Virtual CT navigation image of the hepato-biliary system

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Seventy-four consecutive patients were referred for the evaluation of hepatobiliary disease after discovery based on clinical symptoms and ultrasound. The CT scan started at the level of the diaphragm and covered the entire liver, common bile duct and pancreas. Using a power injector, contrast medium was injected through a 20-G high-pressure intravenous catheter at a rate of 4 mL/sec in an antecubital vein. The volume of contrast medium delivered was 2 mL per kilogram of body weight. Fourteen patients who underwent percutaneous transhepatic bileduct drainage (PTBD) to eliminate obstructive jaundice were injected by PTBD tube of contrast medium in addition to intravenous injection. The raw data was transferred automatically to a workstation in a 512 x 512 pixel format via Ethernet. The 3-or 4-phase source 2D CT images were reviewed and analyzed for 3D reconstruction and to obtain a fusion image. Virtual CT navigation image were obtained using virtual endoscopic technique on the workstation. These images were analyzed qualitatively based on visualization of the critical structures. While evaluating these frill scale-3D and virtual images obtained by our institute, these images were clearly depicted in most of cases. The depict of organs can be reconstructed while there were a significant difference of attenuation value between the organ and a region around structure, but the several cases were difficult to produce 3D image in small size and the equal attenuation value around the structure. We emphasize that our new technique may contribute to the laparoscopy during surgery as the aid of understanding of anatomical structures in these organs. Our images are extremely helpful to the surgeon in localizing lesions and minimizing operating time, the extent of surgical resection, and blood loss.