Pe ei adaSil ae al. BMC Med Imaging (2020) 20:120
h ps://doi.o g/10.1186/s12880-020-00520-0
CASE REPORT
Ad anced hepa ic asculobilia y imaging
segmen a ion and3D econs uc ion asanaid
in hesu gical managemen o high bilia y
s enosis
Nuno Pe ei a da Sil a1* , Inês Ab eu1, Ma co Se ôdio2, Luís Fe ei a2, Hen ique Alexand ino2,3,4,5
and Paulo Dona o1,3
Abs ac
Backg ound: Th ee-dimensional (3D) models a e inc easingly used o help su geons, guiding hem h ough he
complex hepa ic asculobilia y ana omy. The bilia y ac is a ela i ely un apped e i o y wi h only a ew case epo s
desc ibed in medical li e a u e. Ou aim is o p esen an inno a i e 3D econs uc ion me hodology o bilia y imaging
and su gical planning, applied o a case o ia ogenic bilia y s ic u e, wi h usion o segmen ed CT and MRI images.
Case p esen a ion: A selec ed case o Bismu h ype III ia ogenic bilia y s enosis o 3D planning. CT and MR s udies
we e acqui ed wi h dedica ed p o ocols o segmen a ion. Two adiologis s pe o med segmen a ion and 3D model
pos -p ocessing, using bo h imaging echniques o ai h ully ende he ana omical s uc u es. Measu emen s o
ana omical landma ks we e aken in bo h he CT/MRI and he 3D model o assu e i s accu acy and di e ences in
measu emen we e calcula ed. The 3D model eplica es ana omical s uc u es and pa hology wi h high accu acy, wi h
only 2.2% a ia ion be ween STL, CT and MRI measu emen s. The model was discussed wi h he su gical eam and
used in he su gical planning, imp o ing con idence in his delica e p ocedu e, due o he de ailed p io knowledge
o he pa ien ’s ana omy.
Conclusion: Th ee-dimensional econs uc ions a e a apidly g owing a ea o esea ch wi h a signi ican impac in
he pe sonalized and p ecision medicine. The cons uc ion o 3D models ha combine ascula and bilia y ana omy,
using di e en imaging echniques, espec i ely CT and MRI, will p edic ably con ibu e o a mo e igo ous planning
o complex li e su ge ies.
Keywo ds: Th ee-dimensional (3D) model, Bilia y s ic u e, Hepa obilia y imaging, P e-ope a i e planning,
Pe sonalized medicine, Image pos -p ocessing, Compu ed omog aphy, Magne ic esonance imaging, Case epo
© The Au ho (s) 2020. Open Access This a icle is licensed unde a C ea i e Commons A ibu ion 4.0 In e na ional License, which
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Backg ound
Th ee-dimensional (3D) p in ing is a apidly g owing
a ea o esea ch wi h a signi ican impac in pe sonalized
and p ecision medicine. The design o 3D models and
3D p in ing ha e been de eloped o di e en medical
pu poses.
3D models, o en p in ed, a e widely used as su gical
aids in o hopedic and maxillo acial su ge y due o he
ela i e ease in bone segmen a ion [1]. Li e models a e
also inc easingly used o help su geons, guiding hem
h oughou he complex li e ana omy, namely in umo
esec ions and p e- ansplan s udies [2–6].
Open Access
*Co espondence: nunoapsil [email protected]
1 Medical Imaging Depa men , Coimb a Uni e si y Hospi al Cen e ,
P ace a P o . Mo a Pin o, 3000-075 Coimb a, Po ugal
Full lis o au ho in o ma ion is a ailable a he end o he a icle
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Pe ei adaSil ae al. BMC Med Imaging (2020) 20:120
A sys ema ic e iew by Pe ica e al. [7] con i med he
added alues o he models on hese su gical p oce-
du es. The bilia y ac howe e is, as o ye , a ela i ely
un apped e i o y wi h only a ew case epo s desc ibed
in medical li e a u e [4, 8, 9].
