Measurement Of Liver Volume Research Articles

Predicting liver function after hemihepatectomy in patients with hepatocellular carcinoma using different modalities.

In response to Dr. Yue et al's study on prognostic factors for post-hemihepatectomy outcomes in hepatocellular carcinoma (HCC) patients, this critical review identifies methodological limitations and proposes enhancements for future research. While the study identifies liver stiffness measure and standard residual liver volume as potential predictors, concerns regarding small sample size, reliance on biochemical markers for safety assessment, and inadequate adjustment for confounding variables are raised. Recommendations for rigorous methodology, including robust statistical analysis, consideration of confounding factors, and selection of outcome measures with clinical components, are proposed to strengthen prognostic assessments. Furthermore, validation of novel evaluation models is crucial for enhancing clinical applicability and advancing understanding of postoperative outcomes in patients with HCC undergoing hemihepatectomy.

Deep learning-based liver cyst segmentation in MRI for autosomal dominant polycystic kidney disease

Abstract Background Autosomal dominant polycystic kidney disease (ADPKD) can lead to polycystic liver disease (PLD), characterized by liver cysts. Although majority of the patients are asymptomatic, massively enlarged liver secondary to PLD can cause discomfort, and compression on adjacent structures requiring cyst aspiration/fenestration, partial liver resection, or liver transplantation. Monitoring PLD by measuring liver volume fails to track the early stages when liver cyst volume is too small to affect liver volume. Purpose To improve PLD assessment in the early stages by automating detection and segmentation of liver cysts using deep learning (DL) models. Materials and Methods A self-configured UNet-based platform (nnU-Net) was trained with 40 ADPKD subjects with liver cysts annotated by a radiologist. Internal (n = 7), External (n = 10), and test-retest reproducibility (n = 17) validations included macro- and micro-level performance metrics: patient-level Dice scores (PDice), along with voxel-level true positive rates (VTPR), as well as analysis of time saved in a model-assisted scenario. Additionally, we assessed human-level reliability in liver cyst segmentation and evaluated the model’s test-retest reproducibility. We further compared liver volume vs cyst volume for tracking disease in a subject with 16+ years follow-up. Results The model achieved an 82% ± 11% PDice and a 75% ± 15% VTPR on the internal test sets (n = 7 patients), and 80% ± 12% Dice score and a 91% ± 7% VTPR on the external test sets (n = 10 patients). It excelled particularly in detecting small liver cysts, a challenging task for manual annotation. This efficiency translated to a median of 91% (IQR: 14%) reduction in annotation time compared to manual labeling. Test-retest assessment demonstrated excellent reproducibility, with coefficients of variation of 94% for liver cyst fraction and 92% for cyst count. Conclusion DL automation of liver cyst segmentations demonstrates potential to improve tracking of liver cyst volume in polycystic liver disease.

Post mortem analysis of hepatic volume and lipid content by magnetic resonance imaging and spectroscopy in fixed murine neonates.

Maternal obesity and hyperglycemia are linked to an elevated risk for obesity, diabetes, and steatotic liver disease in the adult offspring. To establish and validate a noninvasive workflow for perinatal metabolic phenotyping, fixed neonates of common mouse strains were analyzed postmortem via magnetic resonance imaging (MRI)/magnetic resonance spectroscopy (MRS) to assess liver volume and hepatic lipid (HL) content. The key advantage of nondestructive MRI/MRS analysis is the possibility of further tissue analyses, such as immunohistochemistry, RNA extraction, and even proteomics, maximizing the data that can be gained per individual and therefore facilitating comprehensive correlation analyses. This study employed an MRI and 1H-MRS workflow to measure liver volume and HL content in 65 paraformaldehyde-fixed murine neonates at 11.7 T. Liver volume was obtained using semiautomatic segmentation of MRI acquired by a RARE sequence with 0.5-mm slice thickness. HL content was measured by a STEAM sequence, applied with and without water suppression. T1 and T2 relaxation times of lipids and water were measured for respective correction of signal intensity. The HL content, given as CH2/(CH2+ H2O), was calculated, and the intrasession repeatability of the method was tested. The established workflow yielded robust results with a variation of ~3% in repeated measurements for HL content determination. HL content measurements were further validated by correlation analysis with biochemically assessed triglyceride contents (R2= 0.795) that were measured in littermates. In addition, image quality also allowed quantification of subcutaneous adipose tissue and stomach diameter. The highest HL content was measured in C57Bl/6N (4.2%) and the largest liver volume and stomach diameter in CBA (53.1 mm3 and 6.73 mm) and NMRI (51.4 mm3 and 5.96 mm) neonates, which also had the most subcutaneous adipose tissue. The observed effects were independent of sex and litter size. In conclusion, we have successfully tested and validated a robust MRI/MRS workflow that allows assessment of morphology and HL content and further enables paraformaldehyde-fixed tissue-compatible subsequent analyses in murine neonates.

