Fast and accurate liver volumetry prior to hepatectomy.
Volumetric assessment of the liver is essential in the prevention of postresectional liver failure after partial hepatectomy. Currently used methods are accurate but time-consuming. This study aimed to test a new automated method for preoperative volumetric liver assessment.



Patients who underwent a contrast enhanced portovenous phase CT-scan prior to hepatectomy in 2012 were included. Total liver volume (TLV) and future remnant liver volume (FRLV) were measured using TeraRecon Aquarius iNtuition(®) (autosegmentation) and OsiriX(®) (manual segmentation) software by two observers for each software package. Remnant liver volume percentage (RLV%) was calculated. Time needed to determine TLV and FRLV was measured. Inter-observer variability was assessed using Bland-Altman plots.



Twenty-seven patients were included. There were no significant differences in measured volumes between OsiriX(®) and iNtuition(®). Moreover, there were significant correlations between the OsiriX(®) observers, the iNtuition(®) observers and between OsiriX(®) and iNtuition(®) post-processing systems (all R(2) > 0.97). The median time needed for complete liver volumetric analysis was 18.4 ± 4.9 min with OsiriX(®) and 5.8 ± 1.7 min using iNtuition(®) (p < 0.001).



Both OsiriX(®) and iNtuition(®) liver volumetry are accurate and easily applicable. However, volumetric assessment of the liver with iNtuition(®) auto-segmentation is three times faster compared to manual OsiriX(®) volumetry.
Department of Surgery, Maastricht University Medical Center & NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Department of Surgery, University Hospital Aachen, Division of General, Visceral and Transplantation Surgery, Aachen, Germany. Electronic address: T.lodewick@maastrichtuniversity.nl.
Toine M
TM
Lodewick
Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Carsten W K P
CW
Arnoldussen
Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Max J
MJ
Lahaye
Department of Surgery, Maastricht University Medical Center & NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
Kim M C
KM
van Mierlo
Department of Surgery, Maastricht University Medical Center & NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Department of Surgery, University Hospital Aachen, Division of General, Visceral and Transplantation Surgery, Aachen, Germany.
Ulf P
UP
Neumann
Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Regina G
RG
Beets-Tan
Department of Surgery, Maastricht University Medical Center & NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Department of Surgery, University Hospital Aachen, Division of General, Visceral and Transplantation Surgery, Aachen, Germany.
Cornelis H C
CH
Dejong
Department of Surgery, Maastricht University Medical Center & NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Department of Surgery, University Hospital Aachen, Division of General, Visceral and Transplantation Surgery, Aachen, Germany.
Ronald M
RM
van Dam
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000601:surgery*; D017093:Liver Failure / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009929:Organ Size; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012984:Software; D012986:Software Validation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media