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Open Access 01-10-2010

Virtual Liver Resection and Volumetric Analysis of the Future Liver Remnant using Open Source Image Processing Software

Authors: Joost R. van der Vorst, Ronald M. van Dam, Rogier S. A. van Stiphout, Maartje A. van den Broek, Ilona H. Hollander, Alfons G. H. Kessels, Cornelis H. C. Dejong

Published in: World Journal of Surgery | Issue 10/2010

Abstract

Background

After extended liver resection, a remnant liver that is too small can lead to postresection liver failure. To reduce this risk, preoperative evaluation of the future liver remnant volume (FLRV) is critical. The open-source OsiriX^® PAC software system can be downloaded for free and used by nonradiologists to calculate liver volume using a stand-alone Apple computer. The purpose of this study was to assess the accuracy of OsiriX^® CT volumetry for predicting liver resection volume and FLVR in patients undergoing partial hepatectomy.

Methods

Preoperative contrast-enhanced liver CT scans of patients who underwent partial hepatectomy were analyzed by three observers. Two surgical trainees measured the total liver volume, resection volume, and tumor volume using OsiriX^®, and a radiologist measured these volumes using CT scanner-linked Aquarius iNtuition^® software. Resection volume was correlated with prospectively determined resection weight, and differences in the measured liver volumes were analyzed. Interobserver variability was assessed using Bland–Altman plots.

Results

25 patients (M/F ratio: 13/12) with a median age of 61 (range, 34–77) years were included. There were significant correlations between the weight and volume of the resected specimens (Pearson’s correlation coefficient: R² = 0.95). There were no major differences in total liver volumes, resection volumes, or tumor volumes for observers 1, 2, and 3. Bland–Altman plots showed a small interobserver variability. The mean time to complete liver volumetry for one patient using OsiriX^® was 19 ± 3 min.

Conclusions

OsiriX^® liver volumetry performed by surgeons is an accurate and time-efficient method for predicting resection volume and FLRV.

Khan AZ, Morris-Stiff G, Makuuchi M (2008) Patterns of chemotherapy-induced hepatic injury and their implications for patients undergoing liver resection for colorectal liver metastases. J Hepatobiliary Pancreat Surg 16(2):137–144CrossRefPubMed

Schindl MJ, Redhead DN, Fearon KC et al (2005) The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 54(2):289–296CrossRefPubMed

Ferrero A, Vigano L, Polastri R et al (2007) Postoperative liver dysfunction and future remnant liver: where is the limit? Results of a prospective study. World J Surg 31(8):1643–1651CrossRefPubMed

Jarnagin WR, Gonen M, Fong Y et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1, 803 consecutive cases over the past decade. Ann Surg 236(4):397–406CrossRefPubMed

Shoup M, Gonen M, D’Angelica M et al (2003) Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg 7(3):325–330CrossRefPubMed

Armuzzi A, Candelli M, Zocco MA et al (2002) Review article: breath testing for human liver function assessment. Aliment Pharmacol Ther 16(12):1977–1996CrossRefPubMed

Fazakas J, Mandli T, Ther G et al (2006) Evaluation of liver function for hepatic resection. Transpl Proc 38(3):798–800CrossRef

Gill RA, Goodman MW, Golfus GR et al (1983) Aminopyrine breath test predicts surgical risk for patients with liver disease. Ann Surg 198(6):701–704CrossRefPubMed

Schneider PD (2004) Preoperative assessment of liver function. Surg Clin North Am 84(2):355–373CrossRefPubMed

10.

Seyama Y, Kokudo N (2009) Assessment of liver function for safe hepatic resection. Hepatol Res 39(2):107–116CrossRefPubMed

11.

Clavien PA, Petrowsky H, DeOliveira ML et al (2007) Strategies for safer liver surgery and partial liver transplantation. N Engl J Med 356(15):1545–1559CrossRefPubMed

12.

Makuuchi M, Kosuge T, Takayama T et al (1993) Surgery for small liver cancers. Semin Surg Oncol 9(4):298–304CrossRefPubMed

13.

Stockmann M, Lock JF, Riecke B et al (2009) Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg 250(1):119–125CrossRefPubMed

14.

Wigmore SJ, Redhead DN, Yan XJ et al (2001) Virtual hepatic resection using three-dimensional reconstruction of helical computed tomography angioportograms. Ann Surg 233(2):221–226CrossRefPubMed

15.

Dello SA, van Dam RM, Slangen JJ et al (2007) Liver volumetry plug and play: do it yourself with ImageJ. World J Surg 31(11):2215–2221CrossRefPubMed

16.

Tu R, Xia LP, Yu AL et al (2007) Assessment of hepatic functional reserve by cirrhosis grading and liver volume measurement using CT. World J Gastroenterol 13(29):3956–3961PubMed

Title: Virtual Liver Resection and Volumetric Analysis of the Future Liver Remnant using Open Source Image Processing Software
Authors: Joost R. van der Vorst
Ronald M. van Dam
Rogier S. A. van Stiphout
Maartje A. van den Broek
Ilona H. Hollander
Alfons G. H. Kessels
Cornelis H. C. Dejong
Publication date: 01-10-2010
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 10/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0663-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Virtual Liver Resection and Volumetric Analysis of the Future Liver Remnant using Open Source Image Processing Software

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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