Thomas Leger1, Arthur Petit2,3, Yassine Moustarhfir4,3, Yves Ajavon4, Nicolas Sellier4, Olivier Seror2,3,5, Olivier Sutter6. 1. Service d'imagerie médicale, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France. 2. Unité de Radiologie Interventionnelle, Hôpital Avicenne (APHP), Hôpitaux Universitaires Paris- Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, 125 Rue de Stalingrad 93000, Bobigny, France. 3. Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Universite Paris 13, communaute d'universités et établissements Sorbonne Paris cité, Paris, France. 4. Service de Radiologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris- Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bondy, France. 5. Centre de Recherche Des Cordeliers, Inserm, Sorbonne Université, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Université Paris, Paris, France. 6. Unité de Radiologie Interventionnelle, Hôpital Avicenne (APHP), Hôpitaux Universitaires Paris- Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, 125 Rue de Stalingrad 93000, Bobigny, France. olivier.sutter@aphp.fr.
Abstract
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.
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.
Authors: J Altenbernd; S Zimmer; L Andrae; B Labonte; J Gruber; H Beier; M Abdulgader; M Buechter; M Forsting; J Theysohn Journal: Acta Radiol Open Date: 2022-09-20