Value of preoperative computed tomography and three-dimensional reconstruction of major vascular structures before ex vivo liver resection and autotransplantation for hepatic alveolar echinococcosis

Abstract

Objective To evaluate the application value of preoperative computed tomography (CT) and three-dimensional reconstruction (3DR) of major vessels regarding lesion infiltration severity, vascular morphology & function and predict vascular surgeries during ex vivo liver resection and autotransplantation (ELRA) for end-stage hepatic alveolar echinococcosis (AE). Methods Preoperative radiological & angiographical, intraoperative photographic and pathological materials were retrospectively collected in 40 consecutive patients undergoing ELRA for end-stage hepatic alveolar echinococcosis from January 2017 to January 2019. Severity of lesion infiltration, morphological & functional status as well as predictive value for surgical planning of hepatic venous system (HVs), inferior vena cava (IVC), portal venous system (PVs) and hepatic arterial supply system (HAs) were estimated, then compared with those built golden standards: angiography, intraoperative diagnosis and pathological examinationss. Results Evaluation accuracy of CT and 3DR for lesion infiltration severity, vascular morphology & function and predicting vascular surgeries respectively were 68.1%, 71.9%, 78.9% and 57.5%, 89.2%, 71.1% and all paired data had statistical significance (all P<0.05). Furthermore, CT had a higher certainty of predicting the use of vascular prosthesis during surgery than 3DR (77.5% and 70.0%, P<0.05). Conclusions Pre-ELRA CT is recommended for evaluating lesion infiltration severity and predicting corresponding vascular surgery. However, 3DR has more certainty in evaluating vascular morphology & function. Furthermore, CT is more reliable than 3DR in predicting vascular prosthesis during ELRA. However, optional better solutions should be studied for higher assurance. Key words: Liver transplantation; Echinococcosis; Three-dimensional computer-aided design