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Morphometric Imaging Techniques and the Functional Liver Remnant

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Venous Embolization of the Liver

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Abstract

Surgical resection is the treatment of choice for select patients with primary and ­secondary hepatic malignancies. The goal of hepatic surgery is complete resection with preservation of sufficient liver parenchyma. Inadequate hepatic reserve can result in the development of hepatic dysfunction and failure. One parameter used to assess the adequacy of liver reserve is to measure the future liver remnant (FLR) volume. Accurate measurement of FLR is important not only as a surrogate marker for liver function, but also assists in the selection of patients for preoperative portal vein ­embolization (PVE). The preferred modality to provide accurate and reproducible measurements of FLR is computer tomography (CT) volumetry. CT volumetry measurements can be performed utilizing either manual or automated techniques. The measured FLR is standardized to the patient’s total liver volume (TLV), which is derived from the body surface area (BSA). Various equations have been derived that relate TLV to BSA. CT volumetry provides hepatic surgeons and radiologists an informed approach toward the surgical management of patients with complex liver disease.

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Abbreviations

BH:

Body Height

BSA:

Body Surface Area

BW:

Body Weight

CRM:

Colorectal Metastasis

CT:

Computed Tomography

CTAP:

CT Angioportograms

FLR:

Future Liver Remnant

FLV:

Functional Liver Volume

HCC:

Hepatocellular Carcinoma

ICG:

Indocyanine Green Clearance

INR:

International Normalized Ratio

LV:

Liver Volume

MRI:

Magnetic Resonance Imaging

PVE:

Portal Vein Embolization

RLV:

Remnant Liver Volume

sFLR:

Standardized Future Liver Remnant

TLV:

Total Liver Volume

99mTc-GSA:

Technetium-99 m Galactosyl Serum Albumin

References

  1. Pawlik TM, Schulick RD, Choti MA. Expanding criteria for resectability of colorectal liver metastases. Oncologist. 2008;13(1):51-64.

    Article  PubMed  Google Scholar 

  2. Adam R, Lucidi V, Bismuth H. Hepatic colorectal metastases: methods of improving resectability. Surg Clin North Am. 2004;84(2):659-671.

    Article  PubMed  Google Scholar 

  3. Elias D, Baton O, Sideris L, et al. Hepatectomy plus intraoperative radiofrequency ablation and chemotherapy to treat technically unresectable multiple colorectal liver metastases. J Surg Oncol. 2005;90(1):36-42.

    Article  PubMed  Google Scholar 

  4. Elias D, Manganas D, Benizri E, et al. Trans-metastasis hepatectomy: results of a 21-case study. Eur J Surg Oncol. 2006;32(2):213-217.

    Article  PubMed  CAS  Google Scholar 

  5. Hemming AW, Reed AI, Howard RJ, et al. Preoperative portal vein embolization for extended hepatectomy. Ann Surg. 2003;237(5):686-691. discussion 691-693.

    PubMed  Google Scholar 

  6. Pawlik TM, Choti MA. Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg. 2007;11(8):1057-1077.

    Article  PubMed  Google Scholar 

  7. Ng KK, Vauthey JN, Pawlik TM, et al. Is hepatic resection for large or multinodular hepatocellular carcinoma justified? Results from a multi-institutional database. Ann Surg Oncol. 2005;12(5):364-373.

    Article  PubMed  Google Scholar 

  8. Takizawa D, Kakizaki S, Sohara N, et al. Hepatocellular carcinoma with portal vein tumor thrombosis: clinical characteristics, prognosis, and patient survival analysis. Dig Dis Sci. 2007;52(11):3290-3295.

    Article  PubMed  Google Scholar 

  9. Vauthey JN, Pawlik TM, Abdalla EK, et al. Is extended hepatectomy for hepatobiliary malignancy justified? Ann Surg. 2004;239(5):722-730. discussion 730-732.

    Article  PubMed  Google Scholar 

  10. Virani S, Michaelson JS, Hutter MM, et al. Morbidity and mortality after liver resection: results of the patient safety in surgery study. J Am Coll Surg. 2007;204(6):1284-1292.

