Top

Published in:

Open Access 01-08-2017 | Review

Liver segmentation: indications, techniques and future directions

Authors: Akshat Gotra, Lojan Sivakumaran, Gabriel Chartrand, Kim-Nhien Vu, Franck Vandenbroucke-Menu, Claude Kauffmann, Samuel Kadoury, Benoît Gallix, Jacques A. de Guise, An Tang

Published in: Insights into Imaging | Issue 4/2017

Abstract

Objectives

Liver volumetry has emerged as an important tool in clinical practice. Liver volume is assessed primarily via organ segmentation of computed tomography (CT) and magnetic resonance imaging (MRI) images. The goal of this paper is to provide an accessible overview of liver segmentation targeted at radiologists and other healthcare professionals.

Methods

Using images from CT and MRI, this paper reviews the indications for liver segmentation, technical approaches used in segmentation software and the developing roles of liver segmentation in clinical practice.

Results

Liver segmentation for volumetric assessment is indicated prior to major hepatectomy, portal vein embolisation, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and transplant. Segmentation software can be categorised according to amount of user input involved: manual, semi-automated and fully automated. Manual segmentation is considered the “gold standard” in clinical practice and research, but is tedious and time-consuming. Increasingly automated segmentation approaches are more robust, but may suffer from certain segmentation pitfalls. Emerging applications of segmentation include surgical planning and integration with MRI-based biomarkers.

Conclusions

Liver segmentation has multiple clinical applications and is expanding in scope. Clinicians can employ semi-automated or fully automated segmentation options to more efficiently integrate volumetry into clinical practice.

Teaching points

• Liver volume is assessed via organ segmentation on CT and MRI examinations.

• Liver segmentation is used for volume assessment prior to major hepatic procedures.

• Segmentation approaches may be categorised according to the amount of user input involved.

• Emerging applications include surgical planning and integration with MRI-based biomarkers.

Available only for authorised users

Castell DO, O’Brien KD, Muench H, Chalmers TC (1969) Estimation of liver size by percussion in normal individuals. Ann Intern Med 70(6):1183–1189CrossRefPubMed

Vauthey JN, Chaoui A, Do KA et al (2000) Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery 127(5):512–519. doi:10.1067/msy.2000.105294 CrossRefPubMed

Martel G, Cieslak KP, Huang R et al (2015) Comparison of techniques for volumetric analysis of the future liver remnant: implications for major hepatic resections. HPB (Oxford) 17(12):1051–1057. doi:10.1111/hpb.12480 CrossRef

Heymsfield SB, Fulenwider T, Nordlinger B, Barlow R, Sones P, Kutner M (1979) Accurate measurement of liver, kidney, and spleen volume and mass by computerized axial tomography. Ann Intern Med 90(2):185–187CrossRefPubMed

Nakayama Y, Li Q, Katsuragawa S et al (2006) Automated hepatic volumetry for living related liver transplantation at multisection CT. Radiology 240(3):743–748. doi:10.1148/radiol.2403050850 CrossRefPubMed

Masutani Y, Uozumi K, Akahane M, Ohtomo K (2006) Liver CT image processing: a short introduction of the technical elements. Eur J Radiol 58(2):246–251CrossRefPubMed

Campadelli P, Casiraghi E, Esposito A (2009) Liver segmentation from computed tomography scans: a survey and a new algorithm. Artif Intell Med 45(2–3):185–196. doi:10.1016/j.artmed.2008.07.020 CrossRefPubMed

Fulcher AS, Szucs RA, Bassignani MJ, Marcos A (2001) Right lobe living donor liver transplantation: preoperative evaluation of the donor with MR imaging. AJR Am J Roentgenol 176(6):1483–1491CrossRefPubMed

Yamanaka J, Saito S, Fujimoto J (2007) Impact of preoperative planning using virtual segmental volumetry on liver resection for hepatocellular carcinoma. World J Surg 31(6):1249–1255. doi:10.1007/s00268-007-9020-8 CrossRefPubMed

10.

Couinaud C (1954) Liver lobes and segments: notes on the anatomical architecture and surgery of the liver. Presse Med 62(33):709–712PubMed

11.

