scholarly journals Repeatability and reproducibility of deep-learning-based liver volume and Couinaud segment volume measurement tool

2021 ◽  
Author(s):  
Amirkasra Mojtahed ◽  
Luis Núñez ◽  
John Connell ◽  
Alessandro Fichera ◽  
Rowan Nicholls ◽  
...  
Keyword(s):  
Liver Volume ◽  
Future Liver Remnant ◽  
Measurement Tool ◽  
Limits Of Agreement ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Medical Software ◽  
Segment Volume ◽  
Volume Measurements ◽  
Repeatability And Reproducibility

Abstract Purpose Volumetric and health assessment of the liver is crucial to avoid poor post-operative outcomes following liver resection surgery. No current methods allow for concurrent and accurate measurement of both Couinaud segmental volumes for future liver remnant estimation and liver health using non-invasive imaging. In this study, we demonstrate the accuracy and precision of segmental volume measurements using new medical software, Hepatica™. Methods MRI scans from 48 volunteers from three previous studies were used in this analysis. Measurements obtained from Hepatica™ were compared with OsiriX. Time required per case with each software was also compared. The performance of technicians and experienced radiologists as well as the repeatability and reproducibility were compared using Bland–Altman plots and limits of agreement. Results High levels of agreement and lower inter-operator variability for liver volume measurements were shown between Hepatica™ and existing methods for liver volumetry (mean Dice score 0.947 ± 0.010). A high consistency between technicians and experienced radiologists using the device for volumetry was shown (± 3.5% of total liver volume) as well as low inter-observer and intra-observer variability. Tight limits of agreement were shown between repeated Couinaud segment volume (+ 3.4% of whole liver), segmental liver fibroinflammation and segmental liver fat measurements in the same participant on the same scanner and between different scanners. An underestimation of whole-liver volume was observed between three non-reference scanners. Conclusion Hepatica™ produces accurate and precise whole-liver and Couinaud segment volume and liver tissue characteristic measurements. Measurements are consistent between trained technicians and experienced radiologists. Graphic abstract

Rescue partial ALPPS for left hemihepatectomy with reconstruction of the middle hepatic vein

2021 ◽  
Author(s):  
Masaharu Kogure ◽  
Takaaki Arai ◽  
Hirokazu Momose ◽  
Ryota Matsuki ◽  
Yutaka Suzuki ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Vein ◽  
Retention Rate ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Middle Hepatic Vein ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Left Hemihepatectomy ◽  
Icg R15

Major hepatectomy in patients with insufficient future liver remnant (FLR) volume and impaired liver functional reserve has considerable risks for posthepatectomy liver failure (PHLF). The patient was a male in his 70 with an intrahepatic cholangiocarcinoma (ICC) in left hemiliver, involving the middle hepatic vein (MHV). Although FLR volume after left hemihepatectomy was estimated to be 64.4% of the total liver volume, an indocyanine green retention rate at 15 min (ICG-R15) value was 24.2%, thus the patient underwent left portal vein embolization (PVE). The FLR volume increased to 71.3%, however, the non-congestive FLR volume was re-estimated as 45.8% after resection of the MHV, the ICG-R15 value was 29.0%, and ICG-Krem was calculated as 0.037. We performed partial rescue ALPPS (Associating Liver Partition and Portal vein occlusion for Staged hepatectomy) for left hemihepatectomy with the MHV reconstruction. On the first stage, partial liver partition was done along Rex-Cantlie’s line, preserving the MHV and sacrificing the remaining branches to segment 8. The FLR volume increased to 77.4% on day 14. The ICG-R15 value was 29.6%, but ICG-Krem after MHV reconstruction was estimated to be 0.059. The second stage operation on day 21 was left hemihepatectomy with the MHV reconstruction using the left superficial femoral vein graft. The usage of rescue partial ALPPS may contribute to preventing PHLF by introducing occlusion of the portal and/or venous branches in the left hemiliver before curative hepatectomy.

scholarly journals Efficacy of percutaneous transhepatic portal vein embolization using gelatin sponge particles and metal coils

2018 ◽  
Vol 7 (4) ◽  
pp. 205846011876968 ◽  
Author(s):  
Tomohiro Komada ◽  
Kojiro Suzuki ◽  
Takashi Mizuno ◽  
Tomoki Ebata ◽  
Masaya Matsushima ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Clinical Status ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Gelatin Sponge ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Gelatin Sponge Particles ◽  
The Mean