    Article  PubMed  Google Scholar 

  11. Zhou L, Rui JA, Wang SB, et al. Outcomes and prognostic factors of cirrhotic patients with hepatocellular carcinoma after radical major hepatectomy. World J Surg. 2007;31(9):1782-1787.

    Article  PubMed  Google Scholar 

  12. Fan ST, Lai EC, Lo CM, et al. Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Arch Surg. 1995;130(2):198-203.

    Article  PubMed  CAS  Google Scholar 

  13. Nagasue N, Yukaya H. Liver resection for hepatocellular carcinoma: results from 150 consecutive patients. Cancer Chemother Pharmacol. 1989;23(suppl):S78-S82.

    Article  PubMed  Google Scholar 

  14. Thompson HH, Tompkins RK, Longmire WP Jr. Major hepatic resection. A 25-year experience. Ann Surg. 1983;197(4):375-388.

    Article  PubMed  CAS  Google Scholar 

  15. Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236(4):397-406. discussion 406-407.

    Article  PubMed  Google Scholar 

  16. Abdalla EK, Barnett CC, Doherty D, et al. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg. 2002;137(6):675-680. discussion 680-681.

    Article  PubMed  Google Scholar 

  17. Stone HH, Long WD, Smith RB III, Haynes CD. Physiologic considerations in major hepatic resections. Am J Surg. 1969;117(1):78-84.

    Article  PubMed  CAS  Google Scholar 

  18. Fan ST, Lo CM, Liu CL, et al. Safety of donors in live donor liver transplantation using right lobe grafts. Arch Surg. 2000;135(3):336-340.

    Article  PubMed  CAS  Google Scholar 

  19. Farges O, Belghiti J, Kianmanesh R, et al. Portal vein embolization before right hepatectomy: prospective clinical trial. Ann Surg. 2003;237(2):208-217.

    PubMed  Google Scholar 

  20. Abdalla EK, Denys A, Chevalier P, et al. Total and segmental liver volume variations: implications for liver surgery. Surgery. 2004;135(4):404-410.

    Article  PubMed  Google Scholar 

  21. Delesse MA. Procede mechanique pour determiner la composition des roches. C R Acad Sci. 1847;25:544-545.

    Google Scholar 

  22. Weibel ER. Principles and methods for the morphometric study of the lung and other organs. Lab Invest. 1963;12:131-155.

    PubMed  CAS  Google Scholar 

  23. Hennig A. Kritische btrachtungen zur volumenund Oberflachen-messung in der mikroskopie. Zeiss Werkz. 1958;30:76-86.

    Google Scholar 

  24. Fritschy P, Robotti G, Schneekloth G, Vock P. Measurement of liver volume by ultrasound and computed tomography. J Clin Ultrasound. 1983;11(6):299-303.

    Article  PubMed  CAS  Google Scholar 

  25. Henderson JM, Heymsfield SB, Horowitz J, Kutner MH. Measurement of liver and spleen volume by computed tomography. Assessment of reproducibility and changes found following a selective distal splenorenal shunt. Radio­logy. 1981;141(2):525-527.

    PubMed  CAS  Google Scholar 

  26. Kamel IR, Kruskal JB, Pomfret EA, et al. Impact of multidetector CT on donor selection and surgical planning before living adult right lobe liver transplantation. AJR Am J Roentgenol. 2001;176(1):193-200.

    PubMed  CAS  Google Scholar 

  27. Leelaudomlipi S, Sugawara Y, Kaneko J, et al. Volumetric analysis of liver segments in 155 living donors. Liver Transpl. 2002;8(7):612-614.

    Article  PubMed  Google Scholar 

  28. Farraher SW, Jara H, Chang KJ, et al. Liver and spleen volumetry with quantitative MR imaging and dual-space clustering segmentation. Radiology. 2005;237(1):322-328.

    Article  PubMed  Google Scholar 

  29. Caldwell SH, de Lange EE, Gaffey MJ, et al. Accuracy and significance of pretransplant liver volume measured by magnetic resonance imaging. Liver Transpl Surg. 1996;2(6):438-442.

