Vania Tacher1,2,3, Arthur Petit4, Haytham Derbel4, Luigi Novelli4, Manuel Vitellius4, Fourat Ridouani4, Alain Luciani4,5,6, Alain Rahmouni4,6, Christophe Duvoux6,7, Chady Salloum8, Mélanie Chiaradia4, Hicham Kobeiter4,6. 1. Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France. vania.tacher@aphp.fr. 2. Institut Mondor de Recherche Biomédicale, Inserm U955 équipe n°18, Créteil, France. vania.tacher@aphp.fr. 3. Université Paris-Est Créteil (UPEC), Créteil, 94010, France. vania.tacher@aphp.fr. 4. Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France. 5. Institut Mondor de Recherche Biomédicale, Inserm U955 équipe n°18, Créteil, France. 6. Université Paris-Est Créteil (UPEC), Créteil, 94010, France. 7. Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Hépatologie, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France. 8. Assistance Publique - Hôpitaux de Paris (AP-HP), Service de Chirurgie Digestive, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, France.
Abstract
INTRODUCTION: To assess the safety, feasibility and effectiveness of image fusion guidance with pre-procedural portal phase computed tomography with intraprocedural fluoroscopy for transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: All consecutive cirrhotic patients presenting at our interventional unit for TIPS creation from January 2015 to January 2016 were prospectively enrolled. Procedures were performed under general anesthesia in an interventional suite equipped with flat panel detector, cone-beam computed tomography (CBCT) and image fusion technique. All TIPSs were placed under image fusion guidance. After hepatic vein catheterization, an unenhanced CBCT acquisition was performed and co-registered with the pre-procedural portal phase CT images. A virtual path between hepatic vein and portal branch was made using the virtual needle path trajectory software. Subsequently, the 3D virtual path was overlaid on 2D fluoroscopy for guidance during portal branch cannulation. Safety, feasibility, effectiveness and per-procedural data were evaluated. RESULTS: Sixteen patients (12 males; median age 56 years) were included. Procedures were technically feasible in 15 of the 16 patients (94%). One procedure was aborted due to hepatic vein catheterization failure related to severe liver distortion. No periprocedural complications occurred within 48 h of the procedure. The median dose-area product was 91 Gy cm2, fluoroscopy time 15 min, procedure time 40 min and contrast media consumption 65 mL. Clinical benefit of the TIPS placement was observed in nine patients (56%). CONCLUSION: This study suggests that 3D image fusion guidance for TIPS is feasible, safe and effective. By identifying virtual needle path, CBCT enables real-time multiplanar guidance and may facilitate TIPS placement.
INTRODUCTION: To assess the safety, feasibility and effectiveness of image fusion guidance with pre-procedural portal phase computed tomography with intraprocedural fluoroscopy for transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: All consecutive cirrhotic patients presenting at our interventional unit for TIPS creation from January 2015 to January 2016 were prospectively enrolled. Procedures were performed under general anesthesia in an interventional suite equipped with flat panel detector, cone-beam computed tomography (CBCT) and image fusion technique. All TIPSs were placed under image fusion guidance. After hepatic vein catheterization, an unenhanced CBCT acquisition was performed and co-registered with the pre-procedural portal phase CT images. A virtual path between hepatic vein and portal branch was made using the virtual needle path trajectory software. Subsequently, the 3D virtual path was overlaid on 2D fluoroscopy for guidance during portal branch cannulation. Safety, feasibility, effectiveness and per-procedural data were evaluated. RESULTS: Sixteen patients (12 males; median age 56 years) were included. Procedures were technically feasible in 15 of the 16 patients (94%). One procedure was aborted due to hepatic vein catheterization failure related to severe liver distortion. No periprocedural complications occurred within 48 h of the procedure. The median dose-area product was 91 Gy cm2, fluoroscopy time 15 min, procedure time 40 min and contrast media consumption 65 mL. Clinical benefit of the TIPS placement was observed in nine patients (56%). CONCLUSION: This study suggests that 3D image fusion guidance for TIPS is feasible, safe and effective. By identifying virtual needle path, CBCT enables real-time multiplanar guidance and may facilitate TIPS placement.
Authors: Timo C Meine; Cornelia L A Dewald; L S Becker; Aline Mähringer-Kunz; Benjamin Massoumy; Sabine K Maschke; Martha M Kirstein; Thomas Werncke; Frank K Wacker; Bernhard C Meyer; Jan B Hinrichs Journal: Abdom Radiol (NY) Date: 2020-11