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

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 b...

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Bibliographic Details
Published in:World journal of surgery 2010-10, Vol.34 (10), p.2426-2433
Main Authors: van der Vorst, Joost R., van Dam, Ronald M., van Stiphout, Rogier S. A., van den Broek, Maartje A., Hollander, Ilona H., Kessels, Alfons G. H., Dejong, Cornelis H. C.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adult
Aged
Biological and medical sciences
Cardiac Surgery
Colorectal Neoplasms - pathology
Female
General aspects
General Surgery
Hepatectomy - adverse effects
Humans
Image Processing, Computer-Assisted
Liver - diagnostic imaging
Liver - pathology
Liver Failure - etiology
Liver Failure - prevention & control
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Liver Resection
Liver Volume
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Middle Hepatic Vein
Organ Size
Preoperative Care
Remnant Liver Volume
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Surgery, Computer-Assisted
Thoracic Surgery
Tomography, X-Ray Computed
Total Liver Volume
Vascular Surgery
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Summary: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: R 2  = 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.
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-010-0663-5