Comple e bilia y s enosis esul ing om ia ogenic
inju y can be li e- h ea ening. Su gical epai wi h Roux-
en-Y hepa icojejunos omy is he gold s anda d he apy as
i ensu es bilia y ou low and econs i u es bilio-en e ic
d ainage. Gi en he high densi y and equen ana omic
a iabili y o asculo-bilia y s uc u es in he li e hilum,
me iculous p eope a i e planning is c ucial. This equi es
excellen p eope a i e imaging, usually wi h mul iple
modali ies, such as compu ed omog aphy (CT) and
magne ic esonance—wi h cholangiopanc ea og aphy
(MRCP). Howe e , hese di e en modali ies will p o ide
dis inc ea u es ha need h ee-dimensional in eg a ion
by he su gical eam o plan he app oach [10].
Fo ins ance, he a e ial and po al ascula ana omy
a e eliably demons a ed by he CT-angiog aphy, while
bilia y ana omy is bes depic ed by MRCP. An in eg a ed
app oach o hese images would be ex emely help ul as i
would p o ide a oadmap o his challenging ana omical
a ea, u he compounded wi h adhesions and in lamma-
o y changes.
We p esen a case o a pa ien wi h an ia ogenic bil-
ia y s ic u e in which we used an inno a i e 3D econ-
s uc ion me hodology, using images om wo dis inc
modali ies, one o ascula illus a ion (CT) and o he
o bilia y ee ana omy demons a ion (MRCP). We
belie e ha his app oach can be used in o he con-
ex s o complex su gical, endoscopic and in e en-
ional adiology p ocedu es, pa icula ly in cases o
benign o malignan bilia y s enosis, as well as in li e
ansplan a ion.
Case p esen a ion
A 50-yea -old male pa ien p esen ed o he eme gency
depa men wi h jaundice, e e (39°C) and cholu ia in
he p e ious 2days. The pa ien had unde gone cholecys-
ec omy o cholecys oli hiasis and Mi izzi synd ome
wo yea s ea lie (Fig.1). He epo ed simila episodes in
he p e ious mon hs, wi h milde symp oms.
He also had pe sonal medical his o y o G a es’ dis-
ease, ulce a i e coli is and clea cell ca cinoma o he
kidney (ha ing unde gone lapa oscopic igh pa ial
neph ec omy 10yea s ea lie ).
The labo a o y s udies showed ele a ion o li e
enzymes, mainly gamma glu amyl anspep idase (GGT)
and o al and di ec bili ubin, o 789 U/L [N: < 55U/L],
10.1mg/dL [N:0.3–1.2mg/dL] and 6.7mg/dL [N:0.1–
0.3mg/dL], espec i ely, and a sligh ele a ion o aspa -
a e amino ans e ase (AST), alanine amino ans e ase
(ALT) and alkaline phospha ase (ALP). C- eac i e p o-
ein was also ele a ed (7.12mg/dL; N:0–0,.mg/dL).
The pa ien was admi ed o medical ea men o
cholangi is and unde wen imaging es s o cha ac e ize
he bile duc s, wi h suspicion o ia ogenic/pos in lam-
ma o y bilia y s enosis.
A MRI was pe o med wi h MRCP p o ocol and wi h
hepa obilia y con as , con i ming dila a ion o he
in ahepa ic bile duc s wi h an ab up s op nea he bil-
ia y con luence, in close con ac wi h he i s po ion
o he duodenum. In he hepa obilia y phase, con as
was exc e ed o he duodenal bulb and no con as was
p esen in he choledochal duc , seemingly con i ming
Fig. 1 Co onal and Axial Abdominal in he po al enous phase. A calci ied gallbladde s one is isible in he in undibulum (a ow) causing
comp ession and dila ion o he common bile duc (a owhead), he Mi izzi synd ome
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Pe ei adaSil ae al. BMC Med Imaging (2020) 20:120
hepa icoduodenal is ula. S enosis o he main bilia y
ac was con i med, wi h app oxima ely 3cm in leng h
(Figs.2, 3).
