Tacher Vania, Petit Arthur, Derbel Haytham, Novelli Luigi, Vitellius Manuel, Ridouani Fourat, Luciani Alain, Rahmouni Alain, Duvoux Christophe, Salloum Chady, Chiaradia Mélanie, Kobeiter Hicham
Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
Institut Mondor de Recherche Biomédicale, Inserm U955 équipe n°18, Créteil, France.
Cardiovasc Intervent Radiol. 2017 Nov;40(11):1732-1739. doi: 10.1007/s00270-017-1699-9. Epub 2017 May 17.
To assess the safety, feasibility and effectiveness of image fusion guidance with pre-procedural portal phase computed tomography with intraprocedural fluoroscopy for transjugular intrahepatic portosystemic shunt (TIPS) placement.
All consecutive cirrhotic patients presenting at our interventional unit for TIPS creation from January 2015 to January 2016 were prospectively enrolled. Procedures were performed under general anesthesia in an interventional suite equipped with flat panel detector, cone-beam computed tomography (CBCT) and image fusion technique. All TIPSs were placed under image fusion guidance. After hepatic vein catheterization, an unenhanced CBCT acquisition was performed and co-registered with the pre-procedural portal phase CT images. A virtual path between hepatic vein and portal branch was made using the virtual needle path trajectory software. Subsequently, the 3D virtual path was overlaid on 2D fluoroscopy for guidance during portal branch cannulation. Safety, feasibility, effectiveness and per-procedural data were evaluated.
Sixteen patients (12 males; median age 56 years) were included. Procedures were technically feasible in 15 of the 16 patients (94%). One procedure was aborted due to hepatic vein catheterization failure related to severe liver distortion. No periprocedural complications occurred within 48 h of the procedure. The median dose-area product was 91 Gy cm, fluoroscopy time 15 min, procedure time 40 min and contrast media consumption 65 mL. Clinical benefit of the TIPS placement was observed in nine patients (56%).
This study suggests that 3D image fusion guidance for TIPS is feasible, safe and effective. By identifying virtual needle path, CBCT enables real-time multiplanar guidance and may facilitate TIPS placement.
评估术前门静脉期计算机断层扫描与术中透视相结合的图像融合引导技术在经颈静脉肝内门体分流术（TIPS）置入中的安全性、可行性和有效性。
前瞻性纳入2015年1月至2016年1月在我院介入科接受TIPS手术的所有连续性肝硬化患者。手术在配备平板探测器、锥形束计算机断层扫描（CBCT）和图像融合技术的介入手术室中全身麻醉下进行。所有TIPS均在图像融合引导下置入。肝静脉插管后，进行一次非增强CBCT采集，并与术前门静脉期CT图像进行配准。使用虚拟针道轨迹软件在肝静脉和门静脉分支之间创建一条虚拟路径。随后，将三维虚拟路径叠加在二维透视上，以在门静脉分支插管过程中提供引导。评估安全性、可行性、有效性和术中数据。
纳入16例患者（12例男性；中位年龄56岁）。16例患者中有15例（94%）手术在技术上可行。1例手术因严重肝脏变形导致肝静脉插管失败而中止。术后48小时内未发生术中并发症。中位剂量面积积为91Gy·cm，透视时间15分钟，手术时间40分钟，造影剂用量65mL。9例患者（56%）观察到TIPS置入的临床获益。
本研究表明，TIPS的三维图像融合引导可行、安全且有效。通过识别虚拟针道，CBCT可实现实时多平面引导，并可能有助于TIPS置入。
