Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, China.
World J Gastroenterol. 2023 May 28;29(20):3157-3167. doi: 10.3748/wjg.v29.i20.3157.
It has been confirmed that three-dimensional (3D) imaging allows easier identification of bile duct anatomy and intraoperative guidance of endoscopic retrograde cholangiopancreatography (ERCP), which reduces the radiation dose and procedure time with improved safety. However, current 3D biliary imaging does not have good real-time fusion with intraoperative imaging, a process meant to overcome the influence of intraoperative respiratory motion and guide navigation. The present study explored the feasibility of real-time continuous image-guided ERCP.
To explore the feasibility of real-time continuous image-guided ERCP.
We selected 2 3D-printed abdominal biliary tract models with different structures to simulate different patients. The ERCP environment was simulated for the biliary phantom experiment to create a navigation system, which was further tested in patients. In addition, based on the estimation of the patient's respiratory motion, preoperative 3D biliary imaging from computed tomography of 18 patients with cholelithiasis was registered and fused in real-time with 2D fluoroscopic sequence generated by the C-arm unit during ERCP.
Continuous image-guided ERCP was applied in the biliary phantom with a registration error of 0.46 mm ± 0.13 mm and a tracking error of 0.64 mm ± 0.24 mm. After estimating the respiratory motion, 3D/2D registration accurately transformed preoperative 3D biliary images to each image in the X-ray image sequence in real-time in 18 patients, with an average fusion rate of 88%.
Continuous image-guided ERCP may be an effective approach to assist the operator and reduce the use of X-ray and contrast agents.
三维（3D）成像已被证实可更轻松地识别胆管解剖结构，并为内镜逆行胰胆管造影术（ERCP）提供术中指导，从而降低辐射剂量和手术时间，并提高安全性。然而，当前的 3D 胆道成像与术中成像并没有很好的实时融合，该过程旨在克服术中呼吸运动的影响并指导导航。本研究探索了实时连续图像引导 ERCP 的可行性。
探索实时连续图像引导 ERCP 的可行性。
我们选择了两个具有不同结构的 3D 打印腹部胆道模型，以模拟不同的患者。在胆道模型实验中模拟 ERCP 环境，以创建导航系统，并在患者中进行进一步测试。此外，基于对患者呼吸运动的估计，对 18 例胆石症患者的 CT 胆道 3D 成像进行了术前注册，并在 ERCP 期间与 C 臂单元生成的 2D 透视序列实时融合。
在胆道模型中连续图像引导 ERCP 的注册误差为 0.46mm±0.13mm，跟踪误差为 0.64mm±0.24mm。在估计呼吸运动后，3D/2D 配准可将术前 3D 胆道图像实时准确地转换为 X 射线图像序列中的每个图像，18 例患者的平均融合率为 88%。
连续图像引导 ERCP 可能是一种有效的辅助操作方法，可以减少 X 射线和造影剂的使用。