The pa ien was diagnosed wi h Bismu h ype III s e-
nosis a e cholecys ec omy, associa ed wi h hepa i-
coduodenal is ula. Gi en he young pa ien age and a e
discussion in a mul idisciplina y se ing, he pa ien was
o e ed su gical econs uc ion. Abdominal iphasic CT
was also pe o med o de ec po en ial associa ed ascu-
la inju y and o ob ain a p eope a i e ana omical map-
ping. The imaging p o ocols used in MRI and CT a e
de ailed below.
3D planning‑CT andMR p o ocols
P e-con as and iphasic pos -con as abdomi-
nal CT was pe o med on a 64-slice CT scanne (GE
Ligh Speed VCT) wi h he ollowing scanning p o-
ocol: de ec o collima ion 64-slice × 0.625 mm wi h
gan y o a ion o 500 ms, 120 kVp and 134 mAs, a
slice hickness o 0.625mm wi h esul ing oxel size o
0.625 × 0.625 × 0.625 mm3 (Fig.4).
The MRI was pe o med in a 3T machine (Magne om
p isma i -Siemens Medical Solu ions, E langen, Ge -
many) using axial and co onal HASTE; axial in-phase and
ou -o -phase T1-weigh ed imaging; axial T2-weigh ed a
Fig. 2 MRI one yea a e cholecys ec omy. Co onal HASTE (a) shows in a-hepa ic bile duc dila ion wi h an ab up s op a he con luence, in
close con ac wi h he duodenum (a ow). In he hepa obilia y phase (b) con as was exc e ed o he duodenal bulb (a ow) and no con as was
depic ed in he choledochus (a owhead), con i ming is ulisa ion
Fig. 3 MR cholangiog aphy. a Volume ende ing (VR); b maximum in ensi y p ojec ion (MIP) 50 mm. Bo h e o ma ions show in a-hepa ic bile
duc dila ion wi h ab up s op a he con luence. On B, he dis al choledochus is iden i ied (a ow) wi h no signs o choledocholi hiasis. A s enosis o
he common bile duc wi h a leng h o 3 cm was diagnosed
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Pe ei adaSil ae al. BMC Med Imaging (2020) 20:120
sa u a ed sequence; 3D colangiog aphic sequence; axial
DWI b-50-100-800 and a p econ as and pos con as
T1-weigh ed 3D VIBE a e 10mL endo enous gadox-
e ic acid injec ion on a e ial, po al, ansi ional and
hepa obilia y phases. The segmen a ion was pe o med
in he hepa obilia y phase, a 3D Dixon sequence, 20min
a e injec ion, wi h a 320 × 320 ma ix and ield o iew
(FOV) o 320 × 280 (Figs.2,3).
3D planning: image pos ‑p ocessing andsegmen a ion
O iginal CT and MRCP images in Digi al Imaging and
Communica ions in Medicine (DICOM) o ma we e
expo ed o a sepa a e wo ks a ion wi h In elliSpace Po -
al, e sion 9 (Phillips Heal hca e, Bes , The Ne he lands)
o pos -p ocessing and segmen a ion.
Two adiologis s ained in 3D p in ing pe o med seg-
men a ion o MR and CT images. The li e , po al and
hepa ic eins we e segmen ed using in he po al enous
phase, he coeliac unk and hepa ic a e y using he
a e ial phase imaging. The in ahepa ic bile duc s we e
segmen ed in bo h he CT (po al enous phase) and he
hepa obilia y phase o he hepa ic MR. Rega ding he
segmen a ion echniques, bo h manual and semi-au o-
ma ic segmen a ion echniques we e used wi h di e -
en me hods in o de o ai h ully ende he ana omical
s uc u es including h esholding echnique, edge de ec-
ion, egion g owing and mul iple slice in e pola ion.
The la ge olume s uc u es, such as he li e and po al
ein, we e ini ially segmen ed wi h semi-au oma ic selec-
ion ools o edge de ec ion and h esholding, he con-
ou s we e de ined and adjus ed manually. The smalle
calibe essels and bilia y duc s we e segmen ed s ep-by-
s ep, wi h high p ecision selec ion ools equi ing manual
delinea ion using egion g owing echnique.
