OBJECTIVES: To establish a three-dimensional (3D) visualization-based classification of the left hepatic portal vein (LHPV) and left hepatic vein (LHV) systems using 3D reconstruction technology to facilitate precise segmental/subsegmental resection of left liver lesions. METHODS: Thin-slice contrast-enhanced CT datasets from 244 patients were reconstructed using MI-3DV Works software. The spatial anatomy (origins, branching patterns, and spatial relationships) of the LHPV and LHV branches was analyzed to determine their 3D classifications and segmental liver divisions for guiding surgical planning for anatomical left liver resections. RESULTS: The 3D models of the third- and fourth-order branches of the LHPV and LHV were successfully reconstructed for all the 244 patients. Two types of the LHPV system were identified, where the LHPV either had independent origins [242 cases (99.1%)] or had right anterior portal branches arising from the LHPV trunk [2 cases (0.9%)]. 3D classifications identified two types of the Segment II of the LHPV (based on branch number), 3 types of the Segment III (by spatial distribution of the branches), compact vs dispersed types of the left lateral lobe (determined by Segment II/III branches proximity), 3 types of the Segment IV (by branch number and origin), and 3 types the fourth hilar vessels (transverse branches of the left portal vein) for their supplied segments. The LHV system had two drainage types into the inferior vena cava, and the umbilical fissure veins were classified into 3 types by drainage patterns and distance to the venous roots. These classifications combined with liver segmentations allowed individualized surgical planning for segment-specific resections. CONCLUSIONS The 3D classification of the LHPV and LHV provides valuable clinical guidance for precise anatomical resections of left liver lesions using liver segments or subsegments as anatomical units to enhance surgical accuracy and improve the outcomes of hepatobiliary surgery.
Humans ; Hepatectomy/methods* ; Imaging, Three-Dimensional ; Hepatic Veins/anatomy & histology* ; Portal Vein/anatomy & histology* ; Liver/surgery* ; Liver Neoplasms/blood supply* ; Tomography, X-Ray Computed ; Female

OBJECTIVETo construct a three-dimensional (3D) liver model of Wuzhishan mini-pig for virtual liver surgeries.

METHODSThe biliary tree and hepatic arteries of Wuzhishan mini-pig were perfused with perchloroethylene and ethyl acetate along mixed with lead oxide, and the hepatic vein and portal vein were perfused with a mixture of dental base acrylic resin and lead oxide. The sectional images were acquired using a 64-slice spiral CT, and the 3D models of the portal vein, hepatic vein, biliary tree, hepatic arteries, and liver parenchyma were reconstructed using Mimics software; the resection image of the liver was also designed. The intrahepatic vascular cast was prepared by corroding the soft tissue with hydrochloric acid.

RESULTS AND CONCLUSIONThe intrahepatic vascular cast obtained fully retained the vascular architecture and displayed the fifth- and sixth-level branches of the hepatic vein and portal vein and the third- and fourth-level branches of the artery and bile duct. The 3D model of liver allowed stereoscopic and accurate display of the third- and fourth-level branches of the hepatic vein and portal vein and the second- and third-level branches of the artery and bile duct. The 3D model showed fewer branches but represented the structural distribution identical to the cast. The 3D model could clearly display the spatial relationship between the vasculature and the soft tissue in virtual resection of the liver tissues, and thus provides a useful model for training of laparoscopic liver resection.

Animals ; Bile Ducts ; Hepatic Artery ; Hepatic Veins ; Imaging, Three-Dimensional ; Liver ; anatomy & histology ; Models, Anatomic ; Portal Vein ; Swine ; Swine, Miniature ; Tomography, Spiral Computed

OBJECTIVETo study the value of three-dimensional (3D) visualization, 3D printing and 3D laparoscopy (3-3D techniques) in the diagnosis and surgical treatment of hepatic tumors.

METHODSFrom November 2013 to January 2015, 22 patients with hepatic tumors admitted in our department underwent abdominal thin-slice CT scanning. The CT images were imported into Medical Image three Dimensional Visualization System (MI-3DVS) for 3D reconstruction. Standard Template Library (STL) files were exported for 3D printing. The hepatic vascular classification and predicted liver resection were performed with the aid of MI-3DVS system. The 3D models were then printed and virtual liver resections were executed accordingly. Based on these preoperative surgical planning data, we performed anatomical hepatectomy using 3D laparoscopy, and the intraoperative blood loss, volume of virtual and actual liver resection and postoperative hospital stay were recorded.

RESULTSAccording to Michels's classifications, 19 patients had type I, 2 had type II, and 1 had type VIII hepatic arteries; based on Cheng classifications, the portal vein was classified into type I in 17 cases, type II in 2 cases, and type III in 2 cases, and type IV in 1 case; according to Nakamura classifications, the right hemiliver hepatic vein was classified into type I in 10 cases, type II in 7 cases, and type III in 5 cases. In the virtual operations, the mean volume of liver resected was 490 ± 228 ml and the mean remnant liver volume was 885 ± 139 ml, with a remnant to functional liver volume ratio of (71 ± 11)%. The 3D printed models stereoscopically displayed the location of the liver tumors and adjacent liver vascular structure clearly. Laparoscopic hepatectomy was performed successfully in 20 patients guided by the 3-3D techniques, and the other 2 patients required convertion to open hepatectomy. The mean operation time was 186 ± 92 min, the intraoperative blood loss was 284 ± 286 ml, the mean actual liver resection volume was 491 ± 192 ml, and the mean postoperative hospital stay of the patients was 8.6 ± 3.7 days.

