CT Image fusion-guided portal vein puncture during transjugular intrahepatic portosystemic shunt

doi:10.3877/cma.j.issn.2095-5782.2022.04.004

Abstract

Abstract:

Objective

To evaluate the feasibility, safety and utility of 2D-3D registration method of CT image fusion (IF) technology for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) placement.

Methods

The clinical data of 48 patients with cirrhosis and portal hypertension who had undergone TIPS in our hospital from March 2016 to September 2022 were retrospectively collected. There were 39 males and 9 females with a mean age of 55 years (range: 35~88), and they were divided into conventional group (n=31) and fusion group (n=17). In the conventional group, portal vein puncture during TIPS placement was performed with DSA fluoroscopy guidance, and CT image fusion was used to guide the portal vein puncture in the fusion group.Mismatch between three-dimensional pre-procedure computed tomography angiography and digital subtraction angiography (DSA) images of portal vein on image fusion was quantitatively analyzed. Number of the portal vein puncture attempts, puncture time, contrast agent dosage, X-ray exposure time and dose-area product, cumulative air kerma, procedure time and puncture-related complications were compared between the two groups.

Results

TIPS was successfully performed in both groups. There were 5 cases of puncture-related complications in the conventional group and one patient died of liver failure after operation. No puncture-related complications occurred in the fusion group.The mismatch value was 1~10 mm(2.82 ± 2.43 mm) in cranio-caudal axis and 1~5 mm (2.06 ± 1.20 mm) laterally.Number of the portal vein puncture attempts, puncture time, contrast agent dosage, X-ray exposure time and dose-area product and cumulative air kerma of fusion group were shorter or less than those of conventional group (P < 0.05). The puncture-related complications and procedure time of fusion group were less than those of conventional group without statistically significant difference.

Conclusions

The 2D-3D registration method of CT image fusion technology for portal vein puncture during TIPS placement is feasible and safe, which might improve puncture accuracy, reduce puncture time, radiation dose and contrast agent dosage, and is worthy of clinical application.

Key words: Image fusion, Transjugular intrahepatic portosystemic shunt(TIPS), Portal hypertension, Portal vein puncture, Imaging guidance

Yongyu Zhang, Jianan He, Dashuai Wang, Ni Zhao, Weile Huang, Hui Guo. CT Image fusion-guided portal vein puncture during transjugular intrahepatic portosystemic shunt[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(04): 365-370.

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References 21

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		常规组	融合组
性别[n（%）]
	男	24（77.42）	14（82.36）
	女	7（22.58）	3（17.64）
年龄（岁）		53.00 ± 9.62	58.76 ± 14.22
肝硬化病因[n（%）]
	乙肝	30（96.77）	17（100）
	自身免疫性肝炎	1（3.23）	0（0）
TIPS指征n（%）
	急性静脉曲张破裂出血	29（93.55）	16（94.12）
	顽固性腹水	2（6.45）	1（5.88）
门静脉主干直径（mm）		14.58 ± 2.43	14.41 ± 2.65
门静脉右支直径（mm）		10.16 ± 1.81	11.71 ± 2.29
门静脉左支直径（mm）		11.06 ± 2.44	10.88 ± 2.12
靶门静脉直径（mm）		11.55 ± 2.23	11.65 ± 2.45

		常规组	融合组
性别[n（%）]
	男	24（77.42）	14（82.36）
	女	7（22.58）	3（17.64）
年龄（岁）		53.00 ± 9.62	58.76 ± 14.22
肝硬化病因[n（%）]
	乙肝	30（96.77）	17（100）
	自身免疫性肝炎	1（3.23）	0（0）
TIPS指征n（%）
	急性静脉曲张破裂出血	29（93.55）	16（94.12）
	顽固性腹水	2（6.45）	1（5.88）
门静脉主干直径（mm）		14.58 ± 2.43	14.41 ± 2.65
门静脉右支直径（mm）		10.16 ± 1.81	11.71 ± 2.29
门静脉左支直径（mm）		11.06 ± 2.44	10.88 ± 2.12
靶门静脉直径（mm）		11.55 ± 2.23	11.65 ± 2.45

组别	门静脉穿刺次数	穿刺时间（min）	对比剂用量（mL）	X线曝光时间（min）	DAP（mGy·cm²）	CAK（mGy）	手术时间（min）
常规组	6.52 ± 3.41	12.87 ± 7.31	192.06 ± 44.21	56.00 ± 17.16	176 265 ± 55 693	650.58 ± 260.39	124.42 ± 38.82
融合组	2.65 ± 1.32	4.35 ± 2.40	142.47 ± 23.76	40.00 ± 10.10	116 897 ± 32 522	411.12 ± 172.51	116.00 ± 17.26
统计值	5.593	5.935	5.055	3.514	4.660	3.816	1.036
P值	-	-	-	0.001	-	-	0.306
组别	手术方式		穿刺门静脉			穿刺位置与拟穿刺靶门静脉的一致性	穿刺相关并发症（例）			死亡
组别	TIPS	TIPS + SEVE	左支	右支	分叉	穿刺位置与拟穿刺靶门静脉的一致性	腹腔出血	穿破肝包膜	胆道损伤	死亡
常规组	9（29.03）	22（70.97）	10（32.26）	12（38.71）	9（29.03）	23（74.19）	1	3	1	1（3.23）
融合组	0（0.00）	17（10.00）	7（41.18）	7（41.18）	3（17.64）	15（88.23）	0	0	0	0（0.00）
统计值	0.006		0.382	0.028	0.759	1.313	3.061			-
P值	0.938		0.537	0.867	0.384	0.252	0.080			-

组别	门静脉穿刺次数	穿刺时间（min）	对比剂用量（mL）	X线曝光时间（min）	DAP（mGy·cm²）	CAK（mGy）	手术时间（min）
常规组	6.52 ± 3.41	12.87 ± 7.31	192.06 ± 44.21	56.00 ± 17.16	176 265 ± 55 693	650.58 ± 260.39	124.42 ± 38.82
融合组	2.65 ± 1.32	4.35 ± 2.40	142.47 ± 23.76	40.00 ± 10.10	116 897 ± 32 522	411.12 ± 172.51	116.00 ± 17.26
统计值	5.593	5.935	5.055	3.514	4.660	3.816	1.036
P值	-	-	-	0.001	-	-	0.306
组别	手术方式		穿刺门静脉			穿刺位置与拟穿刺靶门静脉的一致性	穿刺相关并发症（例）			死亡
组别	TIPS	TIPS + SEVE	左支	右支	分叉	穿刺位置与拟穿刺靶门静脉的一致性	腹腔出血	穿破肝包膜	胆道损伤	死亡
常规组	9（29.03）	22（70.97）	10（32.26）	12（38.71）	9（29.03）	23（74.19）	1	3	1	1（3.23）
融合组	0（0.00）	17（10.00）	7（41.18）	7（41.18）	3（17.64）	15（88.23）	0	0	0	0（0.00）
统计值	0.006		0.382	0.028	0.759	1.313	3.061			-
P值	0.938		0.537	0.867	0.384	0.252	0.080			-

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