The Anatomical Study And Clinical Significance Of Three-dimensional Visualization Model Of Hilar Cholangiocarcinoma

Objective:The imaging 3D reconstruction system(Myrian system)was used in this study to reconstruct the CT image data of patients with hilar cholangiocarcinoma and establish a three-dimensional visualization model of hilar cholangiocarcinoma,which showed the complex anatomical structure of the liver,vascular variation,spatial proximity of the tumor and vasculature,and making virtual surgery plans,then studied and analyzed the anatomical features and clinical significance of the three-dimensional visualization model of hilar portal cholangiocarcinoma.Method:The clinical data of 103 patients with hilar cholangiocarcinoma who were admitted to the First Hospital of China Medical University from July 2014 to March2018 were collected and analyzed.The multi-slice spiral CT images were converted to three-dimensional images by using Myrian system,and then image segmentation,three-dimensional reconstruction and pulse display were performed to observe the three-dimensional visualization and vascular variation and invasion in patients with hilar cholangiocarcinoma,and compared with the actual observations in surgery.Results:A total of 103 patients were included in the study,including 68 males and 35 females,with an average age of 64.2±7.8 years.Three-dimensional reconstruction results showed that 103 patients’ Bismuth classification were 11 cases of Type I,34 cases of Type II,13 cases of Type III A,28 cases of Type III B,and 17 cases of Type IV;.The variation rate of perihilar bile ducts was 10.7%,including RPSD converging into LHD type,RPSD converging into CHD type and trifurcation type,the incidence rates were 3.9%,3.9%,2.9%.the variation rate of portal vein in hilar region was14.6%,the occurance rate of typical branch form,trifurcation type,I-shaped type was85.4%,2.9%,11.7%,the invasion rate of portal vein was 13.6%.The variation rate of hepatic artery was 21.4%,the invasion rate of hepatic artery was 40.0%.A total of 25 patients were undergone combined liver resection,comparing with the actual observations in surgery,the preoperative three-dimensional reconstruction diagnosis rate was 96.0(24/25)% in the diagnosis of hilar cholangiocarcinoma.And the sensitivity of the portal vein variation in patients with hilar cholangiocarcinoma was 1,the specificity was 1,the sensitivity of the hepatic artery variation was 0.75,and the specificity was 1.The proportion of portal vein invasion which was consistent with three-dimensional imaging results was 24/25(96.0 %),and the ratio of hepatic artery invasion results to three-dimensional imaging results was 23/25(92.0 %).Conclusion:The three-dimensional visualization model of liver in patients with hilar cholangiocarcinoma can clearly show the liver,intrahepatic dilated bile duct,portal vein,and hepatic artery.It truly reflects the classification of hilar cholangiocarcinoma,the distribution and variation of hepatic bile duct,portal vein,and hepatic artery.The reconstructed three-dimensional visualization model of the liver is of great significance for judging portal vein and hepatic artery invasion,making preoperative plans,and predicting possible vascular variations in surgery.