Virtual Hepatic Resection Using Three-Dimensional Reconstruction of Helical Computed Tomography Angioportograms

Abstract

ObjectiveTo establish the accuracy of virtual hepatic resection using three-dimensional (3D) models constructed from computed tomography angioportography (CTAP) images in determining the liver volume (LV) resected during resectional liver surgery. Summary Background DataThe ability to measure LV before surgery could be useful in determining the extent and nature of hepatic resection. Accurate assessment of LV and an estimate of liver function may also allow prediction of postoperative liver failure in patients undergoing resection, assist in volume-enhancing embolization procedures, help with the planning of staged hepatic resection for bilobar disease, and aid in selection of living-related liver donors. MethodsA retrospective study was conducted involving 27 patients scheduled for liver resection. Using mapping technology, 3D models were constructed from helical CTAP images. From these 3D models, tumor volume, total LV, and functional LV were calculated and were compared with body weight. The 3D liver models were subjected to a virtual hepatectomy along established anatomical planes, and the resected LV was calculated. The resected volume predicted by radiologists (unaware of the actual weight) was compared with the specimen weight measured after actual surgical resection. ResultsA significant correlation was found between body weight and functional LV but not total LV. The computer prediction of resected LV after virtual hepatectomy of 3D models compared well with resected liver weight. ConclusionVirtual hepatectomy of 3D CTAP reconstructed images provides an accurate prediction of liver mass removed during subsequent hepatic resection. The authors intend to combine this technology with an assessment of liver function to attempt to predict patients at risk for liver failure after hepatic resection.

The small remnant liver after major liver resection: How common and how relevant?

“…11 The functional liver volumes were computed from the patients' body weights and heights using a formula 16 that proved to be very accurate in our patients. As in similar studies, tumor volumes were considered to be nonfunctional liver parenchyma, 9,[20][21][22] and patients with multiple tumors that could not be accurately measured were excluded from the analysis. 11,20 Our first objective was to determine how often a major hepatectomy results in a small RLV.…”

Assessment of Intraoperative Liver Deformation During Hepatic Resection: Prospective Clinical Study

“…Preoperative planning of liver resection is based on ultrasound (US), computed tomography (CT), and/or magnetic resonance imaging (MRI) and provides visualization of liver anatomy [18]. While these imaging methods provide excellent visualization of intrahepatic vascular branches, neither the number and distribution nor the extent of liver territories can be assessed reliably.…”

Precise Local Resection for Hepatocellular Carcinoma Based on Tumor-Surrounding Vascular Anatomy Revealed by 3D Analysis

“…Previous works have shown the advantages of 3D analysis in liver resection planning [17,18,19,20], but its implementation in local resection of HCC has not been addressed. The paramount important issue in performing local resection of HCC is how to properly set a transection plane which will allow achievements of adequate surgical margins and complete preservation of the circulation in the remnant liver.…”

“…Recently, a new three-dimensional (3D) analysis technique using 2D CT data has been developed, which allows 3D visualization of intrahepatic vessels [14,15,16], and has been shown to have advantages in planning of liver resection [17,18,19,20]. On the integrated 3D virtual images of intrahepatic anatomy, the tumor-surrounding vessels could be stereoscopically identified, irrespective of anatomical variation, and the real 3D relationships between the tumor and the adjacent vascular anatomy could be viewed from different aspects.…”