Nanashima Atsushi, Abo Takafumi, Sakamoto Ichiro, Hayashi Hideyuki, Fukuda Toru, Tobinaga Syuuichi, Araki Masato, Sawai Terumitsu, Nagayasu Takeshi
Division of Surgical Oncology and Department of Surgery, Nagasaki University Hospital, Nagasaki, Japan.
Hepatogastroenterology. 2012 Sep;59(118):1748-57. doi: 10.5754/hge11818.
BACKGROUND/AIMS: Recent developments in radiological technology allowed acquisition of images with high spatial resolution that facilitate effective 3-dimensional (3D) reconstruction of fusion images. Present study utilized 3D cholangiography and angiography with multi-detector-row computed tomography (MDCT) to acquire information regarding operative simulations.
3D-fusion images were evaluated in 39 patients with hepatobiliary malignancies who underwent surgical resections.
An aberrant branch of segment 3 over the umbilical portal vein, a large hepatoma compressed the hilar vessels, an aberrant branch of the caudate lobe vasculature in case of metastatic liver tumor with a right-sided umbilical portal vein and transected biliary leakage were clearly observed by 3D imaging system. Four patients with intrahepatic cholangiocarcinoma underwent multiple biliary stent placements and adequate placement of biliary stents was possible. In 22 patients with extrahepatic biliary carcinomas, visualization of the extent of tumor invasion by 3D-fusion images was equivalent to conventional cholangiography. In 2 patients, adequate placement of multiple stents could be visualized with this system. In 2 patients who underwent hepatectomy, more extended cancer invasion was observed than was visualized by 3D-fusion images.
3D fusion images were very useful for preoperative simulations in order to understand relationships between tumors and adjacent vasculatures.
背景/目的：放射技术的最新进展使得能够获取具有高空间分辨率的图像，有助于有效地对融合图像进行三维（3D）重建。本研究利用多排探测器计算机断层扫描（MDCT）进行三维胆管造影和血管造影，以获取有关手术模拟的信息。
对39例接受手术切除的肝胆恶性肿瘤患者的三维融合图像进行评估。
通过三维成像系统可清晰观察到：脐门静脉上方的3段异常分支、巨大肝癌压迫肝门血管、右侧脐门静脉合并肝尾状叶血管异常分支以及转移性肝肿瘤患者的肝内胆管横断性漏液。4例肝内胆管癌患者接受了多次胆管支架置入，且能够实现胆管支架的充分置入。在22例肝外胆管癌患者中，三维融合图像对肿瘤侵犯范围的显示与传统胆管造影相当。在2例患者中，利用该系统可清晰显示多个支架的充分置入。在2例接受肝切除术的患者中，观察到的癌侵犯范围比三维融合图像显示的更广。
三维融合图像对于术前模拟非常有用，有助于了解肿瘤与相邻血管之间的关系。
