3D-Elaboration of postoperative CT data after liver resection: technique and utility

Abstract

3D reconstructions of CT data permit precise planning of liver surgery. To analyze the realisation of surgical plans 3D reconstructed postoperative CT data were evaluated. Pre- and postoperative CT data were analyzed on a series of 15 liver resections (2 hemihepatectomies and 13 segmental resections) by 3D reconstruction of portal and hepatic veins. Virtual surgical resection plans were compared with 3D reconstructed postoperative CT data and clinical data. Pre- and postoperative CT data as the basis for subsequent processing were of comparable quality. Detailed elaboration of data could be realized with an overall data processing and analyzation time of 120 min. The best correlation between calculated and actually measured liver resection volume was obtained by intersection volumes of portal and hepatic veins (k = 0.828, P < 0.000). However, portal and hepatic vein analysis revealed 9 and 12% of liver parenchyma with unplanned resection and 5 and 1% of unplanned residual tissue. No correlation with clinical data was found in this series. Volume calculation without consideration of vascular anatomy is less suited for precise assessment of surgical plan implementation in our study. Comparison of pre- and postoperative vascular structures with the aid of three-dimensionally reconstructed CT data is feasible. Unplanned resected and remained liver tissue can be identified. However, its clinical meaning for quantitative analysis of surgical plan implementation is questionable and should be investigated in larger series.