The inal da ase was expo ed in o S anda d Tessella-
ion Language (STL) o be iewed and p ocessed wi h he
Meshmixe 3.5 (Au odesk, Inc). Using he CT STL as a
e e ence, he MRI STL was ini ially supe imposed using
h ee-dimensional Ca esian coo dina es and hen manu-
ally adjus ed o achie e a eliable o e lap, using e e ence
poin s placed along he igh and le hepa ic duc s, he
pos e io b anch o he igh hepa ic duc and on he
con e gences o mo e dis al sec o al duc s on bo h CT
and MR STLs.
The o iginal (CT) model and he used model
(CT + MR) we e e iewed join ly by he adiologis s and
he su gical eam, concluding ha he bile duc s we e
mo e accu a ely segmen ed using MRCP han CT, due o
i s supe io con as esolu ion. Du ing he edi ing p o-
cess, some de o mi ies and ee objec s we e emo ed
and he bo de s we e smoo hed (Fig.5).
3D planning: esul s
Measu emen s o ana omical landma ks we e aken in
bo h he CT/MRI and he 3D model o assu e i s accu-
acy. The s uc u es we e measu ed h ee imes by bo h
Radiologis s o each echnique and he mean alue was
used. The s uc u es measu ed we e: he igh and le
hepa ic duc , main po al ein, p ope hepa ic a e y and
igh and le b anches o he hepa ic a e y. Di e ences
in measu emen s o he diame e o he a o emen ioned
s uc u es we e calcula ed be ween bo h MR, CT and
STL (Fig. 6), using he ollowing o mula:
%
di e ence =
(A
−
B)
(A+B)
2
×
100
. The pe cen age o di e ence
in he measu emen using CT only and used CT/MR
we e low bu he ag eemen was sligh ly be e when
using used imaging (5.2% and 2.1% espec i ely)
(Table1).
Fig. 4 Abdominal CECT wi h co onal e o ma ion. a A e ial phase; b po al enous phase. The in ica e ana omical ela ions be ween he s enosis,
he duodenal loop and essels a e appa en bu i s cha ac e iza ion is somewha insu icien . Close con ac be ween he igh hepa ic a e y and
s enosis is depic ed
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Pe ei adaSil ae al. BMC Med Imaging (2020) 20:120
Fig. 5 3D models on Meshmixe (STL o ma ). The segmen ed issues a e isualized in a on al iew (abo e) and a bo om iew (below). On he
igh , he li e was excluded o easie isualiza ion o he ana omy o he in e nal s uc u es. Colou legend: anspa en —li e ; da k blue—hepa ic
eins and in e io ena ca a; ligh blue—po al ein; ed—ao a and hepa ic a e y; g een—bile duc s
Fig. 6 Measu emen s o he hepa ic a e y ( op ow) and main po al ein (bo om ow) in bo h CT and STL

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The pa ien had an in e es ing ana omical a ia ion, an
accesso y hepa ic ein appa en ly d aining S6, which was
also segmen ed and included in ou model. This howe e
did no p esen any clinical consequences.
The ensuing 3D models we e discussed and analyzed
wi h he su gical eam and used in he planning o he
su ge y, emphasizing i s use ulness o he mapping
o ascula ela ions wi h he s enosis and bilia y ee
(Fig.7).
Du ing su ge y, a e dissec ion o adhesions, he
hepa icoduodenal is ula was iden i ied and he duo-
denal o i ice closed. Thanks o he p eope a i e 3D
econs uc ions, he igh hepa ic a e y was ound and
only minimally dissec ed away om he bilia y con e -
gence, hus a oiding de ascula iza ion o he bile duc s.
The hila pla e was lowe ed, and he bilia y con e gence
was dissec ed in a densely in lamed hepa ic hilum, wi h
he usual ana omical landma ks obscu ed (Fig.8). A e
cholangioscopic explo a ion con i med all main bilia y
duc s we e pa en , a Roux-en-Y hepa icojejunos omy
was pe o med. Gi en he pa ien ’s medical his o y o
ulce a i e coli is a hepa ic biopsy was pe o med o
exclude p ima y scle osing cholangi is (PSC).
