Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA.
Department of Surgery, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
J Gastrointest Surg. 2018 Feb;22(2):344-360. doi: 10.1007/s11605-017-3562-3. Epub 2017 Sep 18.
Hepatic resection is performed for various benign and malignant liver tumors. Over the last several decades, there have been improvements in the surgical technique and postoperative care of patients undergoing liver surgery. Despite this, liver failure following an extended hepatic resection remains a critical potential postoperative complication. Patients with underlying parenchymal liver diseases are at particular risk of liver failure due to impaired liver regeneration with an associated mortality risk as high as 60 to 90%. In addition, live donor liver transplantation requires a thorough presurgical assessment of the donor liver to minimize the risk of postoperative complications.
Recently, cross-sectional imaging assessment of diffuse liver diseases has gained momentum due to its ability to provide both anatomical and functional assessments of normal and abnormal tissues. Various imaging techniques are being employed to assess diffuse liver diseases including magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound (US). MRI has the ability to detect abnormal intracellular and molecular processes and tissue architecture. CT has a high spatial resolution, while US provides real-time imaging, is inexpensive, and readily available. We herein review current state-of-the-art techniques to assess the underlying non-tumorous liver. Specifically, we summarize current approaches to evaluating diffuse liver diseases including fatty liver alcoholic or non-alcoholic (NAFLD, AFLD), hepatic fibrosis (HF), and iron deposition (ID) with a focus on advanced imaging techniques for non-invasive assessment along with their implications for patient management. In addition, the role of and techniques to assess hepatic volume in hepatic surgery are discussed.
肝切除术用于治疗各种良性和恶性肝脏肿瘤。在过去几十年中，肝外科手术的技术和术后护理都有所改进。尽管如此，广泛肝切除术后的肝功能衰竭仍然是一个潜在的严重术后并发症。由于肝再生受损，潜在的实质性肝病患者尤其容易发生肝功能衰竭，其相关死亡率高达 60%至 90%。此外，活体供肝移植需要对供肝进行彻底的术前评估，以最大限度地降低术后并发症的风险。
由于能够对正常和异常组织进行解剖学和功能评估，弥漫性肝脏疾病的横断面成像评估最近得到了重视。各种成像技术用于评估弥漫性肝脏疾病，包括磁共振成像（MRI）、计算机断层扫描（CT）和超声（US）。MRI 具有检测异常细胞内和分子过程以及组织结构的能力。CT 具有较高的空间分辨率，而 US 则提供实时成像，价格低廉且易于获得。我们在此综述了评估非肿瘤性肝脏的最新技术。具体而言，我们总结了目前评估弥漫性肝脏疾病的方法，包括脂肪肝（酒精性或非酒精性）（NAFLD、AFLD）、肝纤维化（HF）和铁沉积（ID），重点介绍了用于非侵入性评估的先进成像技术及其对患者管理的影响。此外，还讨论了肝切除术评估肝体积的作用和技术。