Body Weight as a Preferred Method for Normalizing the Computed Tomography-Derived Liver Volume in Dogs without Hepatic Disease.

The assessment of liver size is usually performed using radiography in dogs. However, due to wide variations in patients' sizes and body conformations, accurate diagnosis of hepatomegaly or microhepatia is difficult. Computed tomographic (CT) volumetry can quantitatively and accurately measure liver volume. However, a reliable method for the standardization or normalization of volume in dogs without hepatic disease using CT has not yet been established. The purpose of this study was to assess seven different anatomic measures for normalizing liver volume in dogs and determine the tentative range of liver volume in dogs without hepatic disease. We retrospectively searched medical records from 1 January 2017 through to 1 June 2020 and included dogs with abdominal computed tomography without hepatic disease. The liver volume, lengths of four vertebrae (T11, T12, L2, L3), diameter of the abdominal aorta, body weight, and body condition scores (BCSs) of the dogs were recorded. Forty-one client-owned dogs without evidence of hepatic disease were included. The CT-derived liver volume was 813.8 ± 326.5 cm3 (mean ± SD). Body weight was determined to be the most reliable single-variable method for normalizing liver volume, with a raw CT-derived liver-volume-to-body-weight ratio of 22.1 cm3/kg (95% CI: 12.9-31.3 cm3/kg) and regression prediction model of volume = 19 × BWkg + 97. However, a better normalizing factor would likely be provided by the fat-free mass if it can be accurately measured.

A nomogram for predicting prognosis in patients with transjugular intrahepatic portosystemic shunt creation based on deep learning-derived spleen volume-to-platelet ratio.

The objective of our study was to develop a nomogram to predict post-transjugular intrahepatic portosystemic shunt (TIPS) survival in patients with cirrhosis based on CT images. This retrospective cohort study included patients who had received TIPS operation at the Wenzhou Medical University First Affiliated Hospital between November 2013 and April 2017. To predict prognosis, a nomogram and Web-based probability were developed to assess the overall survival (OS) rates at 1, 3, and 5 years based on multivariate analyses. With deep learning algorithm, the automated measurement of liver and spleen volumes can be realized. We assessed the predictive accuracy and discriminative ability of the nomogram using the concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Age, total bilirubin, and spleen volume-to-platelet ratio (SVPR) were identified as the independent risk factors for OS. The nomogram was constructed based on the above risk factors. The C-index (0.80, 0.74, 0.70), ROC curve (area under curve: 0.828, 0.761, 0.729), calibration curve, and DCA showed that nomogram good at predictive value, stability, and clinical benefit in the prediction of 1-, 3-, 5-year OS in patients with TIPS creation. We constructed a nomogram for predicting prognosis in patients with TIPS creation based on risk factors. The nomogram can help clinicians in identifying patients with poor prognosis, eventually facilitating earlier treatment and selecting suitable patients before TIPS. This study developed the first nomogram based on SVPR to predict the prognosis of patients treated with TIPS. The nomogram could help clinician in non-invasive decision-making.

