Advanced hepatic vasculobiliary imaging segmentation and 3D reconstruction as an aid in the surgical management of high biliary stenosis

BMC Medical Imaging

Marco Serôdio¹  Luís Ferreira¹  Henrique Alexandrino²  Nuno Pereira da Silva³  Inês Abreu³  Paulo Donato⁴ 

[1] Department of Surgery, Coimbra University Hospital Center, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal;Department of Surgery, Coimbra University Hospital Center, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal;Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal;University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Rua Larga, 3004-504, Coimbra, Portugal;University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Rua Larga, 3004-504, Coimbra, Portugal;Medical Imaging Department, Coimbra University Hospital Center, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal;Medical Imaging Department, Coimbra University Hospital Center, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal;Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal;

关键词: Three-dimensional (3D) model;    Biliary stricture;    Hepatobiliary imaging;    Pre-operative planning;    Personalized medicine;    Image post-processing;    Computed tomography;    Magnetic resonance imaging;    Case report;   

DOI  :  10.1186/s12880-020-00520-0

来源: Springer

【 摘 要 】

BackgroundThree-dimensional (3D) models are increasingly used to help surgeons, guiding them through the complex hepatic vasculobiliary anatomy. The biliary tract is a relatively untapped territory with only a few case reports described in medical literature. Our aim is to present an innovative 3D reconstruction methodology for biliary imaging and surgical planning, applied to a case of iatrogenic biliary stricture, with fusion of segmented CT and MRI images.Case presentationA selected case of Bismuth type III iatrogenic biliary stenosis for 3D planning. CT and MR studies were acquired with dedicated protocols for segmentation. Two radiologists performed segmentation and 3D model post-processing, fusing both imaging techniques to faithfully render the anatomical structures. Measurements of anatomical landmarks were taken in both the CT/MRI and the 3D model to assure its accuracy and differences in measurement were calculated. The 3D model replicates anatomical structures and pathology with high accuracy, with only 2.2% variation between STL, CT and MRI measurements. The model was discussed with the surgical team and used in the surgical planning, improving confidence in this delicate procedure, due to the detailed prior knowledge of the patient's anatomy.ConclusionThree-dimensional reconstructions are a rapidly growing area of research with a significant impact in the personalized and precision medicine. The construction of 3D models that combine vascular and biliary anatomy, using different imaging techniques, respectively CT and MRI, will predictably contribute to a more rigorous planning of complex liver surgeries.

【 授权许可】

CC BY