Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Tang, Jian-Hua (Department of Radiology, Zhongshan Hospital Fudan University) ;
  • Yan, Fu-Hua (Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University) ;
  • Zhou, Mei-Ling (Department of Radiology, Zhongshan Hospital Fudan University) ;
  • Xu, Peng-Ju (Department of Radiology, Zhongshan Hospital Fudan University) ;
  • Zhou, Jian (Department of Hepato-Surgery, Zhongshan Hospital Fudan University) ;
  • Fan, Jia (Department of Hepato-Surgery, Zhongshan Hospital Fudan University)
  • Published : 2013.05.30
Download PDF
⟨ Previous Next ⟩

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 (Vresected-Vtumor)/(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.

Keywords

References

  1. Aoyama M, Nakayama Y, Awai K, Inomata Y, Yamashita Y (2013). A simple method for accurate liver volume estimation by use of curve-fitting: a pilot study. Radiol Phys Technol, 6, 180-6. https://doi.org/10.1007/s12194-012-0186-x
  2. Clavien PA, Petrowsky H, DeOliveira ML, Graf R (2007). Strategies for safer liver surgery and partial liver transplantation. N Engl J Med, 356, 1545-59. https://doi.org/10.1056/NEJMra065156
  3. Emirzeoglu M, Sahin B, Selcuk MB, Kaplan S (2005). The effects of section thickness on the estimation of liver volume by the Cavalieri principle using computed tomography images. Eur J Radiol, 56, 391-7. https://doi.org/10.1016/j.ejrad.2005.04.008
  4. Gazzaniga GM, Cappato S, Belli FE, Bagarolo C, Filauro M (2005). Assessment of hepatic reserve for the indication of hepatic resection: how I do it. J Hepatobiliary Pancreat Surg, 12, 27-30. https://doi.org/10.1007/s00534-004-0946-z
  5. Karlo C, Reiner CS, Stolzmann P, et al (2010). CT- and MRIbased volumetry of resected liver specimen: comparison to intraoperative volume and weight measurements and calculation of conversion factors. Eur J Radiol, 75, 107-11. https://doi.org/10.1016/j.ejrad.2009.09.005
  6. Kayaalp C, Arda K, Oto A, Oran M (2002). Liver volume measurement by spiral CT: an in vitro study. Clin Imag, 26, 122-4. https://doi.org/10.1016/S0899-7071(01)00376-X
  7. Kubota K, Makuuchi M, Kusaka K, et al (1997). Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology, 26, 1176-81.
  8. Lee SG, Hwang S, Jung JP, et al (2007). Outcome of patients with huge hepatocellular carcinoma after primary resection and treatment of recurrent lesions. Br J Surg, 94, 320-6. https://doi.org/10.1002/bjs.5622
  9. Lee WC, Chen MF (2005). Assessment of hepatic reserve for indication of hepatic resection: how I do it. J Hepatobiliary Pancreat Surg, 12, 23-6. https://doi.org/10.1007/s00534-004-0947-y
  10. Lodge JP (2005). Assessment of hepatic reserve for the indication of hepatic resection: how I do it. J Hepatobiliary Pancreat Surg, 12, 4-9. https://doi.org/10.1007/s00534-004-0948-x
  11. Luccichenti G, Cademartiri F, Cobelli R, Pavone P (2003). Assessment of organ volume with different techniques using a living liver model. Eur Radiol, 13, 1286-90.
  12. Muller SA, Blauer K, Kremer M, et al (2010). Exact CT-based liver volume calculation including nonmetabolic liver tissue in three-dimensional liver reconstruction. J Surg Res, 160, 236-43. https://doi.org/10.1016/j.jss.2009.04.050
  13. Numminen K, Sipila O, Makisalo H (2005). Preoperative hepatic 3D models: virtual liver resection using three-dimensional imaging technique. Eur J Radiol, 56, 179-84. https://doi.org/10.1016/j.ejrad.2005.03.021
  14. Pomposelli JJ, Tongyoo A, Wald C, Pomfret EA (2012). Variability of standard liver volume estimation versus software-assisted total liver volume measurement. Liver Transpl, 18, 1083-92. https://doi.org/10.1002/lt.23461
  15. Satio S, Yamanaka J, Miura K, et al (2005). A novel 3D hepatectomy simulation based on liver circulation: application to liver resection and transplantation. Hepatology, 41, 1297-304. https://doi.org/10.1002/hep.20684
  16. Schindl MJ, Redhead DN, Fearon KC, et al (2005). The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut, 54, 289-96. https://doi.org/10.1136/gut.2004.046524
  17. Schroeder T, Radtke A, Kuehl H, et al (2006). Evaluation of living liver donors with an all-inclusive 3D multi-detector row CT protocol. Radiology, 238, 900-10. https://doi.org/10.1148/radiol.2382050133
  18. Shirabe K, Shimada M, Gion T, et al (1999). Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg, 188, 304-9. https://doi.org/10.1016/S1072-7515(98)00301-9
  19. Shoup M, Gonen M D, Angelica M, et al (2003). Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg, 7, 325-30. https://doi.org/10.1016/S1091-255X(02)00370-0
  20. Suda K, Ohtsuka M, Ambiru S, et al (2009). Risk factors of liver dysfunction after extended hepatic resection in biliary tract malignancies. Am J Surg, 197, 752-8. https://doi.org/10.1016/j.amjsurg.2008.05.007
  21. Suman A, Carey WD (2006). Assessing the risk of surgery in patients with liver disease. Cleve Clin J Med, 73, 398-404. https://doi.org/10.3949/ccjm.73.4.398
  22. Taniai N, Yoshida H, Tajiri T (2008). Adaptation of hepatectomy for huge hepatocellular carcinoma. J Hepatobiliary Pancreat Surg, 15, 410-6. https://doi.org/10.1007/s00534-007-1317-3
  23. Tong C, Xu X, Liu C, Zhang T, Qu K (2012). Assessment of liver volume variation to evaluate liver function. Front Med, 6, 421-7. https://doi.org/10.1007/s11684-012-0223-5
  24. Torkzad MR, Noren A, Kullberg J (2012). Stereology: a novel technique for rapid assessment of liver volume. Insights Imaging, 3, 387-93. https://doi.org/10.1007/s13244-012-0166-z
  25. Tu R, Xia LP, Yu AL, Wu L (2007). Assessment of hepatic functional reserve by cirrhosis grading and liver volume measurement using CT. World J Gastroenterol, 13, 3956-61. https://doi.org/10.3748/wjg.v13.i29.3956

Cited by

  1. Importance of Volumetric Measurement Processes in Oncology Imaging Trials for Screening and Evaluation of Tumors as Per Response Evaluation Criteria in Solid Tumors vol.15, pp.5, 2014, https://doi.org/10.7314/APJCP.2014.15.5.2375
  2. Diagnosis and Therapy of Primary Hepatic Neuroendocrine Carcinoma: Clinical Analysis of 10 Cases vol.15, pp.6, 2014, https://doi.org/10.7314/APJCP.2014.15.6.2541
  3. Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis vol.21, pp.35, 2015, https://doi.org/10.3748/wjg.v21.i35.10200