Assessment of liver function by gadoxetic acid avidity in MRI in a model of rapid liver regeneration in rats

BackgroundThis animal study investigates the hypothesis of an immature liver growth following ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) by measuring liver volume and function using gadoxetic acid avidity in magnetic resonance imaging (MRI) in models of ALPPS, major liver resection (LR) and portal vein ligation (PVL). MethodsWistar rats were randomly allocated to ALPPS, LR or PVL. In contrast-enhanced MRI scans with gadoxetic acid (Primovist®), liver volume and function of the right median lobe (=future liver remnant, FLR) and the deportalized lobes (DPL) were assessed until post-operative day (POD) 5. Liver functionFLR/DPL was defined as the inverse value of time from injection of gadoxetic acid to the blood pool-corrected maximum signal intensityFLR/DPL multiplied by the volumeFLR/DPL. ResultsIn ALPPS (n = 6), LR (n = 6) and PVL (n = 6), volumeFLR and functionFLR increased proportionally, except on POD 1. Thereafter, functionFLR exceeded volumeFLR increase in LR and ALPPS, but not in PVL. Total liver function was significantly reduced after LR until POD 3, but never undercuts 60% of its pre-operative value following ALPPS and PVL. DiscussionThis study shows for the first time that functional increase is proportional to volume increase in ALPPS using gadoxetic acid avidity in MRI.

The effect of hepatic steatosis on liver volume determined by proton density fat fraction and deep learning-measured liver volume.

We aimed to evaluate the effect of hepatic steatosis (HS) on liver volume and to develop a formula to estimate lean liver volume correcting the HS effect. This retrospective study included healthy adult liver donors who underwent gadoxetic acid-enhanced MRI and proton density fat fraction (PDFF) measurement from 2015 to 2019. The degree of HS was graded at 5% PDFF intervals from grade 0 (no HS; PDFF < 5.5%). Liver volume was measured with hepatobiliary phase MRI using deep learning algorithm, and standard liver volume (SLV) was calculated as the reference lean liver volume. The association between liver volume and SLV ratio with PDFF grades was evaluated using Spearman's correlation (ρ). The effect of PDFF grades on liver volume was evaluated using the multivariable linear regression model. The study population included 1038 donors (mean age, 31 ± 9years; 689 men). Mean liver volume to SLV ratio increased according to PDFF grades (ρ = 0.234, p < 0.001). The multivariable analysis indicated that SLV (β = 1.004, p < 0.001) and PDFF grade*SLV (β = 0.044, p < 0.001) independently affected liver volume, suggesting a 4.4% increase in liver volume per one-point increment in the PDFF grade. PDFF-adjusted lean liver volume was estimated using the formula, liver volume/[1.004 + 0.044 × PDFF grade]. The mean estimated lean liver volume to SLV ratio approximated to one for all PDFF grades, with no significant association with PDFF grades (p = 0.851). HS increases liver volume. The formula to estimate lean liver volume may be useful to adjust for the effect of HS on liver volume. • Hepatic steatosis increases liver volume. • The presented formula to estimate lean liver volume using MRI-measured proton density fat fraction and liver volume may be useful to adjust for the effect of hepatic steatosis on measured liver volume.

Research Progress of Deep Learning in Liver Semantic Segmentation and Volume Measurement Based on Medical Image

Research Progress of Deep Learning in Liver Semantic Segmentation and Volume Measurement Based on Medical Image

Creation of 3D Stereo and MPR Color Anatomical Charts in the Hepatic Segments

We used the Voronoi diagram of a computed tomography (CT) application (i.e., CT liver volume measurement) to depict the liver area, and we obtained depictions of the hepatic segments as a three-dimensional (3D) image based on clinical data; this information can be used for the patient's education and for surgical planning. The hepatic segments use the inter-relationships among the eight subsegments illustrated by Couinaud, those indicated by the portal veins and those provided by hepatic veins. The liver has dual portal and arterial innervation, with the thick portal vein intertwined with thin arteries similar to the intertwining of ivy plants. Couinaud divided the liver into eight segments (S1 to S8) based on portal vein casts. The Voronoi diagram estimates the dominant region of the portal vein, divides the liver into segments, and produces 3D images and multiplanar reconstruction (MPR) images in color. To support understanding of Couinaud's eight hepatic segments (which are explained only in the illustration of the frontal view of the liver), using 3D images created by the Voronoi diagram, we created 3D stereo color anatomical charts of the liver that Couinaud's eight hepatic segments can be confirmed from multiple directions. In addition, we created the MPR color anatomical charts of the liver (S1 to S8) that can be confirmed by color from three directions: axial images, coronal images, and sagittal images in the same way. We converted the data of this anatomical chart into an electronic file that provides a tool that can be easily used in radiological examinations, and we were able to make improvements based on requests from users.

