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Horkaew P, Chansangrat J, Keeratibharat N, Le DC. Recent advances in computerized imaging and its vital roles in liver disease diagnosis, preoperative planning, and interventional liver surgery: A review. World J Gastrointest Surg 2023; 15:2382-2397. [PMID: 38111769 PMCID: PMC10725533 DOI: 10.4240/wjgs.v15.i11.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 11/26/2023] Open
Abstract
The earliest and most accurate detection of the pathological manifestations of hepatic diseases ensures effective treatments and thus positive prognostic outcomes. In clinical settings, screening and determining the extent of a pathology are prominent factors in preparing remedial agents and administering appropriate therapeutic procedures. Moreover, in a patient undergoing liver resection, a realistic preoperative simulation of the subject-specific anatomy and physiology also plays a vital part in conducting initial assessments, making surgical decisions during the procedure, and anticipating postoperative results. Conventionally, various medical imaging modalities, e.g., computed tomography, magnetic resonance imaging, and positron emission tomography, have been employed to assist in these tasks. In fact, several standardized procedures, such as lesion detection and liver segmentation, are also incorporated into prominent commercial software packages. Thus far, most integrated software as a medical device typically involves tedious interactions from the physician, such as manual delineation and empirical adjustments, as per a given patient. With the rapid progress in digital health approaches, especially medical image analysis, a wide range of computer algorithms have been proposed to facilitate those procedures. They include pattern recognition of a liver, its periphery, and lesion, as well as pre- and postoperative simulations. Prior to clinical adoption, however, software must conform to regulatory requirements set by the governing agency, for instance, valid clinical association and analytical and clinical validation. Therefore, this paper provides a detailed account and discussion of the state-of-the-art methods for liver image analyses, visualization, and simulation in the literature. Emphasis is placed upon their concepts, algorithmic classifications, merits, limitations, clinical considerations, and future research trends.
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Affiliation(s)
- Paramate Horkaew
- School of Computer Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Jirapa Chansangrat
- School of Radiology, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Nattawut Keeratibharat
- School of Surgery, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Doan Cong Le
- Faculty of Information Technology, An Giang University, Vietnam National University (Ho Chi Minh City), An Giang 90000, Vietnam
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Kalshabay Y, Zholdybay Z, Di Martino M, Medeubekov U, Baiguissova D, Ainakulova A, Doskhanov M, Baimakhanov B. CT volume analysis in living donor liver transplantation: accuracy of three different approaches. Insights Imaging 2023; 14:82. [PMID: 37184628 DOI: 10.1186/s13244-023-01431-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES The aim of this retrospective study is to compare and evaluate accuracy of three different approaches of liver volume quantification in living donor transplantations. METHODS This is a single-center, retrospective study of 60 donors. The total and right lobe liver volumes were analyzed in the portal-venous phase by two independent radiologists who estimated the volumes using manual, semi-automated and automated segmentation methods. The measured right lobe liver volume was compared to the real weight of the graft after back-table examinations. RESULTS The mean estimated overall liver volume was 1164.4 ± 137.0 mL for manual, 1277.4 ± 190.4 mL for semi-automated and 1240.1 ± 108.5 mL for automated segmentation. The mean estimated right lobe volume was 762.0 ± 122.4 mL for manual, 792.9 ± 139.9 mL for semi-automated and 765.4 ± 132.7 mL for automated segmentation. The mean graft weight was 711.2 ± 142.9 g. The manual method better correlated with the graft weight (r = 0.730) in comparison with the semi-automated (r = 0.685) and the automated (r = 0.699) methods (p < 0.001). The mean error ratio in volume estimation by each application was 12.7 ± 16.6% for manual, 17.1 ± 17.3% for semi-automated, 14.7 ± 16.8% for automated methods. There was a statistically significant difference between the mean error ratio of the manual and the semi-automated segmentations (p = 0.017), and no statistically significant difference between the manual and the automated applications (p = 0.199). CONCLUSION Volume analysis application better correlates with graft weight, but there is no obvious difference between correlation coefficients of all three methods. All three modalities had an error ratio, of which the semi-automated method showed the highest value. CRITICAL RELEVANCE STATEMENT Volume analysis application was more accurate, but there is no drastic difference between correlation coefficients of all three methods.
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Affiliation(s)
- Yerkezhan Kalshabay
- Kazakh National Medical University Named After S.D. Asfendiyarov, Almaty, Republic of Kazakhstan.
