Three-dimensional fusion images of hepatic vasculature and bile duct used for preoperative simulation before hepatic surgery.

Background/Aims: Recent developments in radiological technology allowed acquisition of images with high spatial resolution that facilitate effective 3-dimensional (3D) reconstruction 25 of fusion images. Present study utilized 3D cholangiography and angiography with multidetector-row computed tomography (MDCT) to acquire information regarding operative simulations. Methodology: 3D-fusion images were evaluated in 39 patients with hepatobiliary malignancies who underwent surgical resections. 30 Results: An aberrant branch of segment 3 over the umbilical portal vein, a large hepatoma compressed the hilar vessels, an aberrant branch of the caudate lobe vasculature in case of metastatic liver tumor with a right-sided umbilical portal vein and transected biliary leakage were clearly observed by 3D imaging system. Four patients with intrahepatic cholangiocarcinoma underwent multiple biliary stent placement and adequate placement of 35 biliary stents was possible. In 22 patients with extrahepatic biliary carcinomas, visualization of the extent of tumor invasion by 3D-fusion images was equivalent to conventional cholangiography. In 2 patients, adequate placement of multiple stents could be visualized with this system. In 2 patients who underwent hepatectomy, more extended cancer invasion was observed than was visualized by 3D-fusion images. 40 Conclusions: 3D fusion images were very useful for preoperative simulations in order to understand relationships between tumors and adjacent vasculatures.