CT-derived liver and spleen volume accurately diagnose clinically significant portal hypertension in patients with hepatocellular carcinoma

Clinically significant portal hypertension (CSPH) is a landmark in the natural history of cirrhosis, influencing clinical decisions in patients with hepatocellular carcinoma (HCC). Previous small series suggested that splanchnic volume measurements may predict portal hypertension. We aimed to evaluate whether volumetry obtained by standard multidetector computerised tomography (MDCT) can predict CSPH in patients with HCC. We included 175 patients with HCC, referred for hepatic venous pressure gradient (HVPG) evaluation, in whom contemporary MDCT was available. Liver volume, spleen volume (SV) and liver segmental volume ratio (LSVR: volume of the segments I-III/volume of the segments IV-VIII) were calculated semi-automatically from MDCT. Other non-invasive tests (NITs) were also employed. Volume parameters could be measured in almost 100% of cases with an excellent inter-observer agreement (intraclass correlation coefficient >0.950). SV and LSVR were independently associated with CSPH (HVPG ≥10mmHg) and did not interact with aetiology. The volume Index (VI), calculated as the product of SV and LSVR, predicted CSPH (AUC 0.83; 95% CI 0.77-0.89). Similar results were observed in an external cohort (n= 23) (AUC 0.87; 95% CI 0.69-1.00). Setting a sensitivity and specificity of 98%, VI could have avoided 35.9% of HVPG measurements. The accuracy of VI was similar to that of other NITs. VI also accurately predicted HVPG greater than 12, 14, 16 and 18mmHg (AUC 0.81 [95% CI 0.74-0.88], 0.84 [95% CI 0.77-0.91], 0.85 [95% CI 0.77-0.92] and 0.87 [95% CI 0.79-0.94], respectively). Quantification of liver and spleen volumes by MDCT is a simple, accurate and reliable method of CSPH estimation in patients with compensated cirrhosis and HCC. An increase in portal pressure strongly impacts outcomes after surgery in patients with early hepatocellular carcinoma (HCC). Direct measurement through hepatic vein catheterization remains the reference standard for portal pressure assessment, but its invasiveness limits its application. Therefore, we evaluated the ability of CT scan-based liver and spleen volume measurements to predict portal hypertension in patients with HCC. Our results indicate that the newly described index, based on quantification of liver and spleen volume, accurately predicts portal hypertension. These results suggest that a single imaging test may be used to diagnose and stage HCC, while providing an accurate estimation of portal hypertension, thus helping to stratify surgical risks.

Impact of Preoperative Protein Sparing Modified Fast Diet on Bariatric Surgery.

Bariatric surgery can become technically challenging in the setting of liver steatosis and hepatomegaly. The protein sparing modified fast (PSMF) diet helps in achieving rapid weight loss. The aim of this study is to explore the results of a preoperative PSMF diet on liver volume and steatosis as well as on intraoperative and postoperative complications in patients with hepatomegaly undergoing Roux-en-Y gastric bypass (RYGB). Between January 2010 and January 2021, 713 patients undergoing RYGB as a primary bariatric surgery were divided in two groups. Those with a measured liver length above 16cm and or evidence of liver steatosis on ultrasound (group 1) were offered a preoperative PSMF diet while the remaining (group 2) proceeded directly to surgery. Between January 2010 and April 2012, patients included in group 1 had liver volume measurements on magnetic resonance imaging the day before the diet was started and the day before the surgery. For the length of the study, intraoperative and postoperative data were recorded for both groups. Five days of preoperative PSMF diet resulted in a significant reduction of total and left liver volume (15.8% and 21% respectively, p < 0.001). There was no difference in intraoperative bleeding and conversion rate or postoperative complication rate between both groups. The PSMF diet helps in achieving a rapid decrease in liver volume. Patients with hepatomegaly initially thought to be at a higher risk of intraoperative complications reached comparable rates to patients without hepatomegaly after the diet regimen without any impact on the postoperative course.