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan.
| | - Zhamilya Zholdybay
- Kazakh National Medical University Named After S.D. Asfendiyarov, Almaty, Republic of Kazakhstan
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan
| | - Michele Di Martino
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ulykbek Medeubekov
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan
| | - Dinara Baiguissova
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan
| | - Akmaral Ainakulova
- Kazakh National Medical University Named After S.D. Asfendiyarov, Almaty, Republic of Kazakhstan
| | - Maksat Doskhanov
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan
| | - Bolatbek Baimakhanov
- National Scientific Center of Surgery Named After A.N. Syzganov, 51 Zheltoksan Street, A05F0D2, Almaty, Republic of Kazakhstan
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Pappalardo M, Davies K, Morley S. Fat Grafting in Facial Palsy: A Secondary Revision Technique to Improve the Facial Aesthetics. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4572. [PMID: 36284721 PMCID: PMC9584190 DOI: 10.1097/gox.0000000000004572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/09/2022] [Indexed: 11/06/2022]
Abstract
We report our experience of using autologous fat grafting (AFG) as an adjunct to dynamic and static facial reanimation surgical techniques in patients with facial palsy. A consecutive series of patients with facial palsy (congenital or acquired) treated by AFG between September 2007 and October 2017 were reviewed. Multiple strategies for initial dynamic facial reanimation have been utilized. Indications for AFG included asymmetry, volume deficiency, and visible muscle tethering. Standard AFG technique was used with fat harvested from the lower abdomen or thigh and injected into multiple affected areas. Fat grafting was repeated as necessary. Two-dimensional analysis was performed using standardized pre- and postoperative photographs to assess facial symmetry. Patient, surgeon, and independent evaluator satisfaction was recorded using a five-point Likert scale (0-4). Thirty-two patients with a mean age of 43 ± 15.5 years were treated with AFG following facial reanimation. A mean of 1.7 ± 1.4 secondary procedures were performed following initial dynamic reanimation before fat grafting. The average number of AFG episodes was 2.2 ± 1.4 with a mean volume of 12.9 ± 6.0 ml. Minimal complications were seen in either the donor or the recipient sites. There was significant improvement (P ≤ 0.001) of postoperative quantitative facial symmetry following fat grafting. At one-year follow-up, surgeon, patient, and independent evaluator were mostly satisfied (3.06 ± 0.62, 3.31 ± 0.59, and 3.16 ± 0.57, respectively). We report a positive experience of correction of facial asymmetry, contour abnormality and visible muscle pull with fat transplantation following dynamic facial reanimation. The procedure has been shown to be quick and simple, with few complications.
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Affiliation(s)
- Marco Pappalardo
- From the Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, NHS Scotland, United Kingdom,Division of Plastic and Reconstructive Surgery, Department of Medical and Surgical Sciences, Policlinico University Hospital, University of Modena and Reggio Emilia, Italy
| | - Kerry Davies
- From the Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, NHS Scotland, United Kingdom
| | - Stephen Morley
- From the Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, NHS Scotland, United Kingdom
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Israeliantz N, Lodzinska J, Woods G, Pontes J, Parys M, Schwarz T. A simplified CT-volumetry method for the canine liver. Vet Radiol Ultrasound 2021; 63:47-53. [PMID: 34806252 DOI: 10.1111/vru.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/07/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
Computed tomographic (CT) liver volumetry using the slice addition technique is an accurate, but a time-consuming method. Commonly used DICOM-viewing software only allows contouring of one area per image, which can be troublesome in the transverse plane as different lobes are separated. In this prospective, experimental, methods comparison study, we aimed to determine if hepatic contouring using sagittal reformatting and a reduced number of images would yield accurate results. Computed tomographic studies were performed in five canine cadavers and reviewed using sagittal reformatting. For each dog, the number of images that included the liver was used to create four stacks with progressively fewer images in which the liver would be contoured, each with the following median number of images: A: 60, B: 31, C: 16, and D: 9. Liver volume was calculated by three observers using the different stacks of images. After CT examination, the cadavers were dissected, the liver was removed, and its volume was determined by water displacement. Single score intraclass correlation coefficient was calculated to assess interobserver agreement. Kruskal-Wallis test was used to compare water displacement and CT-based volumes. There was excellent agreement between observers (intraclass correlation coefficient = 0.957; 95% confidence interval, 0.908-0.982, P < 0.0001). No significant difference was found between the volumes obtained by CT-volumetry using each of the stacks and the volumes obtained by water displacement. Using sagittally reformatted images and hepatic contouring in as few as nine images can be an accurate and simple method for CT-volumetry of the canine liver.
