Computed tomography with 3d-modeling in portal hypertension surgery planning

Kolsanov A.V, Zelter P.M., Kolesnik I.V., Kapishnikov A.V., Chaplygin S.S., Solovov D.V.

Purpose. To evaluate experience of using abdominal CT with segmentation and 3D modeling in preoperative planning in patients with portal hypertension syndrome.

Materials and methods. Were examined 40 patients treated in surgical departments of Clinics of Samara State Medical University. All patients underwent abdominal CT scan with modified protocol. The CT data underwent segmentation and 3D modeling.

Results. CT allows to identify the cause and level of block in the portal system; evaluate configuration and degree of portal thrombosis; to identify changes in liver and spleen; visualize collaterals in patients with portal hypertension syndrome. In eight cases, 3D-modelling allowed to abandon H-shaped anastomosis due to the proximity of the veins. In six cases, proximal splenorenal anastomosis was chosen.

A change in the choice of initial surgery was noted in 35% of cases. In 15% of patients, it became possible to identify previously unknown cause of portal hypertension.

Discussion. Portal hypertension due to increase of liver diseases has become an actual problem. Currently, number of patients with portal hypertension is steadily increasing. Diagnostic errors in this disease reach 10-15%. Main method of correction of portal hypertension is surgical. CT is one of the main methods in the examination of patients with portal hypertension. Segmentation and 3D-modelling based on CT data allows to make a 3D model of the venous phase of examination with showing of parenchymal organs.

Conclusions. 1. Using system to simulate and combine phases of CT data allows to choose the best method of surgical intervention for decompression of the portal system;

2. In patients with suspected portal hypertension, it is necessary to change the protocol for multiphase scan due to slower blood flow. If necessary, it is needed to supplement the standard phases with late venous phase.

Samara State Medical University of

Ministry of Health

Samara, Russia

 

Keywords: portal hypertension, preoperative 3-D modeling system "Avtoplan", computed tomography, segmentation.


Corresponding author:  Zelter P.M., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Kolsanov A.V, Zelter P.M., Kolesnik I.V., Kapishnikov A.V., Chaplygin S.S., Solovov D.V. Computed tomography with 3d-modeling in portal hypertension surgery planning. REJR 2019; 9(1):67-74. DOI:10.21569/2222-7415-2019-9-1-67-74.

Received:        14.03.19 Accepted:       29.03.19