Liver Volumetry를 위한 Deep Residual U-Net의 모델 복잡성

Computed Tomography (CT) has been used for liver volume measurement because of the highest location accuracy. Automated segmentation methods may improve CT volumetry time, but it has low accuracy. Residual U-Net which is one of the deep learning methods could improve segmentation accuracy. However optimization of residual U-Net hasn’t been demonstrated yet. The purpose of this paper is to investigate the optimal complexity for CT liver volumetry. The study was conducted using the 3D-IRCADb01 Datasets (10 males, 10 females) published by MIS Training Center, 15 people learned and 5 people tested. Segmented images were generated using Deep Residual U-Nets with a total of four different complexity. As a result, as the model became more complex, the total parameters and training time increased exponentially. In all models, both training and testing showed more than 97% accuracy. All losses were less than 0.2. In the case of DCL, it was the lowest at 0.8037 in 3-layer and the highest at 0.9533 in 5-layer. In conclusion, 5 hidden layers of residual U-Net has the highest dice coefficient loss and could train the datasets faster than other complex models.

“ROLE OF FETAL MRI IN EVALUATION OF CONGENITAL ANOMALIES”

When US evaluation of the second and third-trimester foetus is limited, MR imaging might be used as a supplemental test. Due to a lack of an acceptable acoustic window, US is often limited in cases of oligohydramnios or breech presentation. In both cases, however, MR imaging can clearly show the foetal anatomy in detail. Ossification of the calvaria[1], which inhibits view of the posterior fossa at US, can also impede third trimester foetal assessment. US frequently suggests intracranial pathologic abnormalities such as posterior fossa anomalies (Chiari II syndrome, cerebellar aplasia or hypoplasia). MR imaging can corroborate the US findings, and it can also provide a diagnosis in some circumstances, such as neuronal migrational anomalies. MR imaging certainly has the advantage of being able to analyse the foetus in many planes within a greater field of view. T1-weighted MR imaging can show acute and chronic germinal matrix bleeding, as well as ischemia alterations. Although ultrasound is helpful in detecting corpus callosum abnormalities, it can miss many of the central nervous system problems associated with corpus callosum agenesis. Because the prognosis of agenesis of the corpus callosum is so unpredictable, detecting concomitant central system defects on MR imaging can help with prenatal and postnatal medical care. Although the majority of prenatal MR imaging applications are related to the cranial nervous system, new developments in foetal surgical intervention have expanded the utility of foetal MR imaging in thoracoabdominal illness detection. Fetal MR imaging can help diagnose abnormalities such congenital cystic adenomatoid malformation, congenital diaphragmatic hernia, cystic hygroma, and bronchopulmonary sequestration. Accurate assessment of foetal lung and liver sizes is critical in foetal surgical planning and postnatal prognosis in the case of congenital diaphragmatic hernia. Some high-risk pregnancies may also benefit from obstetric MR imaging, according to preliminary research. With a combination of foetal weight estimates and liver volume measurements, birth weight may be correctly predicted and the diagnosis of intrauterine growth retardation or macrosomia can be made with confidence.

What Is the Optimal Time on a Low-Calorie Diet Prior to Laparoscopic Anti-reflux Surgery? A Prospective Case-Controlled Study

IntroductionA very low-calorie diet (VLCD) or low-calorie diet (LCD) is often used prior to laparoscopic surgery to optimize access to the hiatus. Much debate exists in the literature regarding the required duration for a VLCD or LCD, and how to evaluate the presence of a fatty liver. The aim of our study was to determine the optimal amount of time on an LCD to achieve maximal liver volume reduction, and to assess the accuracy of the InBody 230® vs. bedside ultrasonography vs. magnetic resonance imaging (MRI) in the measurement of liver volume. MethodsSeventeen consecutive patients undergoing laparoscopic anti-reflux surgery were recruited into the study. Each patient underwent body composition analysis with the InBody® 230, liver ultrasound, and liver MRI. Patients then began an LCD with a weekly ultrasound assessment until the day before surgery when they underwent repeat body composition analysis, liver ultrasound, and MRI. ResultsThe mean age was 54 years (range 21, 74). Maximal liver volume loss was noted within 3 weeks for 88% of participants, with 47% achieving their maximal liver volume reduction after the first week of an LCD. The mean reduction in liver volume was 16%, 18.6%, and 19% for MRI, ultrasound, and body composition analysis, respectively. ConclusionClose to 90% of patients require 3 weeks or less on an LCD to achieve maximal liver volume loss prior to laparoscopic anti-reflux surgery. Body composition analysis and bedside ultrasonography were both as accurate as the gold standard MRI in the assessment of liver volume.

