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肝脏容积测量:影像学检查是否可靠?个人经验及文献综述

Liver volumetry: Is imaging reliable? Personal experience and review of the literature.

作者信息

D'Onofrio Mirko, De Robertis Riccardo, Demozzi Emanuele, Crosara Stefano, Canestrini Stefano, Pozzi Mucelli Roberto

机构信息

Mirko D'Onofrio, Riccardo De Robertis, Emanuele Demozzi, Stefano Crosara, Stefano Canestrini, Roberto Pozzi Mucelli, Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy.

出版信息

World J Radiol. 2014 Apr 28;6(4):62-71. doi: 10.4329/wjr.v6.i4.62.

Abstract

The amount of the future liver remnant volume is fundamental for hepato-biliary surgery, representing an important potential risk-factor for the development of post-hepatectomy liver failure. Despite this, there is no uniform consensus about the amount of hepatic parenchyma that can be safely resected, nor about the modality that should be chosen for this evaluation. The pre-operative evaluation of hepatic volume, along with a precise identification of vascular and biliar anatomy and variants, are therefore necessary to reduce surgical complications, especially for extensive resections. Some studies have tried to validate imaging methods [ultrasound, computed tomography (CT), magnetic resonance imaging] for the assessment of liver volume, but there is no clear evidence about the most accurate method for this evaluation. Furthermore, this volumetric evaluation seems to have a certain degree of error, tending to overestimate the actual hepatic volume, therefore some conversion factors, which should give a more reliable evaluation of liver volume, have been proposed. It is widespread among non-radiologists the use of independent software for an off-site volumetric analysis, performed on digital imaging and communications in medicine images with their own personal computer, but very few studies have provided a validation of these methods. Moreover, while the pre-transplantation volumetric assessment is fundamental, it remains unclear whether it should be routinely performed in all patients undergoing liver resection. In this editorial the role of imaging in the estimation of liver volume is discussed, providing a review of the most recent literature and a brief personal series of correlations between liver volumes and resection specimens' weight, in order to assess the precision of the volumetric CT evaluation.

摘要

未来肝脏剩余体积的量对于肝胆外科手术至关重要,是肝切除术后肝衰竭发生的一个重要潜在风险因素。尽管如此,对于可安全切除的肝实质量,以及对此评估应选择何种方式,尚无统一共识。因此,术前评估肝脏体积,以及精确识别血管和胆管的解剖结构及变异,对于减少手术并发症是必要的,尤其是对于广泛切除手术。一些研究试图验证成像方法[超声、计算机断层扫描(CT)、磁共振成像]用于评估肝脏体积,但对于哪种评估方法最准确尚无明确证据。此外,这种体积评估似乎存在一定程度的误差,倾向于高估实际肝脏体积,因此有人提出了一些转换因子,以期对肝脏体积进行更可靠的评估。非放射科医生广泛使用独立软件在个人电脑上对医学数字成像和通信图像进行异地体积分析,但很少有研究对这些方法进行验证。此外,虽然移植前的体积评估至关重要,但对于所有接受肝切除的患者是否都应常规进行仍不清楚。在这篇社论中,我们讨论了成像在肝脏体积估计中的作用,回顾了最新文献,并简要介绍了个人关于肝脏体积与切除标本重量之间相关性的系列研究,以评估CT体积评估的准确性。

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