Background Percutaneous transhepatic portal vein embolization (PTPE) can increase the future liver remnant (FLR) volume before extended liver resection; however, there is no current consensus regarding the best embolic material for PTPE. Purpose To evaluate the efficacy of PTPE using gelatin sponge particles and coils. Material and Methods The medical records of 136 patients who underwent PTPE using gelatin sponge particles and metal coils were retrospectively reviewed. We evaluated the procedural details, liver volume on CT, and clinical status before and after PTPE. Results The mean FLR volume increased significantly from 390 ± 147 cm3 to 508 ± 141 cm3 ( P < 0.001). A mean of 22.1 ± 9.4 days after PTPE, the mean increase in the ratio of FLR volume to total liver volume was 9.4 ± 6.5%. Complications related to PTPE occurred in five patients, including arterial damage (n = 4) and biloma (n = 1). The white blood cell count and C-reactive protein level increased significantly and then returned to baseline within seven days. Aspartate aminotransferase and alanine aminotransferase showed no significant changes. Fever (defined by the Common Terminology Criteria for Adverse Events v4.0) was reported in 74 patients (54%), but it was generally mild (Grade 1/2; n = 72). None of the patients experienced severe complications that required cancellation of surgery. Conclusion PTPE with gelatin sponge particles and coils may impose low physical stress on patients and is a safe method of inducing a significant increase of FLR.

scholarly journals The Correlation between the CT Liver Volume and the Actual Weight of the Resected Cirrhotic Liver in Transplantation Patients

2021 ◽  
Author(s):  
Kulyada Eurboonyanun ◽  
Chalerm Eurboonyanun ◽  
Julaluck Promsorn ◽  
Jiranthanin Phaorod ◽  
Tharatip Srisuk ◽  
...  
Keyword(s):  
Liver Volume ◽  
Future Liver Remnant ◽  
P Value ◽  
Ct Volumetry ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Actual Weight ◽  
Total Liver ◽  
Resected Liver ◽  
Functional Liver Volume

Objective: Volumetric assessment with computed tomography (CT), known as CT volumetry, is the preferred method for estimating future liver remnant. However, the data regarding the usage of CT volumetry to estimate future liver remnant of the diseased liver is still lacking. This study was designed to evaluate the correlation between the liver volume, calculated by CT, and the actual weight of the resected liver in patients who underwent orthotopic liver transplantation.Material and Methods: A total of 32 patients having underwent liver transplantation; from March 2009 to June 2015, were included. A radiologist retrospectively reviewed the pre-operative CT and performed the volume measurement. Statistical analysis was performed to determine the relationship between the estimated liver volume and the actual liver weight.Results: The estimated liver volume was significantly different among the cirrhosis of different etiology (p-value=0.001 for the total liver volume and p-value=0.003 for the functional liver volume). Compared with the total liver volume, the functional liver volume had a stronger correlation with the actual weight of the resected liver (r=0.955 vs. r=0.786). The following formula can be used to accurately estimate the expected weight of the resected liver (expected liver weight: ELW), based on the estimated functional liver volume (FLV) derived by CT volumetry: ELW=489.531+(0.618*FLV). The R-squared for this regression model was 0.914.Conclusion: CT volumetry is reliable and accurate in predicting the actual amount of the resected liver parenchyma in cirrhotic patients.

scholarly journals Measured versus Estimated Total Liver Volume to Preoperatively Assess the Adequacy of the Future Liver Remnant

2013 ◽  
Vol 258 (5) ◽  
pp. 801-807 ◽  
Author(s):  
Dario Ribero ◽  
Marco Amisano ◽  
Francesca Bertuzzo ◽  
Serena Langella ◽  
Roberto Lo Tesoriere ◽  
...  
Keyword(s):  
Liver Volume ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Total Liver ◽  
The Future

Portal Vein Embolization: Correlation of Future Liver Remnant Hypertrophy to Type of Embolic Agent Used

2018 ◽  
Vol 69 (3) ◽  
pp. 316-321 ◽  
Author(s):  
Surinder K. Dhaliwal ◽  
Ganesan Annamalai ◽  
Nelofer Gafoor ◽  
Robyn Pugash ◽  
Chris Dey ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Embolic Agent ◽  
Electronic Patient Records ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Radiology Reports ◽  
Pva Particles

Purpose The purpose of this study was to compare the effectiveness of portal vein embolization (PVE) with different embolic agents used at our centre. Specifically, the effectiveness of N-butyl cyanoacrylate (NBCA) glue is compared with that of polyvinyl alcohol (PVA) particles. Methods We performed a retrospective chart review of all patients (N = 77) who underwent PVE at our institution over a 5-year period. Pre- and postprocedural computed tomography or magnetic resonance imaging, when available, were used to measure the volume of total liver volume and future liver remnant (FLR). The absolute values obtained were used to calculate percentage of FLR. The growth in FLR was determined 4–6 weeks after PVE. Technical details of the procedure including the type and amount of embolic agent used were obtained from the chart reviews, electronic patient records, and radiology reports. Statistical analysis was performed using Kruskal-Wallis test, Wilcoxon rank sum test, and the Spearman correlation coefficient with post hoc analysis. Results are expressed as mean ± SD ( P < .05 considered statistically significant). Results NBCA (n = 29) produced a mean change in FLR of 14.8% compared with 9.3% for PVA particles (n = 24; P = .007). Mean change in FLR was 10.1% in the group where a combination of NBCA and PVA particles was used (n = 24). The effect of glue volume and glue-to-lipiodol ratio on the outcome was not found to be statistically significant ( P = .5 and .7, respectively). Conclusions We conclude that NBCA glue is a better embolic agent than PVA particles in inducing liver hypertrophy.

