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. 2010 Oct;34(10):2426-33.
doi: 10.1007/s00268-010-0663-5.

Virtual liver resection and volumetric analysis of the future liver remnant using open source image processing software

Joost R van der Vorst  1 , Ronald M van Dam, Rogier S A van Stiphout, Maartje A van den Broek, Ilona H Hollander, Alfons G H Kessels, Cornelis H C Dejong
Affiliations

Virtual liver resection and volumetric analysis of the future liver remnant using open source image processing software

Joost R van der Vorst et al. World J Surg. 2010 Oct.

Abstract

Background: After extended liver resection, a remnant liver that is too small can lead to postresection liver failure. To reduce this risk, preoperative evaluation of the future liver remnant volume (FLRV) is critical. The open-source OsiriX PAC software system can be downloaded for free and used by nonradiologists to calculate liver volume using a stand-alone Apple computer. The purpose of this study was to assess the accuracy of OsiriX CT volumetry for predicting liver resection volume and FLVR in patients undergoing partial hepatectomy.

Methods: Preoperative contrast-enhanced liver CT scans of patients who underwent partial hepatectomy were analyzed by three observers. Two surgical trainees measured the total liver volume, resection volume, and tumor volume using OsiriX, and a radiologist measured these volumes using CT scanner-linked Aquarius iNtuition software. Resection volume was correlated with prospectively determined resection weight, and differences in the measured liver volumes were analyzed. Interobserver variability was assessed using Bland-Altman plots.

Results: 25 patients (M/F ratio: 13/12) with a median age of 61 (range, 34-77) years were included. There were significant correlations between the weight and volume of the resected specimens (Pearson's correlation coefficient: R(2) = 0.95). There were no major differences in total liver volumes, resection volumes, or tumor volumes for observers 1, 2, and 3. Bland-Altman plots showed a small interobserver variability. The mean time to complete liver volumetry for one patient using OsiriX was 19 +/- 3 min.

Conclusions: OsiriX liver volumetry performed by surgeons is an accurate and time-efficient method for predicting resection volume and FLRV.

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Figures

Fig. 1
Fig. 1
a Picture archiving and communication system integrated in Osirix Software package. b Outlining liver tissue. c 3D liver image
Fig. 2
Fig. 2
Actual resection weight measured in the operating room directly after resection is plotted against the estimated resection volume by observers 1, 2, and 3
Fig. 3
Fig. 3
a Mean total liver volume is plotted for observers 1, 2, and 3. Horizontal lines represent mean ± SD. No significant differences were found. b Mean resection volume is plotted for observers 1, 2, and 3. Horizontal lines represent mean ± SD. No significant differences were found. c Mean metastases volume is plotted for observers 1, 2, and 3. Horizontal lines represent mean ± SD. No significant differences were found. d Mean functional remnant liver volume as a percentage of total functional liver volume is plotted for observers 1, 2, and 3. Horizontal lines represent mean ± SD. No significant differences were found
Fig. 4
Fig. 4
a Mean total volume of observers 1 and 2 is plotted against the difference in total volume between observers 1 and 2. b Mean resection volume of observers 1 and 2 is plotted against the difference in resection volume between observers 1 and 2. c Mean metastases volume of observers 1 and 2 is plotted against the difference in metastases volume between observers 1 and 2 d. Mean functional remnant liver volume as a percentage of total functional liver volume of observers 1 and 2 is plotted against the difference in functional remnant liver volume as a percentage of total functional liver volume between observers 1 and 2
Fig. 5
Fig. 5
a Mean total volume of observers 1 and 3 is plotted against the difference in total volume between observers 1 and 3. b Mean resection volume of observers 1 and 3 is plotted against the difference in resection volume between observers 1 and 3. c Mean metastases volume of observers 1 and 3 is plotted against the difference in metastases volume between observers 1 and 3. d Mean functional remnant liver volume as a percentage of total functional liver volume of observers 1 and 3 is plotted against the difference in functional remnant liver volume as a percentage of total functional liver volume between observers 1 and 3
See this image and copyright information in PMC

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