Evaluation of Computer-Assisted Quantitative Volumetric Analysis for Pre-Operative Resectability Assessment of Huge Hepatocellular Carcinoma

Abstract

Purpose: Hepatic resection is arguably the preferred treatment for huge hepatocellular carcinoma (H-HCC). Estimating the remnant liver volume is therefore essential. This study aimed to evaluate the feasibility of using computer-assisted volumetric analysis for this purpose. Methods: The study involved 40 patients with H-HCC. Laboratory examinations were conducted, and a contrast CT-scan revealed that 30 cases out of the participating 40 had single-lesion tumors. The remaining 10 had less than three satellite tumors. With the consensus of the team, two physicians conducted computer-assisted 3D segmentation of the liver, tumor, and vessels in each case. Volume was automatically computed from each segmented/labeled anatomical field. To estimate the resection volume, virtual lobectomy was applied to the main tumor. A margin greater than 1 cm was applied to the satellite tumors. Resectability was predicted by computing a ratio of functional liver resection (R) as (VresectedVtumor)/(Vtotal-Vtumor) x 100%, applying a threshold of 50% and 60% for cirrhotic and non-cirrhotic cases, respectively. This estimation was then compared with surgical findings. Results: Out of the 22 patients who had undergone hepatectomies, only one had an R that exceeded the threshold. Among the remaining 18 patients with non-resectable H-HCC, 12 had Rs that exceeded the specified ratio and the remaining 6 had Rs that were < 50%. Four of the patients who had Rs less than 50% underwent incomplete surgery due to operative findings of more extensive satellite tumors, vascular invasion, or metastasis. The other two cases did not undergo surgery because of the high risk involved in removing the tumor. Overall, the ratio of functional liver resection for estimating resectability correlated well with the other surgical findings. Conclusion: Efficient pre-operative resectability assessment of H-HCC using computer-assisted volumetric analysis is feasible.

Long‐Term Outcome After Resection of Huge Hepatocellular Carcinoma ≥10 cm: Single‐Institution Experience with 471 Patients

“…When the future remnant liver volume appeared relatively too small, the ratio of future remnant liver to total functional liver volume, after exclusion of tumor volume, was calculated by CT volumetry [7].…”

Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis

“…3D reconstruction of an HAE lesion and the liver enables a more thorough understanding of the location and size of the lesion, as well as the adjacent structures. In addition, 3D reconstruction vividly reflects the structural characteristics of the intrahepatic biliary and vascular network, such as the positional relationship among vessels and the diameters, which ensures an accurate preoperative assessment and smooth surgical procedure [20,21] . The 3D reconstruction system is simple and convenient to operate.…”

Assessing Liver Function in Liver Tumors Patients: The Performance of T1 Mapping and Residual Liver Volume on Gd-EOBDTPA-Enhanced MRI

“…Additionally, residual liver volume (RLV), which contains the anatomic information, is another parameter that is significantly Abbreviations: ICG, indocyanine green retention rate; T1-pre, T1 relaxation time before Gd-EOB-DTPA injection; T1-post, T1 relaxation time 20 min after Gd-EOB-DTPA injection; RLV, residual liver volume; T1, absolute reduction of T1 relaxation time; T1%, reduction rate of T1 relaxation time; volume-assisted T1, T1 * RLV; volume-assisted T1%, T1% * RLV; NLF, normal liver function; ALF, abnormal liver function; ROC, receiver operating characteristic; AUROC, area under the ROC curves; RFA, radiofrequency ablation; TACE, transarterial chemoembolization; LR, liver resection; RLV/TLV, residual to total liver volume ratio; MELD, model of end-stage liver disease; HBP, hepatobiliary phases; VIBE, volume interpolated breath-hold examination; ALT, alanine aminotransferase; AST, aspartate aminotransferase. correlated with hepatic functional reserve in patients treated with LR and TACE (13,14).…”