Dimitroulis D, Tsaparas P, Valsami S et al (2014) Indications, limitations and maneuvers to enable extended hepatectomy: current trends. World J Gastroenterol 20(24):7887–7893. doi:10.3748/wjg.v20.i24.7887 CrossRefPubMedPubMedCentral

12.

Belghiti J, Clavien P, Gadzijev E et al (2000) The Brisbane 2000 terminology of liver anatomy and resections. HBP (Oxford) 2(3):333–339

13.

Gotra A, Chartrand G, Vu K et al (2014) Liver segmentation: a primer for radiologists. Radiological Society of North America 2014 scientific assembly and annual meeting, Chicago

14.

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. doi:10.1007/s00268-007-9123-2

15.

d’Assignies G, Kauffmann C, Boulanger Y et al (2011) Simultaneous assessment of liver volume and whole liver fat content: a step towards one-stop shop preoperative MRI protocol. Eur J Radiol 21(2):301–309. doi:10.1007/s00330-010-1941-1 CrossRef

16.

Abdalla EK, Adam R, Bilchik AJ, Jaeck D, Vauthey JN, Mahvi D (2006) Improving resectability of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol 13(10):1271–1280. doi:10.1245/s10434-006-9045-5 CrossRefPubMed

17.

Abdalla EK (2010) Portal vein embolization (prior to major hepatectomy) effects on regeneration, resectability, and outcome. J Surg Oncol 102(8):960–967. doi:10.1002/jso.21654 CrossRefPubMed

18.

Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN (2007) Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg 94(11):1386–1394. doi:10.1002/bjs.5836 CrossRefPubMed

19.

de Graaf W, van Lienden KP, van den Esschert JW, Bennink RJ, van Gulik TM (2011) Increase in future remnant liver function after preoperative portal vein embolization. Br J Surg 98(6):825–834. doi:10.1002/bjs.7456 CrossRefPubMed

20.

Leung U, Simpson AL, Araujo RL et al (2014) Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure. J Am Coll Surg 219(4):620–630. doi:10.1016/j.jamcollsurg.2014.04.022 CrossRefPubMedPubMedCentral

21.

Meier RP, Toso C, Terraz S et al (2015) Improved liver function after portal vein embolization and an elective right hepatectomy. HPB (Oxford) 17(11):1009–1018. doi:10.1111/hpb.12501 CrossRef

22.

Schnitzbauer AA, Lang SA, Goessmann H et al (2012) Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 255(3):405–414. doi:10.1097/SLA.0b013e31824856f5 CrossRefPubMed

23.

Ielpo B, Caruso R, Ferri V et al (2013) ALPPS procedure: our experience and state of the art. Hepato-Gastroenterology 60(128):2069–2075PubMed

24.

Hernandez-Alejandro R, Bertens KA, Pineda-Solis K, Croome KP (2015) Can we improve the morbidity and mortality associated with the associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) procedure in the management of colorectal liver metastases? Surgery 157(2):194–201. doi:10.1016/j.surg.2014.08.041 CrossRefPubMed

25.

Alvarez FA, Ardiles V, Sanchez Claria R, Pekolj J, de Santibanes E (2013) Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): tips and tricks. J Gastrointest Surg 17(4):814–821. doi:10.1007/s11605-012-2092-2 CrossRefPubMed

26.

Broering DC, Sterneck M, Rogiers X (2003) Living donor liver transplantation. J Hepatol 38(Suppl 1):S119–S135CrossRefPubMed

27.

Low HC, Da Costa M, Prabhakaran K et al (2006) Impact of new legislation on presumed consent on organ donation on liver transplant in Singapore: a preliminary analysis. Transplantation 82(9):1234–1237. doi:10.1097/01.tp.0000236720.66204.16 CrossRefPubMed

28.

Lo CM, Fan ST, Liu CL et al (1997) Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft. Transplantation 63(10):1524–1528CrossRefPubMed

29.

Ben-Haim M, Emre S, Fishbein TM et al (2001) Critical graft size in adult-to-adult living donor liver transplantation: impact of the recipient’s disease. Liver Transpl 7(11):948–953. doi:10.1053/jlts.2001.29033 CrossRefPubMed

30.

