Objective To investigate the guiding significance of medical image three-dimensional visualization system (MI-3DVS) in precise hepatectomy. Methods The clinical data of 45 patients with hepatic neoplasms who were admitted to the Zhujiang Hospital from June 2008 to September 2010 were prospectively analyzed. The preoperative image data of the liver were three-dimensionally reconstructed by MI-3DVS. According to the distribution of the intrahepatic portal veins and hepatic veins, the liver was divided into different sections,and then tumors can be located within these hepatic segments. The volume percentage of residual liver and volume of liver resected were detected. Evaluation of surgical resectability and surgery simulation were done before operation. Results According to the distribution of the intrahepatic portal veins and hepatic veins, all patients were divided into seven types: 21 patients were with normal type which was the same as Couinaud type, six with nondivided type, 11 with non-divided right liver type, four with non-divided left liver type, one with right hepatic vein type, one with double middle hepatic vein type and one with right posterior vein type. Thirty-nine patients received open hepatectomy, and the volume percentage of the residual liver was 74% ± 17%. Postoperative pathological examination confirmed that all the 39 patients were with hepatocellular carcinoma. Six patients received transcatheter arterial chemoembolization. No severe complications such as acute hepatic failure, bleeding, bile leakage were detected. All patients were followed up for six months, and they survived with or without tumor. Conclusion MI-3DVS has guiding significance in preoperative assessment and perioperative guidance for precise hepatectomy.

Objective To study the image segmentation, three-dimensional (3D) reconstruction and simulation operation of choledocholithotomy and T-tube drainage based on the computed tomagraphy (CT) data of patient with choledocholithiasis. Methods Patient with choledocholithiasis underwent 64-slice spiral CT imaging. The images segmentation and 3D reconstruction were performed by Medical Image Process System (MIPS) to construct the 3D model of the hepatobiliary system. The model was modified by FreeForm Modeling System. The virtual surgical instruments were developed by GHOST SDK software, and were imported to the virtual surgery. Results The data of plain, arterial phase, venous phase and portal venous phase scanning were collected, and the data stored in DICOM format were transformed to BMP format. A model of the hepatobiliary system was constructed after the data was segmented by MIPS, and then the model was exported in the STL format. The data in STL format were imported to FreeForm Modeling System for smoothing the model. Different structures were assigned different colors to make the model more vivid. The self-developed virtual surgical instruments were imported to the system, and the virtual surgery for choledocholithiasis was performed with PHANToM. Conclusions With the help of MIPS, the image segmentation and 3D reconstruction of the model are finished rapidly and effectively. After the virtual surgical instruments are developed in FreeForm Modeling System, the virtual surgery can be achieved in the 3D model with the assistance of PHANToM.

ObjectiveTo study the types of anatomical variations of hepatic arteries. Methods Hepatic arteries of 64-slice spiral CT scanning data were three-dimensional constructed by using self-designed software. The types of anatomical variations were analyzed and classified with Michels' classification criteria. Results The model presented with realistic profile of hepatic arteries which allowed vivid three-dimensional observation. Of these patients, 40 had normal hepatic arteries (60.61%), 26 had variations (39.39%), and 5 had infrequent aberrant hepatic arteries that was not included in Michels' classification (7.58%). Conclusion Three-dimensional model of hepatic arteries can volumetricly display the anatomical variations of hepatic arteries.

Objective To study the value of three-dimensional (3D) visualization and virtual surgery system in piggyback liver transplantation. Methods Two patients who suffered from choledocholithiasis were scanned by 64-slice spiral CT and the data were collected. The segmentation of the hepatic CT images was carried out. The 3D model of the liver and the intrahepatic vessels was reconstructed, and was imported to the FreeForm Modeling System in STL format for smoothing and modifying. Piggyback liver transplantation was simulated with the force-feedback equipment (PHANToM). Results The reconstructed 3D model of the liver was vivid, and the process of the virtual piggyback liver transplantation was verisimilar. Conclusions The 3D model of the liver enables the simulation of piggyback liver transplantation. It can reduce the risk and complications of the surgery, and enhance the communication between doctor and patient through designing surgical plan and demonstrating visualized operation before surgery. Virtual liver transplantation is also helpful during the training of medical workers.