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Affiliation(s)
- Nicolas Israeliantz
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, UK
| | - Joanna Lodzinska
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, UK
| | - Glynn Woods
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, UK
| | - Joana Pontes
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, UK.,Present address:Joana Pontes, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium
| | - Maciej Parys
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, UK
| | - Tobias Schwarz
- Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, UK
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5
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Johnston HE, de Crom T, Hargrave C, Adhyaru P, Woodward AJ, Pang S, Ali A, Coombes JS, Keating SE, McLean K, Mayr HL, Macdonald GA, Hickman IJ. The inter- and intrarater reliability and feasibility of dietetic assessment of sarcopenia and frailty in potential liver transplant recipients: A mixed-methods study. Clin Transplant 2020; 35:e14185. [PMID: 33306855 DOI: 10.1111/ctr.14185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022]
Abstract
Sarcopenia and frailty are associated with poorer outcomes in potential liver transplant (LT) recipients. We examined the reliability and feasibility of dietitians assessing sarcopenia and frailty. Seventy-five adults referred for LT underwent assessments of muscle mass (abdominal CTs), physical function (handgrip strength; HGS, short physical performance battery; SPPB), and frailty (Liver Frailty Index; LFI). Inter- and intrarater reliability and agreement were assessed in subsets of patients using intraclass correlation coefficients (ICCs) and Bland-Altman plots. CTs were analyzed by a dietitian and two independent experts, two dietitians assessed function and frailty. Feasibility assessed system, patient, and profession factors (staff survey). Inter- and intrarater reliability for CT-defined low muscle were excellent (ICCs > 0.97). Reliability between dietitians was excellent for HGS (0.968, 95% CI, 0.928-0.986), SPPB (0.932, 95% CI, 0.798-0.973), and LFI (0.938, 95% CI 0.861-0.973). Bland-Altman analysis indicated excellent agreement for HGS. All transplant clinicians valued sarcopenia and frailty in LT assessments and considered the dietitian appropriate to perform them. Seven saw no barriers to implementation into practice, while five queried test standardization, learning from repeat testing, and resource cost. Dietetic assessments of sarcopenia and frailty are reliable, feasible, and valued measures in the assessment of potential LT recipients.
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Affiliation(s)
- Heidi E Johnston
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Tosca de Crom
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.,Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Cathy Hargrave
- Radiation Oncology Princess Alexandra Hospital, South Brisbane, Qld, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
| | - Pooja Adhyaru
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.,Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
| | - Aidan J Woodward
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.,Department of Gastroenterology, Mater Hospital, Brisbane, Qld, Australia
| | - Siong Pang
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Azmat Ali
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Kate McLean
- Department of Radiology, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Hannah L Mayr
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia.,Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia
| | - Graeme A Macdonald
- Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.,Translational Research Institute, Woolloongabba, Qld, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia.,Mater Research Institute, University of Queensland, South Brisbane, Qld, Australia
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6
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Ahn Y, Yoon JS, Lee SS, Suk HI, Son JH, Sung YS, Lee Y, Kang BK, Kim HS. Deep Learning Algorithm for Automated Segmentation and Volume Measurement of the Liver and Spleen Using Portal Venous Phase Computed Tomography Images. Korean J Radiol 2020; 21:987-997. [PMID: 32677383 PMCID: PMC7369202 DOI: 10.3348/kjr.2020.0237] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023] Open
Abstract
Objective Measurement of the liver and spleen volumes has clinical implications. Although computed tomography (CT) volumetry is considered to be the most reliable noninvasive method for liver and spleen volume measurement, it has limited application in clinical practice due to its time-consuming segmentation process. We aimed to develop and validate a deep learning algorithm (DLA) for fully automated liver and spleen segmentation using portal venous phase CT images in various liver conditions. Materials and Methods A DLA for liver and spleen segmentation was trained using a development dataset of portal venous CT images from 813 patients. Performance of the DLA was evaluated in two separate test datasets: dataset-1 which included 150 CT examinations in patients with various liver conditions (i.e., healthy liver, fatty liver, chronic liver disease, cirrhosis, and post-hepatectomy) and dataset-2 which included 50 pairs of CT examinations performed at ours and other institutions. The performance of the DLA was evaluated using the dice similarity score (DSS) for segmentation and Bland-Altman 95% limits of agreement (LOA) for measurement of the volumetric indices, which was compared with that of ground truth manual segmentation. Results In test dataset-1, the DLA achieved a mean DSS of 0.973 and 0.974 for liver and spleen segmentation, respectively, with no significant difference in DSS across different liver conditions (p = 0.60 and 0.26 for the liver and spleen, respectively). For the measurement of volumetric indices, the Bland-Altman 95% LOA was −0.17 ± 3.07% for liver volume and −0.56 ± 3.78% for spleen volume. In test dataset-2, DLA performance using CT images obtained at outside institutions and our institution was comparable for liver (DSS, 0.982 vs. 0.983; p = 0.28) and spleen (DSS, 0.969 vs. 0.968; p = 0.41) segmentation. Conclusion The DLA enabled highly accurate segmentation and volume measurement of the liver and spleen using portal venous phase CT images of patients with various liver conditions.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Seok Yoon
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Heung Il Suk
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea.,Department of Artificial Intelligence, Korea University, Seoul, Korea.