Table 1 Di e ences inmeasu emen inMR, CT andSTL
N/A no applicable
Landma ks Measu emen s (mm) Di e ences (%) inmeasu emen s
(STL/MRI) Di e ences (%)
inmeasu emen s
(STL/CT)
MRI CT STL
Righ hepa ic duc 5.9 5.1 5.7 3.448 11.111
Le hepa ic duc 7.9 7.1 7.9 0 10.667
Main po al ein N/A 16.2 16.8 N/A 3.636
Hepa ic a e y N/A 4.8 4.9 N/A 2.062
Righ hepa ic a e y N/A 4.5 4.6 N/A 2.198
Le hepa ic a e y N/A 4.8 4.9 N/A 2.062
Di e ences in measu emen s using CT as e e ence (%) 5.2
Di e ences in measu emen s using MR as e e ence o bile duc s and CT o o he s uc u es (%) 2.2
Fig. 7 3D models on Meshmixe (STL o ma ). A de ailed iew o he bilia y ee on he le and wi h he a e ial ela ions on he igh . On he
bo om, a zoomed caudal iew o he close ela ionship o he bilia y con e gence and he igh hepa ic a e y. The o he ana omical s uc u es
we e hidden o be e depic he in ica e ana omy. All issues can be o a ed 360º. Colou legend: ed—ao a and hepa ic a e y; g een—bile duc s
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The pa ien made an une en ul eco e y and was dis-
cha ged i e days a e su ge y. On pa hology, he li e
biopsy was nega i e o PSC. Th ee mon hs a e su ge y
he pa ien is well and symp om ee, wi h no mal li e
biochemis y.
Discussion andconclusion
Mos benign bilia y s ic u es a e ia ogenic, ollow-
ing cholecys ec omy o li e ansplan a ion. The main
symp oms include jaundice, p u i us, and da kened
u ine, weigh loss, e e , nausea and omi ing. Compli-
ca ions such as ascending cholangi is, abscess o ma ion
and sepsis can occu [10].
Benign bilia y s ic u es may be loca ed acco ding o
he Bismu h classi ica ion (Fig.9). Type I s ic u es a e
loca ed > 2cm dis al o he con luence o igh and le
hepa ic duc s; ype II s ic u es a e loca ed < 2cm om
he con luence; ype III s ic u es in ol e he con luence
bu he ceiling o he bilia y con luence is in ac ; ype
IV s ic u es cause in e up ion a he con luence; ype
V co espond o a lesion o an abe an igh hepa ic
duc alone o in associa ion wi h inju y o he common
hepa ic duc [11].
Bile duc inju y esul ing in s enosis can be ea ed by
i e a i e pe cu aneous anshepa ic dila ion, wi h las ing
pa ency o he bilia y duc . Biodeg adable s en s may also
p o e o be an in e es ing ea men op ion o benign
bilia y s ic u es, po en ially o e ing be e echnical
esul s and quali y o li e o pa ien s [10, 12].
Endoscopic e og ade dila ion and s en ing is ano he
op ion. Howe e , in his pa icula case, due o he young
age o he pa ien and he p esence o a long s enosis and
Fig. 8 Ope a i e ield a e he comple ion o he dissec ion,
demons a ing he bilia y con e gence (whi e a ow). Su ounding
issue is densely in lamed, making dissec ion di icul and po en ially
haza dous. In his case, he 3D econs uc ion p o ided he ope a i e
eam wi h an accu a e ep esen a ion o pa hology and ana omical
ela ionships
Fig. 9 The Bismu h classi ica ion o bilia y s ic u es—3D models
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associa ed is ula, a su gical app oach was p e e ed a e
mul idisciplina y discussion. The p esence o he is ula
may explain he la e p esen a ion a e cholecys ec omy,
and he p e ious episodes o cholangi is, since i would
allow an in e mi en d ainage o bile o he duodenum.
As usual in ia ogenic bile duc inju ies, associa ed ascu-
la inju y should be suspec ed and can also be esponsi-
ble o la e s enosis, due o ischemic cholangi is [13].
