Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea.
School of Computer Science and Engineering, Soongsil University, Seoul, Korea.
Abdom Radiol (NY). 2021 Apr;46(4):1562-1571. doi: 10.1007/s00261-020-02803-0. Epub 2020 Oct 16.
In living liver donors with rare anatomical anomaly of right-sided ligamentum teres (RSLT), right or left hemiliver procurement is commonly contraindicated. The purpose of this study was to evaluate the hepatic volume profiles in potential donors with RSLT using semi-automated CT volumetry (CTV).
Among 5535 potential donor candidates in our institution between April 2003 and May 2019, 23 cases of RSLT (0.4%) were included. Proportional liver volumes were measured using semi-automated CTV and compared with those of manual volumetry and intraoperative graft weights (seven surgical cases).
The mean percentage volume of the right posterior section was significantly larger than that of the left hemiliver (38.5 ± 8.4% vs. 23.3 ± 5.7%, P < 0.001). Particularly in independent right lateral type, the mean percentage volume of the right posterior section was about two times larger to that of the left hemiliver (41.5% ± 6.5% vs. 21.9% ± 4.4%, P < 0.001), whereas the volume proportions of these two parts were similar between the two parts in bifurcation and trifurcation types (P = 0.810 and 0.979, respectively). Semi-automated CTV of corresponding whole liver, right posterior section, right anterior section, and left hemiliver showed strong correlations with manual CTV (r = 0.989-0.998; P < 0.001). For the seven surgical cases, the graft weights estimated by semi-automated CTV showed a significant correlation with intraoperative graft weights (r = 0.972; P < 0.001).
In independent right lateral type of RSLT, the right posterior section tends to be significantly larger than left hemiliver, and may be an alternative option for graft in potential living liver donors with this rare anatomical anomaly.
在右蒂韧带（RSLT）罕见解剖异常的活体肝供者中，通常不建议进行右或左半肝采集。本研究旨在使用半自动 CT 体积测量（CTV）评估 RSLT 潜在供者的肝体积分布。
在 2003 年 4 月至 2019 年 5 月期间，我们机构的 5535 名潜在供者中，有 23 例 RSLT（0.4%）被纳入本研究。使用半自动 CTV 测量比例肝体积，并与手动体积测量和术中移植物重量（7 例手术）进行比较。
右后叶段的平均体积百分比明显大于左半肝（38.5±8.4%比 23.3±5.7%，P<0.001）。特别是在独立右外侧型中，右后叶段的平均体积百分比约为左半肝的两倍（41.5%±6.5%比 21.9%±4.4%，P<0.001），而分叉型和三分叉型中这两部分的体积比例相似（P=0.810 和 0.979）。相应的全肝、右后叶段、右前叶段和左半肝的半自动 CTV 与手动 CTV 具有很强的相关性（r=0.989-0.998；P<0.001）。对于 7 例手术病例，半自动 CTV 估计的移植物重量与术中移植物重量呈显著相关（r=0.972；P<0.001）。
在 RSLT 的独立右外侧型中，右后叶段往往明显大于左半肝，对于这种罕见解剖异常的潜在活体肝供者，可能是移植物的替代选择。