Hermoye L, Laamari-Azjal I, Cao Z et al (2005) Liver segmentation in living liver transplant donors: comparison of semiautomatic and manual methods. Radiology 234(1):171–178. doi:10.1148/radiol.2341031801 CrossRefPubMed

31.

Kiuchi T, Tanaka K, Ito T et al (2003) Small-for-size graft in living donor liver transplantation: how far should we go? Liver Transpl 9(9):S29–S35. doi:10.1053/jlts.2003.50198 CrossRefPubMed

32.

Fan ST, Lo CM, Liu CL, Yong BH, Chan JK, Ng IO (2000) Safety of donors in live donor liver transplantation using right lobe grafts. Arch Surg 135(3):336–340CrossRefPubMed

33.

Malmberg F, Nordenskjöld R, Strand R, Kullberg J (2014) SmartPaint: a tool for interactive segmentation of medical volume images. Comput Methods Biomech Biomed Eng Imaging Vis 5(1):36–44. doi:10.1080/21681163.2014.960535

34.

Udupa JK, Leblanc VR, Zhuge Y et al (2006) A framework for evaluating image segmentation algorithms. Comput Med Imaging Graph 30(2):75–87. doi:10.1016/j.compmedimag.2005.12.001 CrossRefPubMed

35.

Chartrand G, Cresson T, Chav R, Gotra A, Tang A, De Guise J (2013) Semi-automated liver CT segmentation using Laplacian meshes. 2014 I.E. International Symposium on Biomedical Imaging, Bejing. doi:10.1109/ISBI.2014.6867952

36.

Kass M, Witkin A, Terzopoulos D (1988) Snakes: active contour models. Int J Comput Vis 1(4):321–331CrossRef

37.

Falcão AX, Udupa JK, Samarasekera S, Sharma AS, Hirsch BE, Lotufo RA (1998) User-steered image segmentation paradigms: live wire and live lane. Graph Model Image Process 60(4):233–260CrossRef

38.

Lopez-Mir F, Gonzalez P, Naranjo V, Pareja E, Alcaniz M, Solaz-Minguez J (2013) A fast computational method based on 3D morphology and a statistical filter. Int Conf Bioinform Biomed Eng 2013, Granada, pp 483–490

39.

Sharma N, Aggarwal LM (2010) Automated medical image segmentation techniques. J Med Phys 35(1):3–14. doi:10.4103/0971-6203.58777 CrossRefPubMedPubMedCentral

40.

Boykov YY, Jolly MP (2001) Interactive graph-cuts for optimal boundary and region segmentation of objects in N-D images. ICCV, Vancouver, I:105–112

41.

Soler L, Delingette H, Malandain G et al (2001) Fully automatic anatomical, pathological, and functional segmentation from CT scans for hepatic surgery. Comput Aided Surg 6(3):131–142. doi:10.1002/igs.1016 CrossRefPubMed

42.

Lamecker H, Lange T, Seebass M (2004) Segmentation of the liver using a 3D statistical shape model. Report 04–09, ZIB, Berlin Dahlen

43.

Heimann T, van Ginneken B, Styner MA et al (2009) Comparison and evaluation of methods for liver segmentation from CT datasets. IEEE Trans Med Imaging 28(8):1251–1265. doi:10.1109/TMI.2009.2013851 CrossRefPubMed

44.

Nealen PM, Schmidt MF (2006) Distributed and selective auditory representation of song repertoires in the avian song system. J Neurophysiol 96(6):3433–3447. doi:10.1152/jn.01130.2005 CrossRefPubMed

45.

Gotra A, Chartrand C, Vu KN et al (2015) Comparison of MRI and CT-based semiautomated liver segmentation: a validation study. Abdom Radiol 42(2):478–489. doi:10.1007/s00261-016-0912-7 CrossRef

46.

Jie L, Defeng W, Lin S, Pheng AH (2012) Automatic liver segmentation in CT images based on support vector machine. Proceedings of 2012 IEEE-EMBS, Hong Kong. doi:10.1109/BHI.2012.6211581 CrossRef

47.

Norajitra T, Meinzer HP, Maier-Hein KH (2015) 3D statistical shape models incorporating 3D random forest regression voting for robust CT liver segmentation. Medical Imaging 2015: Computer-Aided Diagnosis. SPIE, Orlando. doi:10.1117/12.2082909

48.

