscopy provides detailed preoperative reconstruction of biliary anatomy and reliable identification of choledocholithiasis with acceptable sensitivity and specificity in a clinical setting. Newer software developments may further enhance its accuracy, so that virtual cholangioscopy might challenge or replace more invasive diagnostic measures in the near future.
我们的目标是评估一种新的软件系统的临床可靠性，该系统采用三维（3D）虚拟解剖重建和腔内虚拟探查来检测胆总管结石以及对胆道解剖结构进行术前可视化。
虚拟现实系统已被应用于胃镜检查、支气管镜检查和结肠镜检查，以及肝脏解剖结构和肝脏病变的三维重建。由于缺乏评估其可靠性的大型临床系列研究，这些系统在术前诊断中的影响尚未确定。
从2000年11月至2002年7月，所有因疑似胆总管结石到我院就诊的患者均被前瞻性纳入研究。所有患者均接受了传统的磁共振胰胆管造影（MRCP）以及术中胆管造影（IOC）或内镜逆行胰胆管造影（ERCP）。将MRCP的数字数据纳入一个原始的虚拟现实软件系统以生成三维重建图像。所有三维重建图像均由一名外科医生和一名对IOC或ERCP结果不知情的计算机软件工程师进行评估。然后根据IOC或ERCP的结果计算敏感性和特异性。
65例患者纳入研究。将图像重建为可导航虚拟现实所需的平均时间为7.5分钟（范围4 - 13.5分钟）。三维虚拟胆管镜检查的敏感性和特异性分别为71%和91%，而标准MRCP的敏感性和特异性分别为61%和86%。
三维虚拟胆管镜检查在临床环境中能提供详细的术前胆道解剖结构重建，并能以可接受的敏感性和特异性可靠地识别胆总管结石。新的软件开发可能会进一步提高其准确性，因此在不久的将来，虚拟胆管镜检查可能会挑战或取代更具侵入性的诊断措施。