Comparison of automatic liver volumetry performance using different types of magnetic resonance images

Measurements of liver volume from MR images can be valuable for both clinical and research applications. Automated methods using convolutional neural networks have been used successfully for this using a variety of different MR image types as input. In this work, we sought to determine which types of magnetic resonance images give the best performance when used to train convolutional neural networks for liver segmentation and volumetry.Abdominal MRI scans were performed at 3 Tesla on 42 adolescents with obesity. Scans included Dixon imaging (giving water, fat, and T2* images) and low-resolution T2-weighted scout images. Multiple convolutional neural network models using a 3D U-Net architecture were trained with different input images. Whole-liver manual segmentations were used for reference. Segmentation performance was measured using the Dice similarity coefficient (DSC) and 95% Hausdorff distance. Liver volume accuracy was evaluated using bias, precision, intraclass correlation coefficient, normalized root mean square error (NRMSE), and Bland-Altman analyses.The models trained using both water and fat images performed best, giving DSC = 0.94 and NRMSE = 4.2%. Models trained without the water image as input all performed worse, including in participants with elevated liver fat. Models using the T2-weighted scout images underperformed the Dixon-based models, but provided acceptable performance (DSC ≥ 0.92, NMRSE ≤6.6%) for use in longitudinal pediatric obesity interventions. The model using Dixon water and fat images as input gave the best performance, with results comparable to inter-reader variability and state-of-the-art methods.

Protocol for a randomized controlled multicenter trial assessing the efficacy of leuprorelin for severe polycystic liver disease: the AGAINST-PLD study

BackgroundIn patients with severe polycystic liver disease (PLD), there is a need for new treatments. Estrogens and possibly other female sex hormones stimulate growth in PLD. In some patients, liver volume decreases after menopause. Female sex hormones could therefore be a target for therapy. The AGAINST-PLD study will examine the efficacy of the GnRH agonist leuprorelin, which blocks the production of estrogen and other sex hormones, to reduce liver growth in PLD.MethodsThe AGAINST-PLD study is an investigator-driven, multicenter, randomized controlled trial. Institutional review board (IRB) approval was received at the University Medical Center of Groningen and will be collected in other sites before opening these sites. Thirty-six female, pre-menopausal patients, with a very large liver volume for age (upper 10% of the PLD population) and ongoing liver growth despite current treatment options will be randomized to direct start of leuprorelin or to 18 months standard of care and delayed start of leuprorelin. Leuprorelin is given as 3.75 mg subcutaneously (s.c.) monthly for the first 3 months followed by 3-monthly depots of 11.25 mg s.c. The trial duration is 36 months. MRI scans to measure liver volume will be performed at screening, 6 months, 18 months, 24 months and 36 months. In addition, blood will be drawn, DEXA-scans will be performed and questionnaires will be collected. This design enables comparison between patients on study treatment and standard of care (first 18 months) and within patients before and during treatment (whole trial). Main outcome is annualized liver growth rate compared between standard of care and study treatment. Secondary outcomes are PLD disease severity, change in liver growth within individuals and (serious) adverse events. The study is designed as a prospective open-label study with blinded endpoint assessment (PROBE).DiscussionIn this trial, we combined the expertise of hepatologist, nephrologists and gynecologists to study the effect of leuprorelin on liver growth in PLD. In this way, we hope to stop liver growth, reduce symptoms and reduce the need for liver transplantation in severe PLD.Trial registration Eudra CT number 2020-005949-16, registered at 15 Dec 2020. https://www.clinicaltrialsregister.eu/ctr-search/search?query=2020-005949-16.