Christ PF, Elshaer MEA, Ettlinger F et al (2016) Automatic liver and lesion segmentation in CT using cascaded fully convolutional neural networks and 3D conditional random fields. MICCAI 2016, 19th International Conference on Medical Image Computing and Computer Assisted Intervention, Athens, 17-21 October 2016. doi:10.1007/978-3-319-46723-8_48

49.

Li CY, Wang XY, Li JL et al (2013) Joint probabilistic model of shape and intensity for multiple abdominal organ segmentation from volumetric CT images. IEEE J Biomed 17(1):92–102. doi:10.1109/TITB.2012.2227273

50.

Rusko L, Bekes G (2011) Liver segmentation for contrast-enhanced MR images using partitioned probabilistic model. Int J Comput Assist Radiol Surg 6(1):13–20. doi:10.1007/s11548-010-0493-9 CrossRefPubMed

51.

Heimann T, Munzing S, Meinzer HP, Wolf I (2007) A shape-guided deformable model with evolutionary algorithm initialization for 3D soft tissue segmentation. Information Processing in Medical Imaging, 20th International Conference, IPMI 2007, Kerkrade, 2-6 July 2007. doi:10.1007/978-3-540-73273-0_1

52.

Torkzad MR, Noren A, Kullberg J (2012) Stereology: a novel technique for rapid assessment of liver volume. Insights Imaging 3(4):387–393. doi:10.1007/s13244-012-0166-z CrossRefPubMedPubMedCentral

53.

Sahin B, Ergur H (2006) Assessment of the optimum section thickness for the estimation of liver volume using magnetic resonance images: a stereological gold standard study. Eur J Radiol 57(1):96–101. doi:10.1016/j.ejrad.2005.07.006 CrossRefPubMed

54.

Filippone A, Blakeborough A, Breuer J et al (2010) Enhancement of liver parenchyma after injection of hepatocyte-specific MRI contrast media: a comparison of gadoxetic acid and gadobenate dimeglumine. J Magn Reson Imaging 31(2):356–364. doi:10.1002/jmri.22054 CrossRefPubMed

55.

Bracco (2017) MultiHance (gadobenate dimeglumine injection) product monograph. Bracco Diagnostics Website. Available via http://imaging.bracco.com/us-en/products-and-solutions/magnetic-resonance-imaging/multihance. Accessed 2 April 2017

56.

Hammerstingl R, Huppertz A, Breuer J et al (2008) Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 18(3):457–467. doi:10.1007/s00330-007-0716-9 CrossRefPubMed

57.

Halavaara J, Breuer J, Ayuso C et al (2006) Liver tumor characterization: comparison between liver-specific gadoxetic acid disodium-enhanced MRI and biphasic CT—a multicenter trial. J Comput Assist Tomogr 30(3):345–354CrossRefPubMed

58.

Grieser C, Denecke T, Rothe JH et al (2015) Gd-EOB enhanced MRI T1-weighted 3D-GRE with and without elevated flip angle modulation for threshold-based liver volume segmentation. Acta Radiol 56(12):1419–1427. doi:10.1177/0284185114558975 CrossRefPubMed

59.

Fernandez-de-Manuel L, Rubio JL, Ledesma-Carbayo MJ et al (2009) 3D liver segmentation in preoperative CT images using a level-sets active surface method. The 31st Annual International Conference of the IEEE EMBS, Minneapolis, 2-6 September 2009

60.

Reiner CS, Karlo C, Petrowsky H, Marincek B, Weishaupt D, Frauenfelder T (2009) Preoperative liver volumetry: how does the slice thickness influence the multidetector computed tomography and magnetic resonance liver volume measurements? J Comput Assist Tomogr 33(3):390–397CrossRefPubMed

61.

Huynh HT, Karademir I, Oto A, Suzuki K (2014) Computerized liver volumetry on MRI by using 3D geodesic active contour segmentation. AJR Am J Roentgenol 202(1):152–159. doi:10.2214/AJR.13.10812 CrossRefPubMedPubMedCentral

62.

