Real-time virtual sonography visualization and its clinical application in biliopancreatic disease

Figure 1 Real-time virtual sonography system. Pre-scanned computed tomography volume data are processed in the main body of the ultrasound machine.

Figure 2 Calibration process. Transfer of the obtained computed tomography (CT) volume data; configuration of the settings for the standard landmark (ensiform cartilage/aorta/portal vein/other); and positional information of the probe is sensed. According to the probe sensor, the multiplanar reconstruction image is shown as an optimal angled plane

Figure 3 Pancreatic endocrine tumor (excellent case). A: Invasive pancreatic mass (60 mm) in body tail. B: Evaluation of the relationship between celiac artery (CA) and splenic artery (SPA): there was no vascular irregularity and the boundary between the tumor and CA/SPA remained intact.

Figure 4 The resulting evaluation levels of the real-time virtual sonography images were 12 excellent (pancreatic cancer, bile duct cancer, cholecystolithiasis and cholangiocellular carcinoma) and 3 good (pancreatic cancer and gallbladder cancer). A: Pancreatic cancer (excellent case); the positional relationships among the tumor and vessels [superior mesenteric artery (SMA) and superior mesenteric vein, (SMV)] were well evaluated; B: Pancreatic cancer (excellent case); the positional relationships among the tumor, vessels [portal vein (PV)], common bile dilatation (CBD), and main pancreatic duct (MPD) were well evaluated; C: Bile duct cancer (excellent case); the positional relationships among the tumor and vessels (SMA, SMV and PV) were well evaluated; D: Bile duct cancer (excellent case); the positional relationship between the tumor and CBD was well evaluated; E: Bile duct cancer (excellent case); the positional relationships among the tumor and vessels [proper hepatic artery (PHA), right hepatic artery (RHA), PV] were well evaluated; F: Bile duct cancer (excellent case); the positional relationships among the tumor and vessels [RHA, PV and inferior vena cava (IVC)] were well evaluated; G: Gallbladder cancer (good case); there was a gap in the positional relationships among the tumor and vessels.