Objective To explore the accuracy and practical significance of the 3-dimensional (3D) reconstruction of the liver and the abdominal blood vessels based on the data of 64-slice spiral computerized tomography (64S-SCT). Methods The 2D images of the liver and the abdominal blood vessels were collected after TLC-scanning with 64S-SCT. The 3D images of the liver, hepatic internal duct system and the abdominal blood vessels were reconstructed by the medical image processing system. The volume of the 3D reconstructed liver was compared with that of the actual liver measured by the 64S-SCT, and the portal vein of the reconstructed liver model was compared with that reconstructed by the Mxview workstation based on the 64S-SCT data. Results The 3D models of the liver, hepatic internal duct system and abdominal blood vessels were vivid, and could be revolved and observed at any direction. The spatial relationship among main intrahepatic ducts was clearly displayed. The actual liver volume and the condition of the intrahepatic ducts were accurately demonstrated. The reconstructed liver, the branches of the hepatic artery and portal vein, and the abdominal blood vessels were simultaneously displayed by adjusting the transparency of the liver model. The portal vein of the reconstructed liver model completely matched that reconstructed by the Mxview workstation based on the 64S-SCT data. Conclusions The 3D models of the liver, hepatic internal duct system and abdominal blood vessels reflect the human anatomy structure, and provide reliable virtual organs and vessel system for virtual liver surgery.

OBJECTIVETo assess the value of abdominal three-dimensional medical image visualization system (MI-3DVS) in assisting complicated hepatectomy.

METHODSTwenty-four patients undergoing complicated hepatectomy for hepatic carcinoma or hepatic focal nodular hyperplasia were enrolled in this study. Three-dimensional models of the organs, vessels and tumors were reconstructed with MI-3DVS, and virtual operations were carried out to assess the feasibility of hepatectomy. The diameter of the liver tumors, intraoperative blood loss and transfusion, complications, in-hospital mortality rate, and one-year survival rate were analyzed in these cases.

RESULTSThe operations were safely completed in all the cases without perioperative deaths. The mean diameter of liver tumor was 9.8∓4.3 cm, and the median volumes of intraoperative blood loss and transfusion were 800 ml and 600 ml, respectively, with a blood transfusion rate of 91.7% (22/24). The incidence of complications was 29.2% (7/24), and the one-year survival rate was 37.5%.

CONCLUSIONThree-dimensional techniques such as volumetric analysis and risk evaluation of residual liver blood supply and drainage can increase the accuracy of surgical planning and improve the safety of complicated hepatectomy.

Carcinoma, Hepatocellular ; surgery ; Female ; Hepatectomy ; adverse effects ; methods ; Humans ; Imaging, Three-Dimensional ; Liver Neoplasms ; surgery ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo construct three-dimensional (3D) models of renal stones and perform percutaneous nephrolithotomy (PCNL) virtual surgery simulation. Methods CT images were obtained from 8 patients with renal stones. Images segmentation and reconstruction were performed using MIMICS 10.0 software to construct the 3D model of the renal stones, which provided the anatomical relationships between the kidney and the adjacent organs. The optimal PCNL virtual surgery simulation for each individual case was performed using FreeForm Modeling System on the basis of the 3D model.

RESULTSEight 3D models of renal stone were constructed. The 3D model of the renal stones represented the interrelationships of the stones, intrarenal vessel, and the collecting system with the adjacent anatomical structures. Individualized PCNL virtual surgery simulations including percutaneous puncture, dilatation and pneumatic lithotripsy were performed successfully in all the 8 3D models.

CONCLUSIONDigital 3D model of renal stone provides the reliable and comprehensive imaging information for surgical design, and PCNL virtual surgery simulation has important clinical significance to improve the stone clearance rate and reduce the surgical complications.

