Chaussy Yann, Vieille Lorédane, Lacroix Elise, Lenoir Marion, Marie Florent, Corbat Lisa, Henriet Julien, Auber Frédéric
Department of Pediatric Surgery, CHU Besançon, 3 Boulevard Fleming, F-25000, Besançon, France; Nanomédecine, Imagerie, Thérapeutique EA 4662, Université Bourgogne Franche-Comté, 16 Route de Gray, F-25000, Besançon, France.
Department of Pediatric Surgery, CHU Besançon, 3 Boulevard Fleming, F-25000, Besançon, France.
J Pediatr Urol. 2020 Dec;16(6):830.e1-830.e8. doi: 10.1016/j.jpurol.2020.08.023. Epub 2020 Aug 28.
Wilms' tumor (WT) is the most common type of malignant kidney tumor in children. Three-dimensional reconstructions can be performed pre-operatively to help surgeons in the planning phase.
The main objective of this study was to determine the variability of WT segmentation and 3D reconstruction. The secondary objectives were to assess the usefulness of these 3D reconstructions in the surgical planning phase and in the selection of patients for nephron-sparing surgery (NSS).
14 scans from 12 patients were manually or semi-automatically segmented by 2 teams using 3D Slicer software. Inter-individual variability of 3D reconstructions was measured based on the Dice index. The utility of 3D reconstructions for the surgical planning was evaluated by 4 pediatric surgeons using a 5-point Likert scale. The possibility of undertaking NSS was evaluated according to the criteria defined in the Umbrella SIOP-RTSG 2016 protocol.
Segmentation of the WT, healthy kidney, pathological kidney, arterial and venous vascularization could be performed for all of the patients in this study. Urinary cavities segmentation could only be performed for 5 out of 14 scans that had a delayed acquisition phase. The mean time required to carry out these segmentations was 8.6 h [3-15 h]. The mean Dice index for all of the scans was good (mean: 0.87; range [0.83-0.91]). Considering each anatomical structure, the Dice index was very good for the WT (mean: 0.95; range [0.91-0.97]) and the healthy kidney (mean: 0.95; range [0.93-0.96]), good for the pathological kidney (mean: 0.87; range [0.69-0.96]) and arterial vascularization (mean: 0.84; range [0.74-0.91]). The Dice index was lower than 0.8 for venous vascularization only (mean: 0.77; range [0.58-0.86]). All the surgeons who were interviewed agreed that the 3D reconstructions were realistic representations and useful for the surgical planning phase. The images reconstructed in 3D allowed most of the criteria defined by the Umbrella SIOP-RTSG 2016 protocol to be evaluated regarding the selection of patients who could benefit from NSS.
The inter-individual variability of 3D reconstructions of WT is acceptable. Three-dimensional representation appears to assist surgeons with the surgical planning phase by allowing them to better anticipate the operative risks. 3D reconstructions can also be an additional tool to better select patients for NSS. However, the manual or semi-automatic method used is very time-consuming, making it difficult for a routinely use. Developing techniques to automate this segmentation process, therefore, appears to be essential if surgeons and radiologists are to use it in daily practice.
肾母细胞瘤（WT）是儿童最常见的恶性肾肿瘤类型。术前可进行三维重建，以帮助外科医生进行手术规划。
本研究的主要目的是确定WT分割和三维重建的变异性。次要目的是评估这些三维重建在手术规划阶段以及在选择适合保留肾单位手术（NSS）的患者中的实用性。
由两个团队使用3D Slicer软件对12例患者的14次扫描进行手动或半自动分割。基于Dice指数测量三维重建的个体间变异性。4名小儿外科医生使用5级李克特量表评估三维重建在手术规划中的实用性。根据Umbrella SIOP-RTSG 2016方案中定义的标准评估进行NSS的可能性。
本研究中的所有患者均可对WT、健康肾、病变肾、动脉和静脉血管进行分割。仅在14次延迟采集期扫描中的5次中能够进行尿腔分割。进行这些分割所需的平均时间为8.6小时[3 - 15小时]。所有扫描的平均Dice指数良好（平均值：0.87；范围[0.83 - 0.91]）。就每个解剖结构而言，WT（平均值：0.95；范围[0.91 - 0.97]）和健康肾（平均值：0.95；范围[0.93 - 0.96]）的Dice指数非常好，病变肾（平均值：0.87；范围[0.69 - 0.96]）和动脉血管（平均值：0.84；范围[0.74 - 0.91]）的Dice指数良好。仅静脉血管的Dice指数低于0.8（平均值：0.77；范围[0.58 - 0.86]）。所有接受访谈的外科医生均同意三维重建是真实的呈现，对手术规划阶段有用。三维重建的图像使得能够根据Umbrella SIOP-RTSG 2016方案定义的大多数标准来评估哪些患者可从NSS中获益。
WT三维重建的个体间变异性是可接受的。三维呈现似乎有助于外科医生在手术规划阶段更好地预测手术风险。三维重建也可以是更好地选择适合NSS患者的额外工具。然而，所使用的手动或半自动方法非常耗时，难以常规使用。因此，如果外科医生和放射科医生要在日常实践中使用它，开发使该分割过程自动化的技术似乎至关重要。
