title: The inhomogeneous distribution of liver function: possible impact on the prediction of post-operative remnant liver function.
abstract: BACKGROUND
  Previous studies have shown that liver function is inhomogeneously distributed in diseased livers, and this uneven distribution cannot be compensated for if a global liver function test is used for the prediction of post-operative remnant liver function. Dynamic Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) can assess segmental liver function, thus offering the possibility to overcome this problem.
  
  
  METHODS
  In 10 patients with liver cirrhosis and 10 normal volunteers, the contribution of individual liver segments to total liver function and volume was calculated using dynamic Gd-EOB-DTPA-enhanced MRI. Remnant liver function predictions using a segmental method and global assessment were compared for a simulated left hemihepatectomy. For the prediction based on segmental functional MRI assessment, the estimated function of the remnant liver segments was added.
  
  
  RESULTS
  Global liver function assessment overestimated the remnant liver function in 9 out of 10 patients by as much as 9.3% [median -3.5% (-9.3-3.5%)]. In the normal volunteers there was a slight underestimation of remnant function in 9 out of 10 cases [median 1.07% (-0.7-2.5%)].
  
  
  CONCLUSIONS
  The present study underlines the necessity of a segmental liver function test able to compensate for the non-homogeneous nature of liver function, if the prediction of post-operative remnant liver function is to be improved.
authors.affiliation: Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Nilsson
authors.forename: Silja
authors.initials: S
authors.lastname: Karlgren
authors.forename: Lennart
authors.initials: L
authors.lastname: Blomqvist
authors.forename: Eduard
authors.initials: E
authors.lastname: Jonas
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008099:Liver / Q000254:growth & development*; D008103:Liver Cirrhosis / Q000473:pathology* / Q000601:surgery*; D008111:Liver Function Tests / Q000379:methods; D008115:Liver Regeneration / Q000502:physiology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D012494:Sampling Studies; D012720:Severity of Illness Index