Reeder SB, Cruite I, Hamilton G, Sirlin CB (2011) Quantitative assessment of liver fat with magnetic resonance imaging and spectroscopy. J Magn Reson Imaging 34(4):729–749. doi:10.1002/jmri.22580 CrossRefPubMed

63.

Yokoo T, Bydder M, Hamilton G et al (2009) Nonalcoholic fatty liver disease: diagnostic and fat-grading accuracy of low-flip-angle multiecho gradient-recalled-echo MR imaging at 1.5 T. Radiology 251(1):67–76. doi:10.1148/radiol.2511080666 CrossRefPubMedPubMedCentral

64.

Yokoo T, Shiehmorteza M, Hamilton G et al (2011) Estimation of hepatic proton-density fat fraction by using MR imaging at 3.0 T. Radiology 258(3):749–759. doi:10.1148/radiol.10100659 CrossRefPubMedPubMedCentral

65.

Le TA, Chen J, Changchien C et al (2012) Effect of colesevelam on liver fat quantified by magnetic resonance in nonalcoholic steatohepatitis: a randomized controlled trial. Hepatology 56(3):922–932. doi:10.1002/hep.25731 CrossRefPubMedPubMedCentral

66.

Tang A, Chen J, Le TA et al (2015) Cross-sectional and longitudinal evaluation of liver volume and total liver fat burden in adults with nonalcoholic steatohepatitis. Abdom Imaging 40(1):26–37. doi:10.1007/s00261-014-0175-0 CrossRefPubMedPubMedCentral

67.

Hernando D, Levin YS, Sirlin CB, Reeder SB (2014) Quantification of liver iron with MRI: state of the art and remaining challenges. J Magn Reson Imaging 40(5):1003–1021. doi:10.1002/jmri.24584 CrossRefPubMedPubMedCentral

68.

Zorzi D, Laurent A, Pawlik TM, Lauwers GY, Vauthey JN, Abdalla EK (2007) Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg 94(3):274–286. doi:10.1002/bjs.5719 CrossRefPubMed

69.

Jhaveri K, Cleary S, Audet P et al (2015) Consensus statements from a multidisciplinary expert panel on the utilization and application of a liver-specific MRI contrast agent (gadoxetic acid). AJR Am J Roentgenol 204(3):498–509. doi:10.2214/ajr.13.12399 CrossRefPubMed

70.

Tamada T, Ito K, Higaki A et al (2011) Gd-EOB-DTPA-enhanced MR imaging: evaluation of hepatic enhancement effects in normal and cirrhotic livers. Eur J Radiol 80(3):e311–e316. doi:10.1016/j.ejrad.2011.01.020 CrossRefPubMed

71.

Gschwend S, Ebert W, Schultze-Mosgau M, Breuer J (2011) Pharmacokinetics and imaging properties of Gd-EOB-DTPA in patients with hepatic and renal impairment. Investig Radiol 46(9):556–566. doi:10.1097/RLI.0b013e31821a218a CrossRef

72.

Motosugi U, Ichikawa T, Sano K et al (2011) Double-dose gadoxetic acid-enhanced magnetic resonance imaging in patients with chronic liver disease. Investig Radiol 46(2):141–145. doi:10.1097/RLI.0b013e3181f9c487 CrossRef

Title: Liver segmentation: indications, techniques and future directions
Authors: Akshat Gotra
Lojan Sivakumaran
Gabriel Chartrand
Kim-Nhien Vu
Franck Vandenbroucke-Menu
Claude Kauffmann
Samuel Kadoury
Benoît Gallix
Jacques A. de Guise
An Tang
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: Insights into Imaging / Issue 4/2017
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1007/s13244-017-0558-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Liver segmentation: indications, techniques and future directions

Abstract

Objectives

Methods

Results

Conclusions

Teaching points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Teaching points

Please log in to get access to this content

Other articles of this Issue 4/2017

Imaging-guided chest biopsies: techniques and clinical results

Ergonomic strategies to improve radiographers’ posture during mammography activities

Breast magnetic resonance imaging: tips for the diagnosis of silicone-induced granuloma of a breast implant capsule (SIGBIC)

Cardiovascular implantable electronic devices: a review of the dangers and difficulties in MR scanning and attempts to improve safety

Early postoperative imaging after non-bariatric gastric resection: a primer for radiologists