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  • 1
    Keywords: MODEL ; PERFUSION ; CT ; TRANSPLANTATION ; MRI ; RESECTION ; tomography ; ADULT ; PREOPERATIVE EVALUATION ; PARTIAL-HEPATECTOMY ; GRAFT VOLUME ; liver volumetry ; LIVING DONORS ; Heidelberg algorithm ; liver interventions ; liver perfusion ; liver perfusion simulator ; multislice CT scan
    Abstract: Background. An exact preoperative liver volume calculation is important prior to liver surgery and living-related liver transplantation. However, CT or MRI assessment of preoperative liver volume is associated with an estimation error of 1.2% to 36%, and little data is available on its accuracy on the segmental level. The aim of this study was to validate arterial and portal venous flow rates and gain information on liver volumetry, including liver segments, in the liver perfusion simulator and compare it to in vivo measurements in a porcine model. Material and Methods. The arterial and portal venous flow rates and liver volumes of 10 pigs were measured in vivo and compared with the flow rates and volumes ex vivo. CT scans were performed and the volume of the liver and its lobes calculated by water displacement or computer-assistance based on the CT scans. The right lateral lobe was plasticized and reconstructed for the volume calculation. Results. In the liver perfusion simulator, arterial and portal venous flow rates comparable to the in vivo rates were achieved. The liver volume had a mean difference of 10.3% between in vivo and ex vivo measurements. In the liver perfusion simulator, the mean deviation in liver volume between the computer calculation and water displacement was 2.8%. On the segmental level, the Heidelberg algorithm provided an accuracy of 97.7%. Conclusion. The liver perfusion simulator is an excellent device for studies in liver perfusion and volumetry. Furthermore, the simulator is applicable for teaching and performing interventions and surgeries in livers.
    Type of Publication: Journal article published
    PubMed ID: 20462596
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  • 2
    Keywords: BLOOD ; Germany ; MODEL ; ALGORITHM ; CT ; SYSTEM ; SYSTEMS ; liver ; RISK ; TISSUE ; computed tomography ; SURGERY ; LIVER-TRANSPLANTATION ; TRANSPLANTATION ; RESECTION ; tomography ; COMPUTED-TOMOGRAPHY ; ADULT ; PREOPERATIVE EVALUATION ; SCIENCE ; FULMINANT HEPATIC-FAILURE ; SCAN ; TIMES ; GRAFT VOLUME ; hepatic blood pool ; liver volumetry ; living donor liver transplantation ; LIVING DONORS ; RIGHT LOBE ; SPLEEN VOLUME ; vessel tree
    Abstract: Exact preoperative determination of the liver volume is of great importance prior to hepatobiliary surgery, especially in living donated liver transplantation (LDLT) and extended hepatic resections. Modern surgery-planning systems estimate these volumes from segmented image data. In an experimental porcine study, our aim was (1) to analyze and compare three volume measurement algorithms to predict total liver volume, and (2) to determine vessel tree volumes equivalent to nonmetabolic liver tissue. Twelve porcine livers were examined using a standardized three-phase computed tomography (CT) scan and liver volume was calculated computer-assisted with the three different algorithms. After hepatectomy, livers were weighed and their vascular system plasticized followed by CT scan, CT reconstruction and re-evaluation of total liver and vessel volumes with the three different algorithms. Blood volume determined by the plasticized model was at least 1.89 times higher than calculated by multislice CT scans (9.7% versus 21.36%, P = 0.028). Analysis of 3D-CT-volumetry showed good correlation between the actual and the calculated liver volume in all tested algorithms with a high significant difference in estimating the liver volume between Heymsfield versus Heidelberg (P = 0.0005) and literature versus Heidelberg (P = 0.0060). The Heidelberg algorithm reduced the measuring error with deviations of only 1.2%. The present results suggest a safe and highly predictable use of 3D-volumetry in liver surgery for evaluating liver volumes. With a precise algorithm, the volume of remaining liver or single segments can be evaluated exactly and potential operative risks can therefore be better calculated. To our knowledge, this study implies for the first time a blood pool, which corresponds to nonmetabolic liver tissue, of more than 20% of the whole liver volume. (C) 2010 Elsevier Inc. All rights reserved
    Type of Publication: Journal article published
    PubMed ID: 19765736
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