title: Image fusion-guided portal vein puncture during transjugular intrahepatic portosystemic shunt placement.
abstract: OBJECTIVE
  The purpose of this study was to assess the feasibility and utility of image fusion (Easy-TIPS) obtained from pre-procedure CT angiography and per-procedure real-time fluoroscopy for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) placement.
  
  
  METHODS
  Eighteen patients (15 men, 3 women) with a mean age of 63 years (range: 48-81 years; median age, 65 years) were included in the study. All patients underwent TIPS placement by two groups of radiologists (one group with radiologists of an experience<3 years and one with an experience≥3 years) using fusion imaging obtained from three-dimensional computed tomography angiography of the portal vein and real-time fluoroscopic images of the portal vein. Image fusion was used to guide the portal vein puncture during TIPS placement. At the end of the procedure, the interventional radiologists evaluated the utility of fusion imaging for portal vein puncture during TIPS placement. Mismatch between three-dimensional computed tomography angiography and real-time fluoroscopic images of the portal vein on image fusion was quantitatively analyzed. Posttreatment CT time, number of the puncture attempts, total radiation exposure and radiation from the retrograde portography were also recorded.
  
  
  RESULTS
  Image fusion was considered useful for portal vein puncture in 13/18 TIPS procedures (72%). The mean posttreatment time to obtain fusion images was 16.4minutes. 3D volume rendered CT angiography images was strictly superimposed on direct portography in 10/18 procedures (56%). The mismatch mean value was 0.69cm in height and 0.28cm laterally. A mean number of 4.6 portal vein puncture attempts was made. Eight patients required less than three attempts. The mean radiation dose from retrograde portography was 421.2dGy.cm2, corresponding to a mean additional exposure of 19%.
  
  
  CONCLUSIONS
  Fusion imaging resulting from image fusion from pre-procedural CT angiography is feasible, safe and makes portal puncture easier during TIPS placement.
authors: Department of General and Vascular Radiology, La Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille, France. Electronic address: Ka.rouabah@gmail.com.
authors: K
authors: K
authors: Rouabah
authors: Department of General and Vascular Radiology, La Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille, France.
authors: A
authors: A
authors: Varoquaux
authors: Department of General and Vascular Radiology, La Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille, France.
authors: J M
authors: JM
authors: Caporossi
authors: Department of General and Vascular Radiology, La Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille, France.
authors: G
authors: G
authors: Louis
authors: Department of General and Vascular Radiology, La Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille, France.
authors: A
authors: A
authors: Jacquier
authors: Department of General and Vascular Radiology, La Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille, France.
authors: J M
authors: JM
authors: Bartoli
authors: Department of General and Vascular Radiology, La Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille, France.
authors: G
authors: G
authors: Moulin
authors: Department of General and Vascular Radiology, La Timone Hospital, 264, rue Saint-Pierre, 13385 Marseille, France.
authors: V
authors: V
authors: Vidal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008103:Liver Cirrhosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011172:Portography / Q000379:methods*; D011677:Punctures / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Image fusion; Imaging guidance; Interventional imaging; Transjugular intrahepatic portosystemic shunt (TIPS)