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Morphometric Imaging Techniques and the Functional Liver Remnant

  • Mathew M. Augustine
  • Ihab R. Kamel
  • Timothy M. PawlikEmail author
Chapter

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.

Keywords

Computer tomography (CT) volumetry Functional liver remnant Future liver remnant volume Morphometric imaging techniques and the functional liver ­remnant MRI of the liver 

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

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Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Mathew M. Augustine
    • 1
  • Ihab R. Kamel
    • 2
  • Timothy M. Pawlik
    • 3
    Email author
  1. 1.Department of SurgeryJohns Hopkins HospitalBaltimoreUSA
  2. 2.Department of RadiologyThe Johns Hopkins HospitalBaltimoreUSA
  3. 3.Division of Surgical Oncology, Department of SurgeryJohns Hopkins HospitalBaltimoreUSA

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