title: Three-dimensional fusion images of hepatic vasculature and bile duct used for preoperative simulation before hepatic surgery.
abstract: OBJECTIVE
  Recent developments in radiological technology allowed acquisition of images with high spatial resolution that facilitate effective 3-dimensional (3D) reconstruction of fusion images. Present study utilized 3D cholangiography and angiography with multi-detector-row computed tomography (MDCT) to acquire information regarding operative simulations.
  
  
  METHODS
  3D-fusion images were evaluated in 39 patients with hepatobiliary malignancies who underwent surgical resections.
  
  
  RESULTS
  An aberrant branch of segment 3 over the umbilical portal vein, a large hepatoma compressed the hilar vessels, an aberrant branch of the caudate lobe vasculature in case of metastatic liver tumor with a right-sided umbilical portal vein and transected biliary leakage were clearly observed by 3D imaging system. Four patients with intrahepatic cholangiocarcinoma underwent multiple biliary stent placements and adequate placement of biliary stents was possible. In 22 patients with extrahepatic biliary carcinomas, visualization of the extent of tumor invasion by 3D-fusion images was equivalent to conventional cholangiography. In 2 patients, adequate placement of multiple stents could be visualized with this system. In 2 patients who underwent hepatectomy, more extended cancer invasion was observed than was visualized by 3D-fusion images.
  
  
  CONCLUSIONS
  3D fusion images were very useful for preoperative simulations in order to understand relationships between tumors and adjacent vasculatures.
authors.affiliation: Division of Surgical Oncology and Department of Surgery, Nagasaki University Hospital, Nagasaki, Japan. a-nanasm@nagasaki-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abo
authors.forename: Ichiro
authors.initials: I
authors.lastname: Sakamoto
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Toru
authors.initials: T
authors.lastname: Fukuda
authors.forename: Syuuichi
authors.initials: S
authors.lastname: Tobinaga
authors.forename: Masato
authors.initials: M
authors.lastname: Araki
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Sawai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000601:surgery; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001662:Biliary Tract Surgical Procedures; D002758:Cholangiography / Q000379:methods*; D003198:Computer Simulation; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007564:Japan; D008099:Liver / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009361:Neoplasm Invasiveness; D010690:Phlebography / Q000379:methods*; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D025321:Surgery, Computer-Assisted