    Article  PubMed  CAS  Google Scholar 

  30. Luft AR, Skalej M, Welte D, et al. Reliability and exactness of MRI-based volumetry: a phantom study. J Magn Reson Imaging. 1996;6(4):700-704.

    Article  PubMed  CAS  Google Scholar 

  31. Zacharia TT. Assessment of future remnant liver regeneration after portal vein embolization using three-dimensional CT and MR volumetric analyses. Australas Radiol. 2006;50(6):543-548.

    Article  PubMed  CAS  Google Scholar 

  32. Heymsfield SB, Fulenwider T, Nordlinger B, et al. Accurate measurement of liver, kidney, and spleen volume and mass by computerized axial tomography. Ann Intern Med. 1979;90(2):185-187.

    PubMed  CAS  Google Scholar 

  33. Soyer P, Roche A, Elias D, Levesque M. Hepatic metastases from colorectal cancer: influence of hepatic volumetric analysis on surgical decision making. Radiology. 1992;184(3):695-697.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  35. Kamel IR, Kruskal JB, Warmbrand G, et al. Accuracy of volumetric measurements after virtual right hepatectomy in potential donors undergoing living adult liver transplantation. AJR Am J Roentgenol. 2001;176(2):483-487.

    PubMed  CAS  Google Scholar 

  36. Shirabe K, Shimada M, Gion T, et al. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg. 1999;188(3):304-309.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  39. Nakayama Y, Li Q, Katsuragawa S, et al. Automated hepatic volumetry for living related liver transplantation at multisection CT. Radiology. 2006;240(3):743-748.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  41. Lu Y, Wu Z, Liu C, Wang HH. Hepatic volumetry with PhotoShop in personal computer. Hepatobiliary Pancreat Dis Int. 2004;3(1):82-85.

    PubMed  Google Scholar 

  42. Rasband W. ImageJ. U.S. National Institutes of Health, Bethesda, 1997–2005.

    Google Scholar 

  43. Johnson TN, Tucker GT, Tanner MS, Rostami-Hodjegan A. Changes in liver volume from birth to adulthood: a meta-analysis. Liver Transpl. 2005;11(12):1481-1493.

    Article  PubMed  Google Scholar 

  44. Urata K, Kawasaki S, Matsunami H, et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology. 1995;21(5):1317-1321.

    Article  PubMed  CAS  Google Scholar 

  45. Vauthey JN, Abdalla EK, Doherty DA, et al. Body surface area and body weight predict total liver volume in Western adults. Liver Transpl. 2002;8(3):233-240.

    Article  PubMed  Google Scholar 

  46. DeLand FH, North WA. Relationship between liver size and body size. Radiology. 1968;91(6):1195-1198.

    PubMed  CAS  Google Scholar 

  47. Zoli M, Magalotti D, Grimaldi M, et al. Physical examination of the liver: is it still worth it? Am J Gastroenterol. 1995;90(9):1428-1432.

    PubMed  CAS  Google Scholar 

  48. Chandramohan A, Eapen A, Govil S, et al. Determining standard liver volume: assessment of existing formulae in Indian population. Indian J Gastroenterol. 2007;26(1):22-25.

    PubMed  Google Scholar 

  49. Heinemann A, Wischhusen F, Puschel K, Rogiers X. Standard liver volume in the Caucasian population. Liver Transpl Surg. 1999;5(5):366-368.

    Article  PubMed  CAS  Google Scholar 

  50. Urata K, Hashikura Y, Ikegami T, et al. Standard liver ­volume in adults. Transplant Proc. 2000;32(7):2093-2094.

    Article  PubMed  CAS  Google Scholar 

  51. Chun YS, Ribero D, Abdalla EK, et al. Comparison of two methods of future liver remnant volume measurement. J Gastrointest Surg. 2008;12(1):123-128.

    Article  PubMed  Google Scholar 

  52. Kiuchi T, Kasahara M, Uryuhara K, et al. Impact of graft size mismatching on graft prognosis in liver trans­plantation from living donors. Transplantation. 1999;67(2):321-327.

