Transjugular intrahepatic portosystemic shunt creation in a polycystic liver facilitated by hybrid cross-sectional/angiographic imaging
ABSTRACT Polycystic liver disease (PCLD) has long been considered to represent a contraindication to transjugular intrahepatic portosystemic shunt (TIPS) creation, primarily because of the risk of hemorrhage. Three-dimensional (3D) navigation within the enlarged and potentially disorienting parenchyma can now be performed during the procedure with the development of C-arm cone-beam computed tomography, which relies on the same equipment already used for angiography. Such a hybrid 3D reconstruction-enabled angiography system was used for safe image guidance of a TIPS procedure in a patient with PCLD. This technology has the potential to expedite any image-guided procedure that requires 3D navigation.
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ABSTRACT: Three-dimensional (3D) C-arm computed tomography is a new and innovative imaging technique. It uses two-dimensional (2D) X-ray projections acquired with a flat-panel detector C-arm angiography system to generate CT-like images. To this end, the C-arm system performs a sweep around the patient, acquiring up to several hundred 2D views. They serve as input for 3D cone-beam reconstruction. Resulting voxel data sets can be visualized either as cross-sectional images or as 3D data sets using different volume rendering techniques. Initially targeted at 3D high-contrast neurovascular applications, 3D C-arm imaging has been continuously improved over the years and is now capable of providing CT-like soft-tissue image quality. In combination with 2D fluoroscopic or radiographic imaging, information provided by 3D C-arm imaging can be valuable for therapy planning, guidance, and outcome assessment all in the interventional suite.12/2008: pages 33-51;
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ABSTRACT: C-arm cone-beam computed tomography (CBCT) is a relatively new imaging technology that uses a conical-shaped radiation beam and a 2-dimensional flat-panel detector to produce 3-dimensional volumetric datasets with excellent spatial resolution. Recently, this technology has been implemented in angiographic units across the country. This imaging modality is particularly useful when both images of "CT-like" quality and real-time fluoroscopic imaging are required for pretreatment planning and intraprocedural guidance. In this article, we describe the use of cone-beam CT technology in various nonvascular and portal venous interventions, including percutaneous vertebroplasty or kyphoplasty, transjugular intrahepatic portosystemic shunt, percutaneous needle biopsy and ablation of pulmonary nodules and renal masses, gastrostomy tube insertion, hepatic radiofrequency ablation, and biliary interventions.Techniques in vascular and interventional radiology 09/2013; 16(3):150-60. DOI:10.1053/j.tvir.2013.02.010
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ABSTRACT: The purpose of this study was to compare two-dimensional digital subtraction angiography (2D-DSA) with C-arm cone-beam volume computed tomography (CACT) in the evaluation of portal vein entry and shunt course during transjugular intrahepatic portosystemic shunt (TIPS) procedure. Between May 2010 and November 2011, 21 patients who underwent direct portography in anteroposterior and lateral projections and subsequent CACT before stent placement during TIPS creation were reviewed retrospectively. CACT images were examined for evaluation of the portal vein entry and shunt course in comparison to 2D-DSA images by two experienced interventional radiologists. CACT was proven to be better than 2D-DSA in identification of the portal vein entry (P < 0.001) and intra- or extrahepatic puncture (P < 0.001). No significant difference was observed in evaluating the shunt course (P = 0.086). The portal vein entry was considered inappropriate in seven (33 %) out of 21 patients; among them, four cases were due to extrahepatic puncture, and three cases were due to peripheral puncture of the portal vein which may result in stent kinking. While 2D-DSA remains the standard imaging method to evaluate portal vein entry, shunt course, and portal vein anatomy during TIPS procedure, CACT can effectively identify the portal vein entry and assess shunt course in difficult cases intra-procedurally, hence may reduce the risk of potential life-threatening intra-abdominal hemorrhage and shunt dysfunction.CardioVascular and Interventional Radiology 04/2015; DOI:10.1007/s00270-015-1087-2 · 1.97 Impact Factor