| | - Jung Hee Son
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yedaun Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Bo Kyeong Kang
- Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sigogne M, Kanagaratnam L, Mora C, Pierre M, Petrache A, Marcus C, Fischbach M, Dramé M, Touré F. Identification of the Factors Associated With Intraperitoneal Pressure in ADPKD Patients Treated With Peritoneal Dialysis. Kidney Int Rep 2020; 5:1007-1013. [PMID: 32647758 PMCID: PMC7335974 DOI: 10.1016/j.ekir.2020.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Peritoneal dialysis (PD) is reported to be underused in the autosomal dominant polycystic kidney disease (ADPKD) population because doctors fear technical failure caused by reduced abdominal space and high intraperitoneal pressure (IPP). Methods We designed a multicenter retrospective study to be carried out in 15 French centers recruiting 60 patients with ADPKD treated with PD to identify factors associated with IPP. Inclusion criteria were start of PD between 2010 and 2017, available tomodensitometry, and IPP measurement in the first year of dialysis. The clinical and radiological data for each patient were reviewed by the same operator. Total kidney volume (TKV), liver volume, and the volume of the abdominal cavity were measured using contouring. Results TKV and the volume of the abdominal cavity in women and men were, respectively, 2397 ml versus 3758 ml and 9402 ml versus 12,920 ml. In the univariate analysis, IPP was significantly and positively associated with body surface area (P = 0.0024), body mass index (BMI) (P < 0.0001), the volume of the abdominal cavity (P = 0.0005), and the volume of the dialysate infused in the peritoneal cavity (IPV) (P = 0.0108). In the multivariate analysis, only BMI was still significantly associated with IPP (P = 0.0004) Conclusions Our results identified BMI as the main factor linked to IPP in patients with ADPKD. Despite a reliable assessment of the volume of their organs we did not find any correlation between liver and kidney volumes and IPP. To our knowledge, this is the first study designed to identify factors associated with IPP in patients with ADPKD on PD.
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Affiliation(s)
- Mickael Sigogne
- Division of Nephrology, University Hospital of Reims, Reims, France.,Division of Nephrology, University Hospital of Angers, Angers, France.,Division of Nephrology, Hospital of Le Mans, Le Mans, France
| | | | - Caroline Mora
- Division of Nephrology, University Hospital of Reims, Reims, France
| | - Malika Pierre
- Division of Nephrology, University Hospital of Reims, Reims, France
| | - Andreea Petrache
- Division of Nephrology, University Hospital of Reims, Reims, France
| | - Claude Marcus
- Division of Nephrology, University Hospital of Reims, Reims, France
| | - Michel Fischbach
- Division of Nephrology, University Hospital of Strasbourg, Strasbourg, France
| | - Moustapha Dramé
- Division of Nephrology, University Hospital of Angers, Angers, France
| | - Fatouma Touré
- Division of Nephrology, University Hospital of Reims, Reims, France.,Nephrology Laboratory, Unit 7369, Matrice Extracellulaire et Dynamique Cellulaire, MEDyC, Reims Champagne Ardenne University, Reims, France
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Broadhurst PJ, Hart AR. An observational study to justify and plan a future phase III randomized controlled trial of metformin in improving overall survival in patients with inoperable pancreatic cancer without liver metastases. J Cancer Res Clin Oncol 2020; 146:1369-1375. [PMID: 32157435 DOI: 10.1007/s00432-020-03177-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Metformin has plausible direct and indirect anti-cancer properties against pancreatic adenocarcinoma cells. However, metformin may only be efficacious in patients with inoperable pancreatic ductal adenocarcinoma (PDAC) without liver metastases. Absorption may be decreased by gastrointestinal symptoms and proton pump inhibitors (PPIs). We aimed to justify and inform a future phase III trial of metformin versus placebo on survival in inoperable PDAC by documenting prevalence of patients meeting eligibility criteria, gastrointestinal symptoms and PPI use. METHODS Patient notes with PDAC were reviewed at a large teaching hospital over 2 years. Study variables were obtained from multiple sources of information. RESULTS 141 participants were identified (51.8% female), of which 37.6% were not prescribed metformin at diagnosis and had no radiological hepatic metastases. Characteristics were similar between non-metformin and metformin users. In eligible patients, 65.2% reported nausea and vomiting and 46.2% were prescribed PPIs. CONCLUSION Approximately, a third of all patients with inoperable PDAC are eligible for a future trial of metformin, allowing an estimate of the number of hospitals required for recruitment. Nausea and vomiting are common and should be managed effectively to prevent trial dropouts. PPI use is frequent and their influence on metformin's pharmacodynamic actions needs to be clarified.