Safety and efficacy of right portal vein embolization in patients with prior left lateral liver resection

2021 ◽  
pp. 028418512110141
Author(s):  
Vincent Van den Bosch ◽  
Federico Pedersoli ◽  
Sebastian Keil ◽  
Ulf P Neumann ◽  
Christiane K Kuhl ◽  
...  
Keyword(s):  
Liver Function ◽  
Portal Vein ◽  
Portal Vein Embolization ◽  
Liver Volume ◽  
Liver Function Tests ◽  
Complete Resection ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Function Tests ◽  
Staged Hepatectomy

Background In patients with bilobar metastatic liver disease, surgical clearance of both liver lobes may be achieved through multiple-stage liver resections. For patients with extensive disease, a major two-staged hepatectomy consisting of resection of liver segments II and III before right-sided portal vein embolization (PVE) and resection of segments V–VIII may be performed, leaving only segments IV ± I as the liver remnant. Purpose To describe the outcome following right-sided PVE after prior complete resection of liver segments II and III. Material and Methods In this retrospective study, 15 patients (mean age = 60.4 ± 9.3 years) with liver metastases from colorectal cancer (n = 14) and uveal melanoma (n = 1) who were scheduled to undergo a major two-stage hepatectomy, were included. Total liver volume (TLV) and volume of the future liver remnant (FLR) were measured on pre- and postinterventional computed tomography (CT) scans, and standardized FLR volumes (ratio FLR/TLV) were calculated. Patient data were retrospectively analyzed regarding peri- and postinterventional complications, with special emphasis on liver function tests. Results The mean standardized post-PVE FLR volume was 26.9% ± 6.4% and no patient developed hepatic insufficiency after the PVE. Based on FLR hypertrophy and liver function tests, all but one patient were considered eligible for the subsequent right-sided hepatectomy. However, due to local tumor progression, only 9/15 patients eventually proceeded to the second stage of surgery.   Conclusion Right-sided PVE was safe and efficacious in this cohort of patients who had previously undergone a complete resection of liver segments II and III as part of a major staged hepatectomy pathway leaving only segments IV(±I) as the FLR. 

scholarly journals Robotic, laparoscopic or open hemihepatectomy for giant liver haemangiomas over 10 cm in diameter

2020 ◽  
Author(s):  
Minggen Hu ◽  
Kuang Chen ◽  
Xuan Zhang ◽  
Chenggang Li ◽  
Dongda Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Oral Intake ◽  
Postoperative Recovery ◽  
Postoperative Outcomes ◽  
Intraoperative Blood Loss ◽  
Liver Remnant ◽  
Significant Difference

Abstract Background: To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas.Methods: From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results: There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 hours of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n=19) and the LH group (n=13), patients in the OH group (n=25) had a significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), and time to get-out-of-bed (P < 0.05); a higher VAS score after 24 hours of surgery (P < 0.05); and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P＞0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P＜0.05). There was no significant difference in the operative time between the RH group and the OH group (P＞0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P＜0.05), and the amount of intraoperative blood loss in the LH group was less than that in the OH group (P＜0.05).Conclusion: Robotic and laparoscopic hemihepatectomies were associated with less intraoperative blood loss,better postoperative recovery and lower pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time.

scholarly journals Robotic, laparoscopic or open hemihepatectomy for giant liver hemangiomas of over 10 cm in diameter

2020 ◽  
Author(s):  
Minggen Hu ◽  
Kuang Chen ◽  
Xuan Zhang ◽  
Chenggang Li ◽  
Dongda Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Oral Intake ◽  
Postoperative Recovery ◽  
Postoperative Outcomes ◽  
Intraoperative Blood Loss ◽  
Liver Remnant ◽  
Significant Difference

Abstract Background To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver hemangiomas.Methods From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver hemangiomas were included into this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results There were no significant differences in age, sex, tumor location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver hemangioma volume, FLR/SLV, resected normal liver volume / resected volume, hepatic disease, rates of blood transfusion, liver function after 24 hours of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n=19), and the LH group (n=13), patients in the OH group (n=25) had significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), time to get-out-of-bed (P < 0.05), a higher VAS score after 24 hours of surgery (P < 0.05) and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P>0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time of the RH group was significantly shorter than the LH group (P<0.05). There was no significant difference in the operative time between the RH group and the OH group (P>0.05). The intraoperative blood loss of the RH group was the least among the three groups (P<0.05) and the intraoperative blood loss of the LH group was less than the OH group (P<0.05).Discussion Robotic, laparoscopic, and open hemihepatectomy were safe and efficacious treatments for giant liver hemangiomas. Robotic and laparoscopic hemihepatectomy were significantly better than open hemihepatectomy in intraoperative blood loss, postoperative recovery and pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and shorter operative time.

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