When p epa ing o a complex bilia y econs uc ion,
he su gical eam is dependen upon op imal p eope a-
i e imaging. This should p o ide he ascula and bilia y
ana omy, he ela ionship o hese s uc u es, as well as
de ec po en ial equen ana omical a ia ions. How-
e e , in eg a ing he ascula and bilia y ana omy is di -
icul since bo h a e bes depic ed in wo dis inc exams,
CT and MR. This complex case beau i ully illus a es he
way in which in es men in 3D models o su gical plan-
ning p o ed o be essen ial. The su geons epo ed ha
he addi ional planning eased he su gical app oach and
imp o ed con idence in his delica e p ocedu e, due o
he de ailed p io knowledge o he pa ien ’s ana omy,
especially in he close ela ions be ween he bilia y ac
and he ascula s uc u es a he le el o a densely
in lamed hepa ic hilum. In Bismu h ype III inju ies he
main bile duc is usually only supplied by he hila com-
ponen o he epicoledochal a e ial plexus, since he
usual 3 and 9 o’clock ma ginal a e ies a e in e up ed
[13]. This makes he a e ial supply o he bile duc s
ex emely agile in hese ci cums ances. Since success-
ul su gical econs uc ion wi h a Roux-en-Y hepa icoje-
junos omy elies on a well ascula ized bile duc s ump,
excessi e dissec ion be ween he bilia y con e gence
and he hepa ic a e y b anches should be a oided. By
e iewing he 3D model he su gical eam managed o
keep dissec ion a he li e hilum o a minimum o sa ely
pe o m he anas omosis. This is pa icula ly ele an
since ana omy was highly dis o ed by dense adhesions
and local in lamma ion.
Ou 3D model eplica es ana omical s uc u es and
pa hology wi h high accu acy be ween STL, CT and MRI
wi hou signi ican disc epancy be ween measu emen s
o he selec ed ana omical landma ks. A ecen sys emic
e iew by Pe ica e al. [7] highligh ed he limi ed s udies
in ol ing quan i a i e assessmen o he accu acy o 3D
p in ed li e models and indica es di e ences be ween
he 3D p in ed li e model and o iginal CT da a o
be ween 0.20% and 20.8%. Ou measu emen s demon-
s a ed high accu acy, wi h only 2.2% a ia ion, al hough
we mus ake in conside a ion ha ou model was no
p in ed, a ac ha migh ha e con ibu ed o he lowe
disc epancy epo ed.
The design o 3D models and 3D p in ing ha e been
de eloped o di e en medical pu poses, s eng hened
by he g ow h o imaging echniques and so wa e o
he acquisi ion, p ocessing and segmen a ion o he
image in Radiology, especially applied o CT and MRI
[14].
The cons uc ion o 3D models ha combine ascu-
la and bilia y ana omy, using di e en imaging ech-
niques, espec i ely CT and MRI, will p edic ably
con ibu e o a mo e igo ous planning o complex
li e su ge ies, such as hepa ic esec ion, li ing-dono
ansplan a ion o , as in he p esen case, bilia y econ-
s uc ion su ge y. In hepa obilia y su ge y, ana omical
a ia ions a e he no m ins ead o he excep ion, and
su gical mishaps can ha e se ious consequences.
The e is scien i ic e idence ha suppo s he bene i s
o 3D models in clinical p ac ice, wi h educed su gi-
cal ime, and subsequen ly anes he ic ime; educ ion
in he numbe and se e i y o complica ions, educed
hospi aliza ion ime and, in u n, lowe cos s wi h each
pa ien ; imp o emen in he p ecision o su ge ies by
be e p eope a i e planning, esul ing in be e ou -
come; echnical imp o emen h ough he possibili y o
simula ion wi h app op ia e models and also imp o ed
communica ion be ween heal hca e p o essionals and
pa ien s and amily membe s [14–19].
Resea ch on 3D gene a ed models in bilia y pa hol-
ogy is s ill limi ed, wi h only a ew cases epo ed in he
li e a u e and no la ge-scale s udies o accu a ely assess
i s ue clinical alue. Howe e , ou 3D model was con-
side ed o be o g ea alue o su gical planning.
