Segmental anatomy of the liver: poor correlation with CT

Abstract

Purpose: To evaluate qualitatively and quantitatively the current procedures for radiologic delineation of the segmental and subsegmental anatomy of the liver.

Materials and methods: Vascular casts of 10 livers were examined with helical computed tomography (CT). Liver segmental and subsegmental anatomy were determined on the CT scans according to customary radiologic practice guidelines. CT anatomic findings were compared with authentic anatomic territories seen at anatomic examination. The differences were assessed quantitatively in five of the 10 livers.

Results: For the marginal (cranial and caudal) portions of the liver, an average (+/- 1 standard deviation) of 17.3% +/- 6.5 of the hepatic area visualized on axial CT scans was attributed to an incorrect subsegment. For the central zones (those adjacent to the right and left branches of the portal vein), this error amounted to 51.6% +/- 19.9. Expressed in absolute numbers, the error amounted to 40 mm on axial CT scans.

Conclusion: The radiologic determination of portal venous territories within the liver must be revised. The indirect landmarks currently used are not reliable for proper delineation. Only procedures that account for the portal venous distribution pattern, including peripheral branches, will result in correct depiction of the complex and variable anatomic reality.