Let’s Measure the Liver Better: A Pilot Study Assessing Inter-Rater Reliability When Measuring the Liver Volume Using Sonography

Objective: When measuring the liver sonographically, liver volume measurement (LVM) is not routinely performed, though considered the gold standard on CT. The objective of this study is to encourage the sonography community to obtain an LVM instead of a single linear measurement on ultrasound, so as not to subject patients to the potentially harmful radiation exposure of a CT scan when assessing liver size. This study compared the consistency and accuracy between expert and novice sonographers in obtaining an LVM on sonography. Materials and Methods: Both groups obtained linear and LVM on 30 participants and calculated LVM using the formula Liver Volume (cc) = 343.71 + (0.84 × ABC). Results: Both groups took longer to obtain LVM than linear, P &lt; .0001. Novices and experts obtained an LVM in a similar amount of time. More consistency was observed among experts when scanning participants in the lower BMI ranges. Novice sonographers’ LVMs were consistent with experts’ only in the lowest BMI range of this study. Conclusion: Groups acquired LVM in similar amounts of time, showing LVM is easy to teach and learn, and has good inter-rater reliability. Difference for both groups to obtain LVM over linear was only 38 seconds. Consequently, it is prudent to incorporate LVM into abdominal ultrasound protocols.

Application of Stereology in Liver Volume Measurements Using Computed Tomography Scan

Application of Stereology in Liver Volume Measurements Using Computed Tomography Scan

Increase of Liver Function and Volume after ALPPS Determined by MRI in a Rat Model

Introduction: It has been hypothesized that rapid increase of liver volume after ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) is not accompanied by a proportional increase of function. This study uses a rat models of major liver resection (LR), ALPPS and portal vein ligation (PVL) to test this hypothesis by measuring liver volume and function with contrast-enhanced magnetic resonance imaging (MRI). Methods: Wistar rats (200-250g) were randomly allocated to LR, ALPPS or PVL. T1-weighted MRI scans (7.0T MR Solutions,Guildford,UK) were performed until postoperative day 5. Uptake kinetics (2D-FLASH;TR/TE=589/8) of Primovist® (1mmol/kg,Bayer AG,Berlin, Germany) were measured in the future liver remnant (FLR) and spleen (blood pool). Liver volume was assessed during the excretion phase (2D-FLASH;TR/TE=4150/11; thickness 1mm). Liver function of the FLR was defined as the inverse value of time [min] from injection of Primovist® to maximum signal intensity multiplied by respective volume of the FLR [ccm]. Results: Percent increase of FLR volume overestimates FLR function at day 1 in all three, ALPPS, LR and PVL. From day 2, function and volume of the FLR increase proportionally in all procedures (Figure 1). Percent increase of liver function exceeds liver volume from day 2 until day 5 in ALPPS and LR, but not in PVL. Conclusion: This animal study rejects the hypothesis that functional increase is not proportional to volume increase in ALPPS. While function is impaired on day 1, ALPPS leads to a congruent increase of volume and function after day 1, similar to LR.

Associations of liver volume and other markers of hepatic steatosis with all-cause mortality in the general population.

We examined the associations between liver volume and other quantitative and qualitative markers of hepatic steatosis with all-cause mortality in the general population. We included 2769 German middle-aged individuals with a median follow-up of 8.9years (23,898 person-years). Quantitative markers used were serum liver enzymes and FIB-4 score, while qualitative markers of hepatic steatosis included magnetic resonance imaging (MRI) measurements of liver fat content and total liver volume. Cox proportional hazards models, adjusted for confounding factors, were undertaken to investigate the associations of liver volume and other markers of hepatic steatosis with all-cause mortality. A larger MRI-assessed liver volume was associated with a nearly three-fold increased risk of all-cause mortality (Hazard Ratio=3.16; 95% confidence interval 1.88; 5.30), independent of age, sex, body mass index, food frequency score, alcohol consumption and education level. This association was consistent in all subgroups considered (men vs. women; presence or absence of overweight/obesity, metabolic syndrome or diabetes). Higher serum liver enzyme levels and FIB-4 score were also significantly associated with higher all-cause mortality in the total population and in all subgroups. No independent associations were found between other quantitative and qualitative markers of hepatic steatosis and the risk of all-cause mortality. We showed for the first time that larger liver volume was associated with a three-fold increase in long-term risk of all-cause mortality. This association remained significant after adjustment for age, sex, alcohol consumption, obesity and other coexisting metabolic disorders.