Purpose

To describe and evaluate an image fusion technique for the portal vein puncture guidance during TIPS procedure: a three-dimensional (3D) virtual target fluoroscopic display obtained with an automated 3D carbon dioxide wedged hepatic vein portography (3D CO₂-WHVP).

Materials and Methods

All the 37 TIPS creations performed in our institution between 3/2017 and 12/2018 were retrospectively reviewed. Seventeen procedures were guided using the 3D CO₂-WHVP technique (group 1) and were compared with the other 20 procedures performed under conventional 2D fluoroscopic guidance (group 2). Image acquisition for the 3D CO₂-WHVP consisted of combining a CBCT acquisition and an automatic CO₂ injection. Once located on the multiplanar reformatted images of the CBCT acquisition, the portal bifurcation was manually segmented to create a virtual target that was overlaid onto live fluoroscopy allowing a real-time 3D guidance during portal vein puncture.

Results

Primary success was 100% in group1 and 95% in group2. Median intervention length, fluoroscopy time and dose area product (DAP) were, respectively, 124 min [IQR 94–137], 40 min [IQR 26–52] and 12140 cGy.cm² [IQR 10147–18495] in group 1 and 146 min [IQR 118–199], 40 min [IQR 36–60] and 13290 cGy.cm² [IQR 10138–19538] in group 2. No technical parameter was significantly different between the two groups. Intraprocedural complication rate was 0% in group 1 and 20% in group 2 (p = 0.05).

Conclusion

Three-dimensional virtual target fluoroscopic display using a CBCT-acquired CO₂ wedged portography is an effective and safe technique to ease intrahepatic puncture of the portal vein during TIPS procedures.

中文翻译：

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使用三维 CO2 楔形肝静脉造影的虚拟目标透视显示进行 TIPS 放置

目的

描述和评估 TIPS 过程中用于门静脉穿刺引导的图像融合技术：通过自动 3D 二氧化碳楔形肝静脉门静脉造影术 (3D CO ₂ -WHVP)获得的三维 (3D) 虚拟目标荧光透视显示。

材料和方法

我们机构在 2017 年 3 月至 2018 年 12 月期间进行的所有 37 项 TIPS 创作都进行了回顾性审查。17 个手术使用 3D CO ₂ -WHVP 技术（第 1 组）进行指导，并与在传统 2D 透视引导下执行的其他 20 个手术（第 2 组）进行了比较。3D CO ₂ -WHVP 的图像采集包括结合 CBCT 采集和自动 CO ₂注射。一旦位于 CBCT 采集的多平面重新格式化图像上，门静脉分叉就会被手动分割以创建一个虚拟目标，该目标覆盖在实时透视上，允许在门静脉穿刺期间进行实时 3D 引导。

结果

第 1 组的初步成功率为 100%，第 2 组为 95%。第 1 组的中位介入长度、透视时间和剂量面积乘积 (DAP) 分别为 124 分钟 [IQR 94-137]、40 分钟 [IQR 26-52] 和 12140 cGy.cm ² [IQR 10147-18495]第 2 组 146 分钟 [IQR 118-199]、40 分钟 [IQR 36-60] 和 13290 cGy.cm ² [IQR 10138-19538]。两组之间的技术参数没有显着差异。第 1 组的术中并发症发生率为 0%，第 2 组为 20%（p  = 0.05）。

结论

使用 CBCT 获得的 CO ₂楔形门静脉造影术的三维虚拟目标透视显示是一种有效且安全的技术，可在 TIPS 手术期间缓解门静脉肝内穿刺。