计算机行肝脏CT断层三维重建及测量在肝癌中的应用研究

Clinical Application of Three-Dimensional Reconstruction and Measurement of CT Photography by Personal Computer in Hepatocarcinoma

目的 探讨利用个人电脑及自行开发的软件对肝脏CT断层图像进行三维重建和测量及其在肝癌患者的临床意义。方法 术前对 46例行原位肝移植的肝硬变门静脉高压症患者和 5例肝癌患者的肝脏CT断层图像进行三维重建和测量 ,术后与肝硬变门静脉高压症患者切除的受体实测肝体积进行对比分析。结果 对 46例肝硬变门静脉高压症患者用本方法测得平均肝脏体积为 ( 983 .3 3± 2 0 6.11)cm3 ,同组实测平均肝脏体积为 ( 90 4.93± 2 0 9.5 6)cm3 ,二者之间呈高度正相关 (r =0 .969) ,本方法测值的平均误差为 8.66%。本方法三维重建肝形状与切除同例肝标本实际形状基本相似。可任意角度旋转来观察三维重建肝。可以在重建肝脏同时重建肿物。当肿物被周围组织遮挡显示不清时 ,可用半透明显示法对肝脏进行半透明处理。同时 ,可测定肿物的体积及预计肝切除后的预留肝量。结论 运用该方法在个人电脑上实现肝脏连续CT断层图像三维重建和体积测量准确性较高。对术前明确肝肿瘤范围 ,正确选择手术术式 ,预测手术进程以及对肝病患者的随访和疗效判定 ,活体肝移植供受体匹配选择都有一定帮助。

Objective To evaluate the clinical value of stereography and measurement of liver volume by personal computer(PC) with the '3D reconstruction system' exploited by ourselves in hepatocarcinoma.Methods By using the '3D reconstruction system' and the Unigraphics 18.0 based on cubic B-Spline surface reconstruction principl, the liver volume in vivo was successfully measured and the three-dimensional image of the liver was rebuilt preoperatively in 46 posthepatitic cirrhosis who were selected for orthotopic liver transplantation. The liver volume of cirrhotic patients with portal hypertension was compared with the reference volume of recipient liver obtained by means of water displacement after transplantation. Meanwhile, observed and analyzed the 3D model of liver reconstructed in 5 hepatocarcinoma patients. Results The mean liver volume of cirrhotic patients (n=46) with portal hypertension measured by the software and water displacement was (983.33±206.11)cm3 and (904.93±209.56)cm3 respectively. Comparison by means of linear regression analysis between volume measurement on 3D reconstruction software and reference volume showed a nearly ideal correlation coefficient (r=0.969,P< 0.001).The mean error of this method was 8.66 %. The 3D model of liver reconstructed was similar in shape to actual liver specimen. At the same time, the 3D model of tumor was reconstructed. It enables doctors to observe the liver and its tumor pathological changes and relationship between the surrounding organization from different point of view through random rotation and semitransparence, and to calculate tumor and residue liver volume. Conclusion The 3D model of liver reconstructed was similar in shape to actual liver specimen and the liver volume determination by this method was relatively accuracy. It is very helpful for surgeon to define the range of hepatocarcinoma, to fix on surgical pattern accurately and to anticipate the operational course. To quantitate the liver volume by this method can contribute to the prognosis, follow-up of chronic liver disease patient, provide accurate estimation before liver transplantation and has a great potential in clinical practice.