The Application Of Virtual Liver Resection Based On Three-dimensional Reconstruction In Hepatectomy For Hepatocellular Carcinoma

Objective:To discuss the application value of virtual liver resection based on threedimensional(3D)reconstruction in hepatic carcinectomy and the evaluation of the residual liver volume.Methods:Twenty patients with hepatocarcinoma underwent computed tomography angiography.Scan data transfered to personal computer as the medical digital imaging and communications(Digitai Imaging and in Medicine,DICOM)format,then imported to virtual liver resection simulation system(Myrian XP-Liver)for 3D reconstruction of the liver.Reconstructed the liver structure(including liver parenchyma,liver neoplasms,hepatic artery,hepatic vein and portal vein)by extracting the similar CT values of neighboring voxels for the generation of individual 3D model.The virtual liver resection was performed under the guidance of the surgeon.The volume of the whole liver,the virtual liver resection and the remnant liver were measured automatically.According to the residual liver volume and hepatic vessel shape to optimized the formulation of the liver section,so as to guide the hepatectomy scheme.Finally,the virtual liver resection was compared with the actual operation process.The correlation between the virtual liver resection volume calculated by the system and the actual liver resection volume calculated by intraoperative weighing method was analyzed also.Results:1.3D reconstruction of liver neoplasms and liver vessels were performed in twenty patients,the virtual liver resection and the evaluation of residual liver volume were carried out.Finally the liver resection were performed successfully.The virtual liver resection match well with the actual operation process,and 20 patients achieved R0 resection.2.The volume of virtual liver resection was significantly positively correlated with the actual liver resection volume(r=0.999,p=0.000).3.We need about 2-3 hours to accomplish 3D reconstruction of the liver structure(including liver parenchyma,liver neoplasms,liver vessels)and virtual liver resection based on Myrian XP-Liver.Conclusions:Myrian XP-Liver can reconstruct the abstract two-dimensional CT images into intuitive 3D images,and showed the clear spatial relationship between the neoplasms and vessels of the liver.Virtual liver resection based on 3D reconstruction can be used to estimate the remnant liver.The application of the 3D reconstruction system in the preoperative evaluation of hepatectomy can accurately improve the safety and efficiency of the operation,so that it possess certain guiding meaning for actual hepatic carcinectomy.