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. 2022 Jan;47(1):143-151.
doi: 10.1007/s00261-021-03262-x. Epub 2021 Oct 4.

Repeatability and reproducibility of deep-learning-based liver volume and Couinaud segment volume measurement tool

Amirkasra Mojtahed  1 , Luis Núñez  2 , John Connell  3 , Alessandro Fichera  2 , Rowan Nicholls  2 , Angela Barone  2 , Mariana Marieiro  2 , Anthony Puddu  2 , Zobair Arya  2 , Carlos Ferreira  2 , Ged Ridgway  2 , Matt Kelly  2 , Hildo J Lamb  4 , Felipe Caseiro-Alves  5 , J Michael Brady  2 , Rajarshi Banerjee  2
Affiliations

Repeatability and reproducibility of deep-learning-based liver volume and Couinaud segment volume measurement tool

Amirkasra Mojtahed et al. Abdom Radiol (NY). 2022 Jan.

Abstract

Purpose: Volumetric and health assessment of the liver is crucial to avoid poor post-operative outcomes following liver resection surgery. No current methods allow for concurrent and accurate measurement of both Couinaud segmental volumes for future liver remnant estimation and liver health using non-invasive imaging. In this study, we demonstrate the accuracy and precision of segmental volume measurements using new medical software, Hepatica™.

Methods: MRI scans from 48 volunteers from three previous studies were used in this analysis. Measurements obtained from Hepatica™ were compared with OsiriX. Time required per case with each software was also compared. The performance of technicians and experienced radiologists as well as the repeatability and reproducibility were compared using Bland-Altman plots and limits of agreement.

Results: High levels of agreement and lower inter-operator variability for liver volume measurements were shown between Hepatica™ and existing methods for liver volumetry (mean Dice score 0.947 ± 0.010). A high consistency between technicians and experienced radiologists using the device for volumetry was shown (± 3.5% of total liver volume) as well as low inter-observer and intra-observer variability. Tight limits of agreement were shown between repeated Couinaud segment volume (+ 3.4% of whole liver), segmental liver fibroinflammation and segmental liver fat measurements in the same participant on the same scanner and between different scanners. An underestimation of whole-liver volume was observed between three non-reference scanners.

Conclusion: Hepatica™ produces accurate and precise whole-liver and Couinaud segment volume and liver tissue characteristic measurements. Measurements are consistent between trained technicians and experienced radiologists.

Keywords: Cirrhosis; Couinaud; Hepatectomy; Hepatic function; Liver resection; Post-hepatectomy liver failure.

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Conflict of interest statement

Perspectum Ltd. is a privately funded commercial enterprise that develops medical devices to address unmet clinical needs, including Hepatica®. RB is the CEO and founder of Perspectum. LN, JC, AF, RN, AB, MM, AP, ZA, CF, MK and JMB are employees of Perspectum. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Anatomical landmarks used to delineate Couinaud segments: a Inferior vena cava (superior), b inferior vena cava (inferior), c middle hepatic vein, d gallbladder fossa, e right hepatic vein, f umbilical fissure, g right portal vein, h left portal vein
Fig. 2
Fig. 2
Comparison of volumetry between Hepatica™ and OsiriX. a Bland–Altman plot demonstrating agreement between volumetry by Hepatica™ and volumetry by OsiriX differentiating the two radiologists. Bias (dashed line) = 2.6%, LOA (black dotted line) [− 3.6%, 8.8%]. b Bland–Altman plot of variability between radiologists in volumetry using OsiriX, Bias (dashed line) = 4.2%, LOA (black dotted line) [− 0.5%, 8.9%]. c Bland–Altman plot of variability between radiologists in volumetry using Hepatica™, Bias (dashed line) = 0.2%, LOA (black dotted line) [− 1.7%, 2.2%]. Green dotted line = [− 10%, 10%]
Fig. 3
Fig. 3
Time spent by one radiologist using software tools for whole-liver volumetry. n = 7 **p = 0.0033 Wilcoxon test
Fig. 4
Fig. 4
Example of Couinaud segment delineations from Hepatica™ on non-contrast-enhanced T1-weighted MR and cT1 images
See this image and copyright information in PMC

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