    Article  PubMed  CAS  Google Scholar 

  53. Lo CM, Fan ST, Liu CL, et al. Minimum graft size for successful living donor liver transplantation. Transplantation. 1999;68(8):1112-1116.

    Article  PubMed  CAS  Google Scholar 

  54. Ogiu N, Nakamura Y, Ijiri I, et al. A statistical analysis of the internal organ weights of normal Japanese people. Health Phys. 1997;72(3):368-383.

    Article  PubMed  CAS  Google Scholar 

  55. Yoshizumi T, Gondolesi GE, Bodian CA, et al. A simple new formula to assess liver weight. Transplant Proc. 2003;35(4):1415-1420.

    Article  PubMed  CAS  Google Scholar 

  56. Yu HC, You H, Lee H, et al. Estimation of standard liver volume for liver transplantation in the Korean population. Liver Transpl. 2004;10(6):779-783.

    Article  PubMed  Google Scholar 

  57. Vauthey JN, Chaoui A, Do KA, et al. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery. 2000;127(5):512-519.

    Article  PubMed  CAS  Google Scholar 

  58. Ribero D, Abdalla EK, Madoff DC, et al. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg. 2007;94(11):1386-1394.

    Article  PubMed  CAS  Google Scholar 

  59. Yigitler C, Farges O, Kianmanesh R, et al. The small remnant liver after major liver resection: how common and how relevant? Liver Transpl. 2003;9(9):S18-S25.

    Article  PubMed  Google Scholar 

  60. Lin XZ, Sun YN, Liu YH, et al. Liver volume in patients with or without chronic liver diseases. Hepatogastroenterology. 1998;45(22):1069-1074.

    PubMed  CAS  Google Scholar 

  61. Ribero D, Curley SA, Imamura H, et al. Selection for resection of hepatocellular carcinoma and surgical strategy: indications for resection, evaluation of liver function, portal vein embolization, and resection. Ann Surg Oncol. 2008;15(4):986-992.

    Article  PubMed  Google Scholar 

  62. Nanashima A, Yamaguchi H, Shibasaki S, et al. Relationship between CT volumetry and functional liver volume using technetium-99 m galactosyl serum albumin scintigraphy in patients undergoing preoperative portal vein embolization before major hepatectomy: a preliminary study. Dig Dis Sci. 2006;51(7):1190-1195.

    Article  PubMed  Google Scholar 

  63. Ashwell G, Harford J. Carbohydrate-specific receptors of the liver. Annu Rev Biochem. 1982;51:531-554.

    Article  PubMed  CAS  Google Scholar 

  64. Kubota K, Makuuchi M, Kusaka K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26(5):1176-1181.

    PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Mathew M. Augustine M.D.

  2. Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA

    Ihab R. Kamel M.D., Ph.D.

  3. Division of Surgical Oncology, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik

Authors
  1. Mathew M. Augustine M.D.
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  2. Ihab R. Kamel M.D., Ph.D.
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  3. Timothy M. Pawlik
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Corresponding author

Correspondence to Timothy M. Pawlik .

Editor information

Editors and Affiliations

  1. New York-Presbyterian Hospital, New York, 10032, New York, USA

    David C. Madoff

  2. University of Tokyo, Hongo 7-3-1, Tokyo, 113-8656, Japan

    Masatoshi Makuuchi

  3. School of Medicine, Dept. Surgery I, Nagoya University, Tsurumai-cho 65, Nagoya, Aichi-ken, 466-8550, Japan

    Masato Nagino

  4. M.D. Anderson Cancer Center, Dept. Surgical Oncology, University of Texas, Holcombe Blvd. 1515, Houston, 77030, Texas, USA

    Jean-Nicolas Vauthey

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Augustine, M.M., Kamel, I.R., Pawlik, T.M. (2011). Morphometric Imaging Techniques and the Functional Liver Remnant. In: Madoff, D., Makuuchi, M., Nagino, M., Vauthey, JN. (eds) Venous Embolization of the Liver. Springer, London. https://doi.org/10.1007/978-1-84882-122-4_11

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  • DOI: https://doi.org/10.1007/978-1-84882-122-4_11

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