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.

[Guidelines for application of computer-assisted indocyanine green molecular fluorescence imaging in diagnosis and surgical navigation of liver tumors (2019)]

Computer-assisted combined indocyanine green (ICG) molecular fluorescence imaging technology can be used for preoperative planning and intraoperative detection from three-dimensional (3D) morphological anatomy and level of cellular function to guide the anatomical, functional and radical hepatectomy of liver tumor. This technology has received wide acceptance and has shown important diagnostic and therapeutic value. This guideline is intended to standardize the application of computer-assisted combined ICG molecular fluorescence imaging for accurate diagnosis and treatment of liver tumors in the following aspects: (1) the workflow of 3D visualization technology; (2) the mechanism and application flow of ICG molecular fluorescence imaging; (3) clinical application of 3D visualization technology and virtual reality technology; and (4) clinical application of ICG molecular fluorescence imaging. ICG molecular fluorescence imaging can help to define tumor boundary, determine hepatic segment and hepatic lobectomy tangent at the molecular and cellular level, and detect small lesions or metastases. According to the fluorescence signal characteristics of liver tumors and combined with rapid frozen pathological examination during operation, the differentiation degree of liver space-occupying lesions (such as primary liver cancer) can be preliminarily determined, and residual tumors and biliary leakage on the hepatic section can be detected after hepatectomy. Computer-assisted ICG molecular fluorescence imaging in the diagnosis and surgical navigation of liver tumors provides a new approach to digital diagnosis and treatment of liver tumors. With its development in clinical practice and the technological innovation, this technology will be further improved to allow more accurate diagnosis and treatment of liver tumors.

[The application of three-dimensional visualization in the endoscopic thyroidectomy]

Objective:To explore the application value of three dimensional（3D） visualization in the endoscopic thyroidectomy. Methods:Fifty patients with thyroid papillary carcinoma confirmed by preoperative fine needle aspiration（FNA） were randomly divided into the combined group （20 cases） and the simple operation group （30 cases）. Endoscopic thyroid surgery combined with three-dimensional visualization model was used in the combined group. Simple operation group was treated with simple endoscopic thyroid surgery. The communication time and communication satisfaction, intraoperative blood loss, operation time and postoperative complications between the two groups were compared. Results:The communication time with patients in the combined group and the simple operation group before operation was （23.05±6.83） min and （28.83±8.57） min. The communication time in the combined group was shorter, and the patients' satisfaction with disease awareness was higher after communication. There was a statistically significant difference between the two groups （P<0.05）. The operation time of combined group and simple operation group was （104.30±13.06） min and （130.46±17.01） min respectively, and the operation time of combined group was shorter （P<0.05）. The intraoperative bleeding volume of combined group and simple operation group was （12.80±6.10） mL and （17.60±5.19） mL , and the combined group had less intraoperative bleeding volume （P<0.05）. There was no significant difference in postoperative complications between the two groups （P>0.05）. Conclusion:3D visualization technology will benefit to improve the efficiency of doctor-patient communication, enhance the safety of the endoscopic thyroidectomy, and then accelerate the postoperative rehabilitation of patients, which worthy of clinical promotion and practice.

Application of imaging technology for the diagnosis of malignancy in the pancreaticobiliary duodenal junction (Review)

The pancreaticobiliary duodenal junction (PBDJ) is the connecting area of the pancreatic duct, bile duct and duodenum. In a broad sense, it refers to a region formed by the head of the pancreas, the pancreatic segment of the common bile duct and the intraduodenal segment, the descending and the horizontal part of the duodenum, and the soft tissue around the pancreatic head. In a narrow sense, it refers to the anatomical Vater ampulla. Due to its complex and variable anatomical features, and the diversity of pathological changes, it is challenging to make an early diagnosis of malignancy at the PBDJ and define the histological type. The unique anatomical structure of this area may be the basis for the occurrence of malignant tumors. Therefore, understanding and subclassifying the anatomical configuration of the PBDJ is of great significance for the prevention and treatment of malignant tumors at their source. The present review comprehensively discusses commonly used imaging techniques and other new technologies for diagnosing malignancy at the PBDJ, offering evidence for physicians and patients to select appropriate examination methods.