Development and validation of a comprehensive new hepatobiliary software. Part II: Segmental liver function.
OBJECTIVE
This study was undertaken to develop comprehensive new hepatobiliary software to quantify segmental and lobar liver function and to obtain FDA approval.


METHODS
Hepatobiliary software written on JAVA platform and loaded on to a PC accepts 99mTc-HIDA dicom image data transferred from a gamma camera. Liver boundary was determined by threshold-based auto edge detection and liver height at right midclavicular (RMCL) line. Geometric mean area of the physiologic right lobe, physiologic left lobe and total liver area were measured. Segmental liver function was determined using the 5th minute frame as the default (100%).


RESULTS
In 24 control participants, mean (+/-SD) liver height at RMCL was 14.7+/-0.12 cm. Geometric mean area of the physiologic right lobe was 116+/-3 cm2, left lobe 96+/-4 cm2, and total liver area 212+/-3 cm. Right upper lobe (segments 7 and 8) contributed 31+/-0.7%, right lower lobe (segments 5 and 6) 34+/-0.6%, left medial (segments 4A and 4B) 24+/-1%, left lateral (segments 2 and 3) 10+/-2%, and caudate lobe (segment 1) 1+/-0.02% of total liver function. In 23 patients, contrast three-dimensional computerized tomographic volume of the right lobe was 1194+/-419 ml, left lobe 434+/-221 ml, and total liver volume 1628+/-490 ml. Right lobe area was 120+/-30 cm2, left lobe (plus caudate) 88+/-29 cm2 with total liver area of 208+/-51 cm. Right upper lobe (segments 7 and 8) contributed 33+/-10%, right lower lobe (segments 5 and 6) 34+/-7%, left medial (segments 4A and 4B) 23+/-6%, left lateral (segments 2 and 3) 9+/-3%, and caudate lobe (segment 1) 1+/-0.4% of total liver function. There was good correlation of RMCL height, and area of right lobe and total liver with computerized tomographic liver volume. Correlation of percentage volume with percentage function was excellent.


CONCLUSIONS
New FDA approved software provides quantitative assessment of segmental, lobar, and total liver size and function from a planar 99mTc-HIDA cholescintigraphy and may enable universal standardization in nuclear hepatology. Quantification may aid surgeons in the determination of the amount of tissue resection during liver surgery.
Krishnamurthy
Gerbail T
GT
Department of Nuclear Medicine and Radiology, Tuality Community Hospital, Hillsboro, Oregon 97123, USA. GTKrishna@aol.com
Krishnamurthy
Shakuntala
S
Milleson
Thomas
T
Minnick
Doug
D
Brown
Paul H
PH
D000328:Adult; D000368:Aged; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging* / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods* / Q000592:standards*; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000000981:diagnostic imaging* / Q000502:physiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods* / Q000592:standards*; D015203:Reproducibility of Results; D012984:Software / Q000592:standards*; D014057:Tomography, X-Ray Computed; D014481:United States; D014486:United States Food and Drug Administration; D055815:Young Adult