Abstract
Preoperative assessment of the liver volume and function of the remnant liver is a mandatory prerequisite before performing major hepatectomy. The aim of this work is to develop and test a software application for evaluation of the residual function of the liver prior to the intervention of the surgeons. For this purpose, a complete software platform consisting of three basic modules: liver volume segmentation, visualization, and virtual cutting, was developed and tested. Liver volume segmentation is based on a patient examination with non-contrast abdominal Computed Tomography (CT). The basis of the segmentation is a multiple seeded region growing algorithm adapted for use with CT images without contrast-enhancement. Virtual tumor resection is performed interactively by outlining the liver region on the CT images. The software application then processes the results to produce a three-dimensional (3D) image of the “resected” region. Finally, 3D rendering module provides possibility for easy and fast interpretation of the segmentation results. The visual outputs are accompanied with quantitative measures that further provide estimation of the residual liver function and based on them the surgeons could make a better decision. The developed system was tested and verified with twenty abdominal CT patient sets consisting of different numbers of tomographic images. Volumes, obtained by manual tracing of two surgeon experts, showed a mean relative difference of 4.5%. The application was used in a study that demonstrates the need and the added value of such a tool in practice and in education.
Highlights
Liver resection is related to surgical removal of a part of the liver due to liver or metastatic colorectal cancers
It has been shown that the incidence of severe hepatic dysfunction and infection following liver resection increased significantly with smaller percentage residual liver volume [2]
We developed, tested and installed a complete software platform with three basic modules: liver volume segmentation, virtual volume resection and 3D liver rendering
Summary
Liver resection is related to surgical removal of a part of the liver due to liver or metastatic colorectal cancers. Hepatic resection may be followed by various complications like rising of ascites, hepatic insufficiency, biliary fistula, hepatic abscess, hemoperitoneum and pleural effusion [1]. It has been shown that the incidence of severe hepatic dysfunction and infection following liver resection increased significantly with smaller percentage residual liver volume [2]. Among patients with normal liver, the limit for safe resection ranges from 20% to 30% future remnant liver of total liver volume [3]. Preoperative assessment of the liver volume and function of the remnant liver is a mandatory prerequisite before major hepatectomy. One approach is the manual liver segmentation comprised of manually tracing of the liver
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