Three-dimensional Reconstruction Of Intrahepatic Veins And Visualization Of Approach In Transjugular Intrahepatic Portosystemic Shunt

The human liver is an important organ with perplexing constructions and great functions in the body. It is very difficulty to recognize the complicated structures of the intrahepatic venous vessels in the intrahepatic interventional therapy and clinical hepatectomy. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective method for reducing portal vein pressure. It has proven useful for treatment of acute and chronic esophageal gastric variceal hemorrhage, severe or refractory ascites, hepatic hydrothorax, and possibly Budd-Chiari syndrome. TIPS is a percutaneous method wherein a decompressive channel is created between a hepatic vein and an intrahepatic branch of the portal vein. The pivotal technique to grasp the three-dimensional relation of the hepatic veins, retrohepatic inferior vena cava and intrahepatic portal vein is useful to design an appropriate interventional therapy route, to choose an accurate centesis point with feasible way, and to build up a steady shunt to avoid damaging the abut structure.In this study, the acquisition technique of the visible human data set was used to obtain the visible intrahepatic venous vessels images from the section of internal jugular vein to the section of liver's bottom. After being registered accurately, the sectional images of intrahepatic venous vessels data set were resampled to create the traverse, coronal and sagittal planes images data set. With the use of image segmental software, the structures of internal jugular vein, brachiocephalic vein, superior vena cava, heart, inferior vena cava and intrahepatic venous vessels were segmented and were reconstructed to get the TIPS and direct intrahepatic portacaval shunt's (DIPS) 3D model and display in stereo space on PC; With the visualizational software, the slice data were import into image workstation to acquire the stereo visualizational model; With the use of vitual endoscopy technique, the result of 3D reconstruction and visualization were performed to vitual endoscopy ramble and to simulate the intervention therapy catheter to virtual intrahepatic portosystemic shunt. The main results and conclusions were as follows:1. With the application of the visible human data set, the sectional images from the plane of internal jugular vein to the the plane of liver bottom plane were resampled after having been registered accurately. The thin sectional anatomy data set from traverse, coronal and sagittal planes were obtained.2. After being matched accurately, the thin sectional resampled images were observed and measured from three orientations to acquire the distinct images and integrated structures. The morphological regularity were interpreted integrally in order to provide the sectional anatomic bases for intrahepatic portosystemic shunt.3. With the use of image segmental software, the structures of internal jugular vein, brachiocephalic vein, superior vena cava, heart, inferior vena cava and intrahepatic venous vessels were segmented and reconstructed to obtain the TIPS and DIPS's 3D model and display on PC. The structures of intrahepatic venous vessels were observed and measured aborativly to provide the stereo morphological data for intrahepatic portosystemic shunt.4. With the visualizational software, the slice data were import into image workstation to acquire the stereo visualizational mode by intractive image segmentation and threshold segmentation. The structures of intrahepatic venous vessels were 3D observed and stereo measured for the farther study on the visualizational base.5. With the use of vitual endoscopy technique, the result of 3D reconstruction and visualization were performed to vitual endoscopy ramble and could be displayed or observed clearly and vividly the internal structures of the veins in vessels.6. With the vascular interventional therapy of intrahepatic portosystemic shunt being displayed on image workstation, the puncture processes of TIPS and DIPS were simulated to establish the basis for setting up the training system model of intrahepatic venous vessels interventional operation.7. According to the characteristic of intrahepatic vein system, we designed the vascular interventional planning and operation path to therapy virtually for the preoperational project of intrahepatic portosystemic shunt.