Impact of virtual imaging procedures on treatment strategies in children with hepatic vascular malformations.
OBJECTIVE
Virtual imaging procedures have only rarely been analyzed in pediatric populations. We evaluated the role of CT-based virtual surgery planning in pediatric patients experiencing hepatic vascular malformations (HVM).


METHODS
We analyzed 12 children with complex hepatic vascular malformations. All of the children received multislice CT scans with contrast medium followed by virtual 3-dimensional reconstructions using the software assistants MeVis LiverAnalyzer and MeVis LiverExplorer. The impact on treatment planning and the correspondence to clinical findings was assessed.


RESULTS
Highest accuracies of virtual data were found in cases of intrahepatic portocaval shunt and persistent ductus venosus. Here, virtual data revealed congenital vascular conditions, which were not always seen using standard imaging diagnostics. In some patients with portalvenous thrombosis, virtual imaging provided important contributions to determining the feasibility of different shunt procedures. However, in some patients experiencing portalvenous thrombosis or liver diffuse hemangioma, virtual methods were not as accurate as standard diagnostic procedures. Nevertheless, these tools facilitated simultaneous and continuous illustrations of the different vascular systems.


CONCLUSIONS
Virtual imaging and planning procedures had an important impact on treatment strategies and outcomes in children with HVM. Their use as standard diagnostic tools in selected cases of HVM should be considered.
Fuchs
Jörg
J
Department of Pediatric Surgery, University Children's Hospital, University of Tübingen, Tuebingen, Germany.
Warmann
Steven W
SW
Sieverding
Ludger
L
Haber
Hans P
HP
Schäfer
Jürgen
J
Seitz
Guido
G
Hofbeck
Michael
M
Bourquain
Holger
H
Peitgen
Heinz O
HO
D002648:Child; D002675:Child, Preschool; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007223:Infant; D008099:Liver / Q000002:abnormalities / Q000098:blood supply* / Q000000981:diagnostic imaging; D008107:Liver Diseases / Q000151:congenital / Q000000981:diagnostic imaging* / Q000601:surgery; D010347:Patient Care Planning; D012984:Software; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface; D014652:Vascular Diseases / Q000151:congenital / Q000000981:diagnostic imaging* / Q000601:surgery