Review of the nomenclature of the liver anatomical and functional areas by three-dimensional volume rendering 64-multislice computed tomography. Proposal for an update of the terminology.

Abstract

In the last centuries, the anatomy of the liver has been the object of increasing interest. The International Anatomical Terminology tries to unify the terminology of liver anatomy, making it a living language. A single, worldwide-accepted classification of the liver still does not exist. In fact, definition of segments according to Couinaud's nomenclature is different from that of Goldsmith and Woodburne. The aim of this paper was to revise the liver topography by 64-Multislice Computed Tomography, in patients who had undergone repair of cholelithiasis, starting from classifications based on the efferent venous system or on the Glissonian system. This technique allows to remove virtually the liver parenchyma, and, together with the subsequent three-dimensional reconstruction of images, represents the best tool to visualise the hepatic ducts and segments. Through this approach, we propose a new terminology, which considers the liver divided into five lobes and seven segments plus one caudate lobe. In conclusion, this paper can represent a working hypothesis for a possible and future revision of the nomenclature of the hepatic functional territories and can be useful for clinical and didactic aims.