Safety margin after radiofrequency ablation of hepatocellular carcinoma: precise assessment with a three-dimensional reconstruction technique using CT imaging.

PURPOSE: To analyse the precise ablative margin (AM) after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and the correlation between AM and local tumour progression (LTP) with a three-dimension (3D) reconstruction technique. METHODS: From March 2011 to May 2013, 134 patients who underwent RFA for 159 primary or recurrent HCCs within Milan criteria were enrolled. Contrast-enhanced computed tomography (CECT) scans were performed 1 week before and 1 month after treatment. The AM was measured in various directions using a 3D reconstruction technique that shows the index tumour and ablated zone on the same image. The average of all obtained AMs (average AM) and the smallest AM (min-AM) were calculated. RESULTS: The min-AM after RFA ranged from 1 to 9.3 mm (median ± standard deviation, 4.8 ± 1.8 mm). LTP was observed in 19 tumours from 19 patients. The median min-AM was 3.1 ± 1.6 mm for patients with LTP, while the median min-AM of patients without LTP was 5.1 ± 1.8 mm (p = 0.023). After RFA, the 1-, 2- and 3-year LTP rates were 10.9, 25.9 and 35.1%, respectively, for patients with min-AM <5 mm, and 4.1, 4.1 and 4.1%, respectively, for patients with min-AM ≥5 mm (p = 0.016). Multivariate analysis showed that only min-AM <5 mm was an independent risk factor for LTP after RFA (p = 0.044, hazard ratio =4.587, 95% confidence interval, 1.045-22.296). CONCLUSIONS: The 3D reconstruction technique is a precise method for evaluating the post-ablation margin. Patients with min-AM less than 5 mm had a higher probability of developing LTP.

Effect of digital three-dimensional reconstruction technique combined with indocyanine green (ICG) excretion test for precision hepatectomy in primary liver cancer.

OBJECTIVE: The aim of this study was to evaluate the residual volume of liver reserve function in liver cancer patients using three-dimensional reconstruction technique (3D technology) and the indocyanine green (ICG) excretion test. METHODS: A retrospective analysis was conducted, and data were collected from 90 liver cancer patients in Ganzhou People's Hospital between January 2017 and December 2021. The control group underwent preoperative resectability evaluation based on traditional two-dimensional images, whereas the experimental group underwent digital three-dimensional reconstruction technique combined with indocyanine green (ICG) excretion test. The intraoperative bleeding volume, accuracy of preoperative surgical planning, operation time, postoperative complication rate, and perioperative mortality were compared between the two groups. RESULTS: The assessment of resected liver volume (resectability) in the experimental group was larger than in the control group (P=0.003). Moreover, the accuracy rate of preoperative surgical planning in the experimental group was higher than in the control group (P=0.014). The intraoperative estimated blood loss favored the experimental group by a mean of 355 ml (P=0.02). Operative time and hospital stay favored the experimental group by a mean time of 204 min (P=0.03). The positive rate of liver resection margin and recurrence rate in the experimental group were lower than in the control group (P=0.021, P=0.004). Moreover, the two groups differed after intervention in terms of AST (P=0.001), ALT (P=0.0001), TBIL (P=0.001), and ALB (P=0.026). CONCLUSION: The combination of three-dimensional reconstruction technique and indocyanine green (ICG) excretion test provides accurate visualization of hepatic anatomy and improves the precision of liver resection surgery, which is of great guiding value. This can optimize the preoperative evaluation and surgical planning for liver resection, shorten the operation time, and reduce intraoperative bleeding volume.

Application of CT-MRI Fusion-Based Three-Dimensional Reconstruction Technique in the Anatomic Study of Posterior Cruciate Ligament.

OBJECTIVE: During PCL reconstruction surgery, precise and personalized positioning of the graft tunnel is very important. In order to obtain patient-specific anatomical data, we established a three-dimensional knee joint fusion model to provide a unified imaging strategy, as well as anatomical information, for individualized and accurate posterior cruciate ligament (PCL) reconstruction. METHODS: This is an exploration study. From January 2019 to January 2020, 20 healthy adults randomly were enrolled and assessed via CT and MRI imaging. A three-dimensional fusion model of the knee joint was generated using the modified MIMIMICS and image fusion software. On the fused image, the areas of the femoral and tibial PCL footprint of both knees were measured. The anatomical center of the PCL footprint was measured at the femoral and tibial ends. The relevant bony landmarks surrounding the PCL femoral and tibial attachment were also measured. Paired t-tests were employed for all statistical analyzes, and p < 0.05 was considered as statistically significant. RESULTS: All 20 subjects achieved successful image fusion modeling and measurement, with an average duration of 12 h. The lengths of the LF1-LF3 were 32.1 ± 1.8, 6.8 ± 2.5, and 23.3 ± 2.1 mm, respectively. The lengths of the LT1-LT3 were 37.3 ± 3.3, 45.6 ± 5.3, and 6.0 ± 1.2 mm, respectively. The distances between the tibial PCL center of the left knee to the medial groove, champagne-glass drop-off, and the apex of the medial intercondylar were 8.4 ± 2.4, 9.2 ± 1.8, and 15.3 ± 1.4 mm, respectively, and the corresponding distances from the right knee were 8.0 ± 2.0, 9.4 ± 2.2, and 16.1 ± 1.8 mm, respectively. We observed no difference between the bilateral sides, in terms of the distance from the PCL center to the PCL attachment-related landmark, under arthroscopic guidance. The area of the femoral and tibial PCL footprints on the left knee were 115.3 ± 33.5 and 146.6 ± 24.4 mm2 , respectively, and the corresponding areas on the right knee were 121.8 ± 35.6 and 142.8 ± 19.5 mm2 , respectively. There was no difference between the bilateral sides in terms of the PCL footprint areas. CONCLUSION: In the fusion image, the PCL attachment center and relevant bony landmarks which can be easily identified under arthroscopy can be accurately measured. The model can also obtain personalized anatomical data of the PCL on the unaffected side of the patient, which can guide clinical PCL reconstruction.