Ou 3D model eplica es ana omical s uc u es and
pa hology wi h high accu acy, wi h only 2.2% a ia ion
be ween STL,CT and MRI measu emen s.
A 3D p in ed model could no be ob ained as we do
no ye possess he adequa e p in ing equipmen in ou
ins i u ion. Howe e , i is he au ho s opinion ha he
added alue o a p in ed model would no be signi i-
can , in his case. Fu he mo e, he de elopmen and
a ailabili y o new i ual eali y echnologies in he
nea u u e may limi he need o p in ed models, in
some ins ances.
We belie e ha 3D models o he bilia y ac can
become aluable ools in daily su gical p ac ice. In he
cu en medical landscape, whe e a “one size i s all”
app oach is inc easingly ou da ed, hese ools can help
ake in o conside a ion pa ien -speci ic needs and p o-
ide a much mo e pe sonalized app oach o hepa obil-
ia y in e en ions.
Abb e ia ions
3D: Th ee-dimensional; ALP: Alkaline phospha ase; ALT: Alanine amino ans-
e ase; AST: Aspa a e amino ans e ase; CT: Compu ed omog aphy; GGT
: Gamma-glu amyl ans e ase; MRCP: Magne ic esonance cholangiopan-
c ea og aphy; MRI: Magne ic esonance imaging; PSC: P ima y scle osing
cholangi is; STL: S anda d essella ion language.
Page 9 o 9
Pe ei adaSil ae al. BMC Med Imaging (2020) 20:120
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Acknowledgemen s
The au ho s would like o acknowledge “Expe 3D—Comp ehensi e T ans-
e sal P og amme in Medical Image Pos P ocessing: 3D P in sing and A i icial
In elligence” and hank co-di ec o s D . Josep Munue a and A nau Valls o
hei excellen eaching cou se.
Au ho s’ con ibu ions
NPS: p ojec de elopmen , da a collec ion and managemen , manusc ip
w i ing, image segmen a ion and pos -p ocessing. IA: p ojec de elopmen ,
da a collec ion and managemen , manusc ip w i ing, image segmen a ion
and pos -p ocessing. MS: clinical and su gical managemen . LF: clinical and
su gical managemen . HA: clinical and su gical managemen , manusc ip
edi ing, p ojec de elopmen . PD: manusc ip edi ing, p ojec de elopmen .
All au ho s ead and app o ed he inal manusc ip .
Funding
This publica ion was unded by Cen o Hospi ala e Uni e si á io de Coimb a.
A ailabili y o da a and ma e ials
The da ase s used and/o analysed du ing he cu en s udy a e a ailable om
he co esponding au ho on easonable eques .
E hics app o al and consen o pa icipa e
No applicable.
Consen o publica ion
W i en in o med consen was ob ained om he pa ien o publica ion o
his case epo and any accompanying images. A copy o he w i en consen
is a ailable o e iew by he Edi o o his jou nal.
Compe ing in e es s
The au ho s decla e ha hey ha e no compe ing in e es s.
Au ho de ails
1 Medical Imaging Depa men , Coimb a Uni e si y Hospi al Cen e , P ace a
P o . Mo a Pin o, 3000-075 Coimb a, Po ugal. 2 Depa men o Su ge y,
Coimb a Uni e si y Hospi al Cen e , P ace a P o . Mo a Pin o, 3000-075 Coim-
b a, Po ugal. 3 Facul y o Medicine, Uni e si y o Coimb a, Rua La ga,
3004-504 Coimb a, Po ugal. 4 Uni e si y o Coimb a, Coimb a Ins i u e
o Clinical and Biomedical Resea ch (iCBR), Rua La ga, 3004-504 Coimb a,
Po ugal. 5 Uni e si y o Coimb a, Cen e o Inno a i e Biomedicine and Bio-
echnology (CIBB), Rua La ga, 3004-504 Coimb a, Po ugal.
Recei ed: 30 June 2020 Accep ed: 13 Oc obe 2020
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Publishe ’s No e
Sp inge Na u e emains neu al wi h ega d o ju isdic ional claims in pub-
lished maps and ins i u ional a ilia ions.