3D NLS-research Of Metatron Hunter 4025 For Diagnostics Of Gall Bladder And Gall-ducts Concretions

NLS-research methods in primary diagnostics of diseases of abdominal cavity organs become more and more available. Up to the present moment the NLS-images were in 2D which did not cover the dimensioned interrelation of structures under research. Significant information volume and accuracy increase is required to achieve fundamental improvement in NLS-image quality.

That is why appearance of Metatron Hunter 4025 systems with 3D pictures feasibility became a new development stage of NLS-graphy. The multidimensional reconstruction mode is based on rendering of 3 mutually perpendicular imaging planes of the organ. The advantage of such method is getting of accurate topographic-anatomical interrelations between targeted structures which results in improvement of picture perception.

Prognostic significance of 3D non-linear picture reconstruction in practical diagnostics is still being updated at the present moment. One of the possible upcoming trends of usage of the given procedure is an early detection of pathological changes in gastrointestinal tract organs which requires emergency and scheduled surgical measures.

NLS-diagnostics may become a procedure of choice for detection of concrements and dilatation degree of bile passages. When examining of patients with choledocholithiasis the classical picture of concrement is a hyperchromogenic structure (5-6 points according to Fleindler’s scale) of various forms. The accuracy of 3D NLS-diagnostics of choledocholithiasis is more than 95.0%.

The minimal size of detected concrement in gall bladder is about 5 mm. for NLS-diagnostic systems of the first generation. Acquired image of concrement and gall bladder walls accuracy significantly improves when using 3D picture reconstruction mode in Metatron Hunter 4025 systems.

One of the main complications of gallstone disease is choledocholithiasis which is found more than in 10% of patients who had underwent cholecystectomy. Concrements in common bile duct are generally developed in case of their migration from gall bladder through cystic duct (diagnostics in the first 2 years after cholecystectomy). Secondary concrements in common bile duct generally develop 2 years after cholecystectomy. These concrements are associated with bile stasis in common bile duct (the narrowing of common bile duct, papillary stenosis, Oddi’s sphincter dysfunction) or with infection.

NLS-diagnostics of choledocholithiasis complications as a method of primary screening has undeniable advantages in comparison with other hardware diagnostic techniques. Though the detection of choledocholithiasis is difficult and in some cases impossible without spectral-entropic analysis. In case of common 2D NLS-graphy the mistakes occur most often when dealing with stones of smaller diameter (up to 5 mm.). 2D NLS-diagnostics of choledocholithiasis is only 60-70%.

Due to approximate density values of cholesterol stone and bile surrounding it the use of X-ray computed tomography does not allow concrements visualizing of the common bile duct especially in case of their small sizes and the lack of bile or pancreatic ducts ectasia.

Also because of this the concrements cannot be differentiated with major duodenal papilla cancer. In this case the use of 3D NLS-research with spectralentropic analysis is mostly reasonable in diagnostics of complicated cases of choledocholithiasis in case of accompanying chronic indurative pancreatitis and also for differential diagnostics of choledocholithiasis with pancreatic gland and bile ducts tumors. X-ray computed tomography is less sensitive to the detection of choledocholithiasis but it identifies more accurate the side and the cause of extrahepatic biliary obstruction in comparison with 2D NLS-diagnostics.

In case of isolated ectasia of the common bile duct or general pancreatic duct it is reasonable to use such diagnostic procedure as endoscopic retrograde cholangiopancreatography which is a ?gold standard? of the common bile duct concrements diagnostics for surgeons. Cannulation of the common bile duct and successful cholangiography processes are possible more than in 90% of patients. Concrements of the common bile duct detected during an operation may also be removed using endoscopic retrograde cholangiopancreatography. But there are both multiple contradictions against using given invasive technique and its complications in the form of pancreatitis, cholangitis, rupture or haemorrhage (occur in 5-8%). The death rate when using given method is 0.2–0.5%. Complete removal of concrements using endoscopic retrograde cholangiopancreatography per single procedure is possible in 71-75% of patients, when performing several procedures in 84–93%.

NLS-researches were carried out using Metatron Hunter 4025 with the use of continuous spiral scanning and spectral-entropic analysis mode. 3D reconstruction was achieved with the use of mathematical program for information processing and image reconstruction in various formats of 4D Tissue:

- superficial volumetric reconstruction that allows receiving realistic superficial image of an object;

- multiplanar volumetric reconstruction of images with formation of a cube, cross section of which can be examined in any of three orthogonal projections.

Using multiplanar volumetric reconstruction of pictures function one can receive multidimensional picture of any anatomical structure. After that the data analysis is performed without presence of the patients.

3D NLS-graphy is an all purpose screening diagnostics method of hepatobiliary system organs diseases. This is a new highprecision technological effective special research method targeted at solution of clearly marked clinical problem. In the present time the methods of 3D NLS-research allow more demonstrable presentation of received results and it makes easier to interpret them by clinicians. 3D NLS-graphy expands opportunities of the common 2D NLS-research due to space pattern and cross-sections previously not available for examination. The use of specific data (especially on the stage of application of the new technique) does not exclude the use of generally accepted algorithm of patient examination but it allows more accurate interpretation of the obtained results. Given technique may be used at an early stage of patient examination because of its availability, relative low-price of the research systems and saving of the time needed for drawing of the conclusion.