title: Three-dimensional volumetry in 107 normal livers reveals clinically relevant inter-segment variation in size.
abstract: BACKGROUND
  The anatomic resection of Couinaud's segments is one of the key techniques in liver surgery. However, the territories and volumes of the eight segments are not adequately assessed based on portal branching.
  
  
  METHODS
  Three-dimensional (3D) perfusion-based volumetry was performed in 107 normal livers. Based on Couinaud classification, the portal branches were identified and the volumes of each segment were calculated. The relationships between branching patterns of the portal veins and segmental volumes were assessed.
  
  
  RESULTS
  In descending order of volume, median volumes of segments VIII, VII, IV, V, III, VI, II and I were recorded. Segment VIII was the largest, accounting for a median of 26.1% (range: 11.1-38.0%) of total liver volume (TLV), whereas segments II and III each represented <10% of TLV. In 69.2% of subjects, the portal branches of segment V diverged from the trunk of the branches of segment VIII. No relationship was found between branching type and segment volume.
  
  
  CONCLUSIONS
  The territories and volumes of Couinaud's segments vary among segments, as well as among individuals. Detailed 3D volumetry is useful for preoperative evaluations of the dissection line and of future liver remnant volume in anatomic segmentectomy.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mise
authors.forename: Shouichi
authors.initials: S
authors.lastname: Satou
authors.forename: Junichi
authors.initials: J
authors.lastname: Shindoh
authors.forename: Claudius
authors.initials: C
authors.lastname: Conrad
authors.forename: Taku
authors.initials: T
authors.lastname: Aoki
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012016:Reference Values; D012984:Software; D014057:Tomography, X-Ray Computed; D055815:Young Adult
references.citation: Ann Surg. 1989 Jul;210(1):20-3
references.pmid: 2662923
references.citation: Br J Surg. 1999 Aug;86(8):1032-8
references.pmid: 10460639
references.citation: Hepatology. 1997 Nov;26(5):1176-81
references.pmid: 9362359
references.citation: AJR Am J Roentgenol. 1994 Dec;163(6):1395-404
references.pmid: 7992736
references.citation: Ann Surg Oncol. 2007 Apr;14(4):1356-65
references.pmid: 17252289
references.citation: Surgery. 1991 Feb;109(2):226-9
references.pmid: 1846986
references.citation: Hepatology. 1993 Jul;18(1):79-85
references.pmid: 8392029
references.citation: Ann Surg Oncol. 2012 Nov;19(12):3697-705
references.pmid: 22722807
references.citation: Radiology. 2000 Feb;214(2):491-5
references.pmid: 10671598
references.citation: Ann Surg. 2010 Feb;251(2):229-35
references.pmid: 19838106
references.citation: World J Surg. 2007 Jun;31(6):1249-55
references.pmid: 17440774
references.citation: Ann Surg. 2005 Aug;242(2):252-9
references.pmid: 16041216
references.citation: Radiology. 1996 Sep;200(3):779-83
references.pmid: 8756931
references.citation: Acta Anat (Basel). 1951;11(4):599-615
references.pmid: 14829155
references.citation: Ann Surg. 1998 Nov;228(5):627-34
references.pmid: 9833800
references.citation: Surgery. 2004 Apr;135(4):404-10
references.pmid: 15041964
references.citation: Transplant Proc. 2007 Jan-Feb;39(1):145-9
references.pmid: 17275493
references.citation: Surgery. 1984 May;95(5):586-92
references.pmid: 6324403
references.citation: Surgery. 2002 Mar;131(3):311-7
references.pmid: 11894036
references.citation: Arch Surg. 2005 Jul;140(7):629-38; discussion 638
references.pmid: 16027326
references.citation: Hepatol Res. 2009 Feb;39(2):107-16
references.pmid: 19208031
references.citation: Clin Anat. 1999;12(4):229-44
references.pmid: 10398382
references.citation: Br J Surg. 2011 Dec;98(12):1742-51
references.pmid: 22034181
references.citation: Surg Gynecol Obstet. 1985 Oct;161(4):346-50
references.pmid: 2996162
references.citation: Semin Surg Oncol. 1993 Jul-Aug;9(4):298-304
references.pmid: 8210909
references.citation: Transplant Proc. 2006 Jun;38(5):1400-3
references.pmid: 16797316
references.citation: Surgery. 2008 Apr;143(4):469-75
references.pmid: 18374043
references.citation: Am J Surg. 2008 Aug;196(2):245-51
references.pmid: 18571618
references.citation: Ann Surg. 2010 May;251(5):917-22
references.pmid: 20395853
references.citation: Hepatology. 2005 Jun;41(6):1297-304
references.pmid: 15846773