Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases

Abstract

Three-dimensional (3D) visualization involves feature extraction and 3D reconstruction of CT images using a computer processing technology. It is a tool for displaying, describing, and interpreting 3D anatomy and morphological features of organs, thus providing intuitive, stereoscopic, and accurate methods for clinical decision-making. It has played an increasingly significant role in the diagnosis and management of liver diseases. Over the last decade, it has been proven safe and effective to use 3D simulation software for pre-hepatectomy assessment, virtual hepatectomy, and measurement of liver volumes in blood flow areas of the portal vein; meanwhile, the use of 3D models in combination with hydrodynamic analysis has become a novel non-invasive method for diagnosis and detection of portal hypertension. We herein describe the progress of research on 3D visualization, its workflow, current situation, challenges, opportunities, and its capacity to improve clinical decision-making, emphasizing its utility for patients with liver diseases. Current advances in modern imaging technologies have promised a further increase in diagnostic efficacy of liver diseases. For example, complex internal anatomy of the liver and detailed morphological features of liver lesions can be reflected from CT-based 3D models. A meta-analysis reported that the application of 3D visualization technology in the diagnosis and management of primary hepatocellular carcinoma has significant or extremely significant differences over the control group in terms of intraoperative blood loss, postoperative complications, recovery of postoperative liver function, operation time, hospitalization time, and tumor recurrence on short-term follow-up. However, the acquisition of high-quality CT images and the use of these images for 3D visualization processing lack a unified standard, quality control system, and homogeneity, which might hinder the evaluation of application efficacy in different clinical centers, causing enormous inconvenience to clinical practice and scientific research. Therefore, rigorous operating guidelines and quality control systems need to be established for 3D visualization of liver to develop it to become a mature technology. Herein, we provide recommendations for the research on diagnosis and management of 3D visualization in liver diseases to meet this urgent need in this research field.

Virtual reality and 3D printing improve preoperative visualization of 3D liver reconstructions—results from a preclinical comparison of presentation modalities and user’s preference

“…3D reconstructions of the liver have been shown to be helpful for resection planning. Several studies have demonstrated that 3D visualizations have advantages over 2D scans (5,25,26). However, the role of the 'presentation modality' for these 3D visualizations is not well investigated.…”

Augmented Reality Navigation for Stereoscopic Laparoscopic Anatomical Hepatectomy of Primary Liver Cancer: Preliminary Experience

“…Overdependence on the skills of surgeons may lead to vascular injury, inaccurate tumor localization, and excessive resection of normal liver tissue. 3D visualization based on preoperative CT has been proven safe and effective for hepatic vessels classification, liver segmentation, simulated hepatectomy, and measurement of liver volume ( 13 , 19 ). However, it mainly plays the role of pre-resection evaluation and cannot be fused into the surgical scene.…”

“…Our proposed LARN system achieved similar functions as the above studies, and the accuracy of our LARN system has been assessed in previous pre-clinical studies on both ex vivo and vivo porcine livers ( 6 ). Preoperatively, 3D models were reconstructed using a homogeneous and standardized 3D visualization processing ( 13 ). Through a fast registration procedure, 3D images were integrated with the current patient and surgical instrument position into a unified coordinate space.…”

“…All patients in the IN group were scanned with Philips Brilliance 64- or 256-multislice spiral CT scanner to collect four-phase CT data during plain scan phase, arterial phase, portal venous phase and delayed phase. The specific scanning parameters and methods were referenced to consensus recommendations of 3D visualization for diagnosis and management of liver diseases ( 13 ). The self-developed 3D visualization system (MI-3DVS, software copyright: No.2008SR18798) was used for 3D reconstruction, and several quality control criteria were followed: (1) Patients should be instructed to hold their breath during CT scan to avoid difficulties in image segmentation and registration between different phases; (2) quality of original CT images should meet the minimum standards of 3D visualization software; (3) 3D reconstruction should be performed by qualified personnel; (4) 3D models should be manually checked and modified by a senior surgeon and an imaging physician.…”

Locoregional Combined With Systemic Therapies for Advanced Hepatocellular Carcinoma: An Inevitable Trend of Rapid Development

“…Due to the application of three-dimensional (3D) visual surgical planning systems, ablative therapies have been increasingly used for larger and high-risk-location tumors ( Li et al, 2017 ; Fang et al, 2020 ). In a comparable study, 223 liver tumors with mean diameters of 5.0 ± 1.5 cm were divided into 3D and 2D planning groups.…”