Adult ; Female ; Humans ; Imaging, Three-Dimensional ; Kidney Calculi ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Nephrostomy, Percutaneous ; methods ; Software ; Tomography, Spiral Computed ; User-Computer Interface

OBJECTIVETo construct a three-dimensional (3D) model of arteries supplying the extrahepatic bile duct with a new segmentation algorithm based on submillimeter CT data.

METHODSThe new image segmentation algorithm based on interactive volume rendering was integrated into Medical Image Three-Dimensional Visualization System (MI-3DVS) as an intersected plug-in. The abdominal submillimeter CTA data of 10 patients were imported into MI-3DVS and the 3D model of the extrahepatic bile duct and its supplying arteries were constructed. The 3D model was zoomed in, zoomed out and spinned for observation and analysis of the arteries supplying the extrahepatic bile duct.

RESULTSThe 3D models of the blood supply to extrahepatic bile duct allowed stereoscopic, and accurate display of the fourth- and fifth-level branches of the hepatic artery, the second-level branches of the cystic artery, the pancreatic duodenal artery arch and the retroportal artery. The 3D models also provided a clear vision of the biliary structures including the hepatobiliary tract, the left and right hepatic ducts, gallbladder, the liver duct, and the common bile duct.

CONCLUSIONBased on the segmentation method of interactive volume rendering, the CT data of the arterioles supplying the extrahepatic bile duct can be extracted and segmented for 3D reconstruction to display the three-dimensional anatomical structures of the extrahepatic bile duct and its supplying arteries.

Bile Ducts, Extrahepatic ; anatomy & histology ; Hepatic Artery ; anatomy & histology ; Humans ; Imaging, Three-Dimensional ; Liver ; blood supply ; Models, Anatomic

OBJECTIVETo explore the application value of the MI-3DVS in patients with hepatic artery variation receiving duodenopancreatectomy.

METHODSA total of 114 patients who had undergone pancreatoduodenectomy were retrospectively summarized and analyzed during January 2010 to July 2012. The clinical data of 64-slice multidetector CT angiography (64-MDCTA) scanning was introduced into MI-3DVS for procedural segmentation, registration and 3-dimensional reconstruction. Based on the reconstructed 3-dimensional model, the origination and bifurcations of variant hepatic artery was observed. And its anatomical relationships with abdominal organs and vessels were also observed. Thereafter, preoperative procedures planning was formulated. The findings were compared to those found during the operation and by postoperative digital subtraction angiography (DSA) of coeliac artery.

RESULTSThe abdominal 3D models can clearly display the size and shape of tumor, the origin and course of the blood vessels, as well as the 3D anatomic relationship between tumors and organs, blood vessels. A total of 14 cases (12.3%, 14/114) were found with variant, including 9 cases (7.9%) with replaced right hepatic artery arising from superior mesenteric artery, 3 cases (2.6%) with replaced common hepatic artery arising from superior mesenteric artery, 2 cases (1.8%) with replaced left hepatic artery arising from left gastric artery. The 14 patients all received standard procedures of duodenopancreatectomy. Compared to the intraoperative findings and postoperative DSA examination, the sensitivity, specificity and accuracy of MI-3DVS to variant hepatic artery is 100%. The preoperative planning guided by MI-3DVS is in line with the intraoperative findings.No postoperative complications occurred in all 14 patients, including hepatic abscesses, biliary fistula and liver failure.

CONCLUSIONSMI-3DVS can accurately diagnose hepatic artery variation before duodenopancreatectomy. Therefore, it contributes to the formulation of preoperative surgical plans.It also increases the success rate of the surgical operations and decreases the occurrence of postoperative complications.

Adult ; Aged ; Aged, 80 and over ; Female ; Hepatic Artery ; abnormalities ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Pancreaticoduodenectomy ; instrumentation ; Retrospective Studies ; Tomography, Spiral Computed ; Young Adult