Arterial Portography during Transarterial Chemoembolization: Still a Necessity in the Age of Contrast-enhanced Cross-sectional Imaging?

The Application of Three-Dimensional Visualization in Preoperative Evaluation of Portal Vein Invasion in Hilar Cholangiocarcinoma

Objective

This study aimed to investigate the use of three-dimensional visualization for preoperative evaluation of portal vein invasion in hilar cholangiocarcinoma (HCCA).

Methods

This recombination study for preoperative computerized tomography images was completed in 42 patients undergoing radical resection of HCCA combined with hepatectomy. Portal vein invasion with postoperative pathology was used as a gold standard to decide if the diagnosis was correct or not. We compared the sensitivity, specificity, positive predictive value, negative predictive value, and total correctness of radiologists and a three-dimensional (3D) visualization model for the assessment of tumor-caused portal vein invasion.

Results

The findings for the estimation of portal vein invasion by radiologists based on CT images were as follows: sensitivity = 90.9%; specificity = 83.8%; positive predictive value = 66.7%; negative predictive value = 96.3%; and overall accuracy = 85.7%. The findings for estimation by the 3D visualization model were as follows: sensitivity = 90.9%; specificity = 96.8%; positive predictive value = 90.9%; negative predictive value = 96.8%; and overall accuracy = 90.5%.

Conclusion

The positive predictive value of 3D visualization technology in the diagnosis of portal vein invasion is notably superior to that of subjective assessment by radiologists. This technique can thus play a significant role in preventing unnecessary resectioning of non-invaded portal veins and hepatectomy.