Application and economic effects of digital three-dimensional reconstruction in hip hemiarthroplasty for intertrochanteric femoral fractures in the elderly / 中国组织工程研究

BACKGROUND:Digital three-dimensional reconstruction technology is gradually applied to orthopedic diseases with the advantages of visualization,accuracy and non-invasiveness,but there is less evidence-based support for its use in artificial hip hemiarthroplasty for intertrochanteric fractures of the femur in the elderly. OBJECTIVE:To investigate the application value and economic effects of digital three-dimensional reconstruction techniques in artificial hip hemiarthroplasty of intertrochanteric fractures of the femur in the elderly. METHODS:One hundred and thirty elderly patients with intertrochanteric femur fractures admitted to Zunyi First People's Hospital from January 2019 to December 2022 were selected and randomly divided into a control group(n=65)and an observation group(n=65).Artificial hip hemiarthroplasty was performed in both groups.The control group adopted the film template measurement method for manual preoperative planning while the observation group adopted a digital three-dimensional reconstruction technique.Preoperative planning and intraoperative actual application of prosthesis compliance rate,fibrinogen,D-dimer,bilateral femoral eccentric distance difference,bilateral lower limb length difference,Harris hip function score,visual analog scale score,excellent and good rate of hip function,complications,and hospitalization cost were observed in both groups. RESULTS AND CONCLUSION:(1)The proportion of acetabular side and femoral side prosthesis in grade 0(fully compliant)was higher in the observation group than that in the control group(P<0.05).(2)Fibrinogen and D-dimer levels in the observation group were lower than those in the control group 3 days after surgery(P<0.05).(3)The difference in bilateral femoral eccentric distance and the difference in bilateral lower limb length in the observation group were smaller than those in the control group immediately after surgery(P<0.05).The differences in Harris and visual analog scale scores were not significantly different between the two groups preoperatively,6 and 12 months postoperatively(P>0.05).There was no significant difference in excellent and good rate of hip function between the two groups 12 months postoperatively(P>0.05).(4)There was no significant difference in the complication rate between the two groups(P>0.05).The hospitalization cost of the observation group was higher than that of the control group(P<0.05).(5)It is indicated that digital three-dimensional reconstruction technology applied in artificial hip hemiarthroplasty of intertrochanteric femoral fracture in the elderly can not only accurately determine the prosthesis type before surgery,but also accurately reconstruct the bilateral lower limbs offline,but its hospitalization cost is high.

Three-dimensional image reconstruction with free open-source OsiriX software in video-assisted thoracoscopic lobectomy and segmentectomy.

OBJECTIVE: The aim of this retrospective study was to evaluate the practice and the feasibility of Osirix, a free and open-source medical imaging software, in performing accurate video-assisted thoracoscopic lobectomy and segmentectomy. METHODS: From July 2014 to April 2016, 63 patients received anatomical video-assisted thoracoscopic surgery (VATS), either lobectomy or segmentectomy, in our department. Three-dimensional (3D) reconstruction images of 61 (96.8%) patients were preoperatively obtained with contrast-enhanced computed tomography (CT). Preoperative resection simulations were accomplished with patient-individual reconstructed 3D images. For lobectomy, pulmonary lobar veins, arteries and bronchi were identified meticulously by carefully reviewing the 3D images on the display. For segmentectomy, the intrasegmental veins in the affected segment for division and the intersegmental veins to be preserved were identified on the 3D images. Patient preoperative characteristics, surgical outcomes and postoperative data were reviewed from a prospective database. RESULTS: The study cohort of 63 patients included 33 (52.4%) men and 30 (47.6%) women, of whom 46 (73.0%) underwent VATS lobectomy and 17 (27.0%) underwent VATS segmentectomy. There was 1 conversion from VATS lobectomy to open thoracotomy because of fibrocalcified lymph nodes. A VATS lobectomy was performed in 1 case after completing the segmentectomy because invasive adenocarcinoma was detected by intraoperative frozen-section analysis. There were no 30-day or 90-day operative mortalities CONCLUSIONS: The free, simple, and user-friendly software program Osirix can provide a 3D anatomic structure of pulmonary vessels and a clear vision into the space between the lesion and adjacent tissues, which allows surgeons to make preoperative simulations and improve the accuracy and safety of actual surgery.