title: New surgical strategy to induce liver hypertrophy: role of MDCT-volumetry to monitor and predict liver growth.
abstract: OBJECTIVE
  To describe the role of MDCT-volumetry to monitor and predict liver hypertrophy in a recently introduced surgical technique in patients needing hepatectomy.
  
  
  METHODS
  This prospective study was approved by the local research and ethics committee and patient informed consent was obtained. Twelve consecutive patients were selected for associating liver partition and portal vein ligation for staged-hepatectomy procedure. The mean absolute the future-liver-remnant (FLR) and FLR/total liver volume (TLV) ratio was calculated before and after surgery to determine the degree of hypertrophy. Six days after surgery a new CT-examination was performed to determine the FLR-volume and FLR/TLV. If the enlargement of the FLR was the expected a second-step surgery was performed. Continuous variables are expressed as mean (range). A p<0.05 was considered significant.
  
  
  RESULTS
  The mean pre-operative FLR-volume was 402 mL and the FLR/TLV was 27%. The mean post-operative FLR-volume 6 days after the first step was 702 mL (range 521-1030 mL) being the mean difference between preoperative and postoperative FLR volume 303 mL (p<0.0001). The mean volume increase was 80% ranged from 21-139%. At day six, FLR/TLV was 46.5% (range 33.5-67.7), morbidity was 41% and mortality 0%.
  
  
  CONCLUSIONS
  MDCT-volumetry has a key role in decision-making, monitoring and predicting liver hypertrophy pre- and postoperatively.
authors.affiliation: Radiology Department, Hospital Italiano, Universidad de Buenos Aires, Argentina. marina.ulla@hospitalitaliano.org.ar
authors.forename: Marina
authors.initials: M
authors.lastname: Ulla
authors.forename: Victoria
authors.initials: V
authors.lastname: Ardiles
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Levy-Yeyati
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Alvarez
authors.forename: Juan C
authors.initials: JC
authors.lastname: Spina
authors.forename: Ricardo D
authors.initials: RD
authors.lastname: Garcia-Mónaco
authors.forename: Eduardo
authors.initials: E
authors.lastname: De Santibañes
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006984:Hypertrophy; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009929:Organ Size; D011446:Prospective Studies