活体肝移植中移植物体积的三维容积评估：它能将估计误差降至最低吗？
Three-Dimensional Volumetric Assessment of Graft Volume in Living Donor Liver Transplantation: Does It Minimise Errors of Estimation?
作者信息
Mohapatra Nihar, Gurumoorthy Subramanya Bharathy Kishore, Kumar Sinha Piyush, Vasantrao Sasturkar Shridhar, Patidar Yashwant, Pamecha Viniyendra
机构信息
Department of HPB Surgery and Liver Transplantation Institute of Liver and Biliary Sciences New Delhi, 70, India.
Department of Radiology Institute of Liver and Biliary Sciences New Delhi, 70, India.
出版信息
J Clin Exp Hepatol. 2020 Jan-Feb;10(1):1-8. doi: 10.1016/j.jceh.2019.03.006. Epub 2019 Mar 26.
BACKGROUND
Accurate volumetric assessment of graft and remnant liver is essential in living donor liver transplantation (LDLT) for optimal clinical outcome in both donors and recipients. Recently, three-dimensional (3D) volumetry is proposed over conventional computed tomography (CT) volumetry to minimise errors. The aim of this study is to assess the correlation of estimated graft volume (EGV) by both the methods with actual graft weight (AGW).
METHODS
One hundred fifty-four consecutive donors were enrolled prospectively. Conventional CT volumetry (semiautomatic) and 3D volumetry were performed using Myrian software. Total liver volume (TLV), EGV, and remnant liver volume (RLV) were assessed using both methods and correlated with intraoperatively measured AGW as the reference standard. Error of estimation was calculated accordingly.
RESULTS
One hundred eighteen donors underwent right hepatectomy excluding middle hepatic vein (MHV), twenty-nine donors had left hepatectomy including MHV and six donors underwent left lateral sectionectomy. The median EGV on CT and 3D volumetry was 628.5 ml (140-1300) and 634.5 ml (156-1349), respectively. The median AGW was 647 gm (200-1004). Both CT and 3D volumetry showed strong correlation with AGW (correlation coefficients: 0.834 and 0.856, respectively). Linear correlation is as follows: (a) AGW = 99.75 + 0.818 × EGV (CT) and (b) AGW = 96.03 + 0.835 × EGV (3D). The mean percentage error for CT and 3D volumetry was 14.2 ± 12.5% and 12.2 ± 11.8%, respectively. The overall accuracy of estimation of EGV improved using 3D software (=0.015). For the subgroup of types of graft, the difference did not reach statistical significance (=0.062, 0.214 and 0.463 for right, left and left lateral grafts, respectively).
CONCLUSION
Both conventional CT and 3D volumetric methods strongly correlate with AGW in donors of LDLT, whereas overall accuracy of estimation of graft weight improved marginally by 3D volumetry.
背景
在活体肝移植（LDLT）中，准确评估移植物和残余肝脏的体积对于供体和受体获得最佳临床结局至关重要。最近，有人提出采用三维（3D）容积测量法取代传统的计算机断层扫描（CT）容积测量法，以尽量减少误差。本研究旨在评估两种方法估算的移植物体积（EGV）与实际移植物重量（AGW）之间的相关性。
方法
前瞻性纳入154例连续的供体。使用Myrian软件进行传统CT容积测量（半自动）和3D容积测量。采用两种方法评估全肝体积（TLV）、EGV和残余肝体积（RLV），并将其与术中测量的AGW作为参考标准进行相关性分析。据此计算估计误差。
结果
118例供体接受了不包括肝中静脉（MHV）的右肝切除术，29例供体接受了包括MHV的左肝切除术，6例供体接受了左外叶切除术。CT和3D容积测量法测得的EGV中位数分别为628.5 ml（140 - 1300）和634.5 ml（156 - 1349）。AGW中位数为647 g（200 - 1004）。CT和3D容积测量法与AGW均显示出强相关性（相关系数分别为0.834和0.856）。线性相关性如下：（a）AGW = 99.75 + 0.818×EGV（CT）；（b）AGW = 96.03 + 0.835×EGV（3D）。CT和3D容积测量法的平均百分比误差分别为14.2±12.5%和12.2±11.8%。使用3D软件时EGV估计的总体准确性有所提高（=0.015）。对于移植物类型的亚组，差异未达到统计学意义（右、左和左外侧移植物分别为=0.062、0.214和0.463）。
结论
在LDLT供体中，传统CT和3D容积测量方法与AGW均具有强相关性，而3D容积测量法对移植物重量估计的总体准确性略有提高。
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