活体亲属肝移植中移植物大小估计的准确性：CT容积测量半自动交互式软件的初步结果
Accuracy of estimation of graft size for living-related liver transplantation: first results of a semi-automated interactive software for CT-volumetry.
作者信息
Mokry Theresa, Bellemann Nadine, Müller Dirk, Lorenzo Bermejo Justo, Klauß Miriam, Stampfl Ulrike, Radeleff Boris, Schemmer Peter, Kauczor Hans-Ulrich, Sommer Christof-Matthias
机构信息
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
Philips Healthcare Germany, Hamburg, Germany.
出版信息
PLoS One. 2014 Oct 17;9(10):e110201. doi: 10.1371/journal.pone.0110201. eCollection 2014.
OBJECTIVES
To evaluate accuracy of estimated graft size for living-related liver transplantation using a semi-automated interactive software for CT-volumetry.
MATERIALS AND METHODS
Sixteen donors for living-related liver transplantation (11 male; mean age: 38.2±9.6 years) underwent contrast-enhanced CT prior to graft removal. CT-volumetry was performed using a semi-automated interactive software (P), and compared with a manual commercial software (TR). For P, liver volumes were provided either with or without vessels. For TR, liver volumes were provided always with vessels. Intraoperative weight served as reference standard. Major study goals included analyses of volumes using absolute numbers, linear regression analyses and inter-observer agreements. Minor study goals included the description of the software workflow: degree of manual correction, speed for completion, and overall intuitiveness using five-point Likert scales: 1--markedly lower/faster/higher for P compared with TR, 2--slightly lower/faster/higher for P compared with TR, 3--identical for P and TR, 4--slightly lower/faster/higher for TR compared with P, and 5--markedly lower/faster/higher for TR compared with P.
RESULTS
Liver segments II/III, II-IV and V-VIII served in 6, 3, and 7 donors as transplanted liver segments. Volumes were 642.9±368.8 ml for TR with vessels, 623.8±349.1 ml for P with vessels, and 605.2±345.8 ml for P without vessels (P<0.01). Regression equations between intraoperative weights and volumes were y = 0.94x+30.1 (R2 = 0.92; P<0.001) for TR with vessels, y = 1.00x+12.0 (R2 = 0.92; P<0.001) for P with vessels, and y = 1.01x+28.0 (R2 = 0.92; P<0.001) for P without vessels. Inter-observer agreement showed a bias of 1.8 ml for TR with vessels, 5.4 ml for P with vessels, and 4.6 ml for P without vessels. For the degree of manual correction, speed for completion and overall intuitiveness, scale values were 2.6±0.8, 2.4±0.5 and 2.
CONCLUSIONS
CT-volumetry performed with P can predict accurately graft size for living-related liver transplantation while improving workflow compared with TR.
目的
使用半自动交互式软件进行CT容积测量，评估活体肝移植中预估移植物大小的准确性。
材料与方法
16例活体肝移植供体（11例男性；平均年龄：38.2±9.6岁）在移除移植物前接受了增强CT检查。使用半自动交互式软件（P）进行CT容积测量，并与手动商业软件（TR）进行比较。对于P软件，肝容积测量时包含或不包含血管。对于TR软件，肝容积测量时始终包含血管。术中重量作为参考标准。主要研究目标包括使用绝对数值分析容积、线性回归分析以及观察者间一致性分析。次要研究目标包括描述软件工作流程：手动校正程度、完成速度以及使用五点李克特量表评估整体直观性：1——与TR相比，P明显更低/更快/更高；2——与TR相比，P略低/更快/更高；3——P和TR相同；4——与P相比，TR略低/更快/更高；5——与P相比，TR明显更低/更快/更高。
结果
6例、3例和7例供体的肝段II/III、II-IV和V-VIII用作移植肝段。TR测量包含血管时的肝容积为642.9±368.8 ml，P测量包含血管时为623.8±349.1 ml，P测量不包含血管时为605.2±345.8 ml（P<0.01）。TR测量包含血管时术中重量与容积的回归方程为y = 0.94x + 30.1（R2 = 0.92；P<0.001），P测量包含血管时为y = 1.00x + 12.0（R2 = 0.92；P<0.001），P测量不包含血管时为y = 1.01x + 28.0（R2 = 0.92；P<0.001）。观察者间一致性显示，TR测量包含血管时偏差为1.8 ml，P测量包含血管时为5.4 ml，P测量不包含血管时为4.6 ml。对于手动校正程度、完成速度和整体直观性，量表值分别为2.6±0.8、2.4±0.5和2。
结论
与TR相比，使用P软件进行CT容积测量能够准确预测活体肝移植的移植物大小，同时改善工作流程。
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