CONCLUSIONSThe 3-3D technique can facilitate the evaluation of preoperative risk and critical anatomical structures and navigate the surgical procedure in real time in anatomical hepatectomy for hepatic tumors.

Blood Loss, Surgical ; Hepatectomy ; Hepatic Artery ; anatomy & histology ; Hepatic Veins ; anatomy & histology ; Humans ; Imaging, Three-Dimensional ; Laparoscopy ; Liver Neoplasms ; diagnosis ; surgery ; Portal Vein ; Printing, Three-Dimensional ; Tomography, X-Ray Computed

OBJECTIVETo study the imaging characteristics and variations of individual digitized hepatic vein and portal vein which were reconstructed by medical image three-dimensional visualization system (MI-3DVS), assess the value of MI-3DVS assisted hepatectomy.

METHODSFrom June 2008 to September 2012, the clinical data of 81 patients who underwent hepatectomy with the assist of MI-3DVS were retrospectively reviewed. There were 61 male and 20 female patients, and their age were 12-81 years (median 46 years). The patients with malignant tumors were in 69 cases and with benign tumors in 12 cases. The characteristics and variations of individual digitized hepatic vein and portal vein were observed.Omnidirectional rotation of the three-dimensional (3D) model to observe the distribution of intrahepatic venous system as well as the relationship between the tumor and the veins. 3D models were then simulated resection by the Freeform modeling system.

RESULTSOf all the 81 3D models of the patients, greater posterior hepatic veins appeared in 10 (12.3%) cases, segment VI hepatic vein appeared in 34 (41.9%) cases. The portal vein was separted with the left branch and the right branch in the hilar in 64 cases, the portal trunk was divided into the left branch of portal vein, the right anterior portal branches, the right posterior portal branches trifurcated in 10 cases, the branch of right anterior portal vein start from the left trunk and the branch of right posterior portal vein start from the main trunk independently in 6 cases, there was 1 case, lack of left branch of portal vein. 81 patients underwent hepatectomy with the assist of MI-3DVS, minor hepatectomy in 57 cases, major hepatectomy in 24 cases (comparatively-reduced major hepatectomy in 12 cases). R0-resection was achieved in all of the patients. Both the inflow and the outflow were maintained in the residual liver after the completion of hepatectomy. Postoperative liver failure was observed in none of the patients.

CONCLUSIONSMI-3DVS in liver resection was the best choice of surgical approach provides an intuitive basis, and it could reduce the risk of surgery to prevent postoperative hepatic failure.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Hepatectomy ; methods ; Hepatic Veins ; anatomy & histology ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Portal Vein ; anatomy & histology ; Retrospective Studies ; Young Adult

BACKGROUND/AIMS: We compared the cirrhosis-prediction accuracy of an ultrasonographic scoring system (USSS) combining six representative sonographic indices with that of liver stiffness measurement (LSM) by transient elastography, and prospectively investigated the correlation between the USSS score and LSM in predicting cirrhosis. METHODS: Two hundred and thirty patients with chronic liver diseases (187 men, 43 women; age, 50.4+/-9.5 y, mean+/-SD) were enrolled in this prospective study. The USSS produces a combined score for nodularity of the liver surface and edge, parenchyma echogenicity, presence of right-lobe atrophy, spleen size, splenic vein diameter, and abnormality of the hepatic vein waveform. The correlations of the USSS score and LSM with that of a pathological liver biopsy (METAVIR scoring system: F0-F4) were evaluated. RESULTS: The mean USSS score and LSM were 7.2 and 38.0 kPa, respectively, in patients with histologically overt cirrhosis (F4, P=0.017) and 4.3 and 22.1 kPa in patients with fibrotic change without overt cirrhosis (F0-F3) (P=0.025). The areas under the receiver operating characteristic (ROC) curves of the USSS score and LSM for F4 patients were 0.849 and 0.729, respectively. On the basis of ROC curves, criteria of USSS > or =6: LSM > or =17.4 had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 89.2%:77.6%, 69.4%:61.4%, 86.5%:83.7%, 74.6%:51.9% and 0.83:0.73, respectively, in predicting F4. CONCLUSIONS: The results indicate that this USSS has comparable efficacy to LSM in the diagnosis of cirrhosis.
Adult ; Area Under Curve ; *Elasticity Imaging Techniques ; Female ; Hepatic Veins/physiopathology ; Humans ; Liver Cirrhosis/pathology/*ultrasonography ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Severity of Illness Index ; Spleen/anatomy & histology ; Splenic Vein/physiology