title: Real-Time 3D CT Image Guidance for Transjugular Intrahepatic Portosystemic Shunt Creation Using Preoperative CT: A Prospective Feasibility Study of 20 Patients.
abstract: OBJECTIVE
  The purpose of this study is to prospectively evaluate the feasibility and efficacy of real-time 3D CT image guidance during transjugular intrahepatic portosystemic shunt (TIPS) creation.
  
  
  METHODS
  Between October 2013 and December 2013, a total of 20 patients were prospectively enrolled in the present study. Previously acquired portal venous phase CT datasets and intraoperative CT datasets were registered on a dedicated workstation. We accomplished semiautomatic registration for the datasets of 11 of 20 patients (55%), and we performed manual registration for the datasets of the remaining nine patients. The selected volume of interest of the CT image showing the portal vein vasculature was overlaid onto the fluoroscopic display to provide real-time 3D CT image guidance during the procedure.
  
  
  RESULTS
  For all 20 patients, TIPS procedures were successfully performed by the same operator. The mean (± SD) number of needle passes required for portal vein entry was 1.8 ± 1.1 passes (range, 1-5 passes). The mean duration of radiographic fluoroscopy was 3.5 ± 1.1 minutes for portal vein entry and 11.4 ± 2.1 minutes for the whole procedure. The mean radiation dose used for the whole TIPS procedure was 295.5 ± 66.6 Gy · cm2. No major technical complications were observed.
  
  
  CONCLUSIONS
  Real-time 3D guidance with the use of preoperative CT is feasible, safe, and effective for assisting in the creation of TIPS. This approach may result in a shorter procedural time and less radiation exposure. However, future studies are required to compare this method with other mapping techniques.
authors: 1 Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Xuefeng
authors: X
authors: Luo
authors: 1 Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Xiaoze
authors: X
authors: Wang
authors: 1 Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Yin
authors: Y
authors: Zhao
authors: 2 Center of Interventional Radiology, West China Hospital, Sichuan University, 37 Guoxue Ln, 610041, Chengdu, Sichuan, China.
authors: Huaiyuan
authors: H
authors: Ma
authors: 3 AX Business Group, Healthcare Sector, Siemens China, Shanghai, China.
authors: Linchao
authors: L
authors: Ye
authors: 1 Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Li
authors: L
authors: Yang
authors: 2 Center of Interventional Radiology, West China Hospital, Sichuan University, 37 Guoxue Ln, 610041, Chengdu, Sichuan, China.
authors: Jiaywei
authors: J
authors: Tsauo
authors: 1 Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors: Mingshan
authors: M
authors: Jiang
authors: 2 Center of Interventional Radiology, West China Hospital, Sichuan University, 37 Guoxue Ln, 610041, Chengdu, Sichuan, China.|4 Department of Interventional Radiology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
authors: Xiao
authors: X
authors: Li
mesh_terms: D000328:Adult; D000368:Aged; D003199:Computer Systems; D005240:Feasibility Studies; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000601:surgery*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: 3D CT; guidance; image registration; roadmap; transjugular intrahepatic portosystemic shunt