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Affiliation(s)
| | - Andrew R Hart
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
- Norfolk and Norwich University Hospital NHS Trust, Norwich, NR4 7TJ, UK
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9
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Link TW, Boddu S, Marcus J, Rapoport BI, Lavi E, Knopman J. Middle Meningeal Artery Embolization as Treatment for Chronic Subdural Hematoma: A Case Series. Oper Neurosurg (Hagerstown) 2019; 14:556-562. [PMID: 28973653 DOI: 10.1093/ons/opx154] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/01/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Traditional treatment for symptomatic subdural hematoma (SDH) has been surgical evacuation, but recurrence rates are high and patients often harbor complex medical comorbidities. Growth and recurrence is thought to be due to the highly friable nature of the vascularized membrane that forms after initial injury. There have been reported cases of middle meningeal artery (MMA) embolization for treatment of recurrent SDH after surgical evacuation with the goal of eliminating the arterial supply to this vascularized membrane. OBJECTIVE To present the first known case series of MMA embolization as upfront treatment for symptomatic chronic SDHs that have failed conservative management in lieu of surgical evacuation. METHODS Five patients with symptomatic chronic SDHs underwent MMA embolization using PVA microparticles at our institution. Size of SDH was recorded in maximum diameter and total volume. RESULTS Four patients underwent unilateral and 1 underwent bilateral MMA embolization successfully. All cases had significant reduction in total volume of SDH at longest follow-up scan: 81.4 to 13.8 cc (7 wk), 48.5 to 8.7 cc (3 wk), 31.7 and 88 to 0 and 17 cc (14 wk, bilateral), 79.3 to 24.2 cc (8 wk), and 53.5 to 0 cc (6 wk). All patients had symptomatic relief with no complications. Histologic analysis of the chronic SDH membrane in a separate patient that required surgery revealed rich neovascularization with many capillaries and few small arterioles. CONCLUSION MMA embolization could present a minimally invasive and low-risk initial treatment alternative to surgery for symptomatic chronic SDH when clinically appropriate.
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Affiliation(s)
- Thomas W Link
- Department of Neurosurgery, Weill Cornell Medical College, New York Pres-byterian Hospital, New York, New York
| | - Srikanth Boddu
- Department of Neurosurgery, Weill Cornell Medical College, New York Pres-byterian Hospital, New York, New York
| | - Joshua Marcus
- Department of Neurosurgery, Weill Cornell Medical College, New York Pres-byterian Hospital, New York, New York
| | - Benjamin I Rapoport
- Department of Neurosurgery, Weill Cornell Medical College, New York Pres-byterian Hospital, New York, New York
| | - Ehud Lavi
- Department of Pathology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Jared Knopman
- Department of Neurosurgery, Weill Cornell Medical College, New York Pres-byterian Hospital, New York, New York
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Abstract
Introduction: Liver volumetry is a routine procedure performed before major hepatectomy or living donor liver transplantation (LDLT) to anticipate the remnant liver volume and prevent liver failure. However, many parameters may impact its accuracy and no large-scale studies have evaluated inter-rater variabilities. We aimed to determine the reliability of volumetric assessments for whole organs in deceased-donor liver transplantations (DDLT) and partial organs in LDLT settings. Patients & Methods: Eight operators (four surgeons + four radiologists) analysed 30 preoperative CT scans (15 whole cirrhotic livers in the DDLT group + 15 partial healthy grafts in the LDLT group), using five software systems. The computed volumes were compared with liver weight; liver density being considered as1. Results: Inter-rater and inter-software concordances were excellent with coefficients of correlation >0.9. However, calculations overestimated the real volumes in 25 cases by a mean of 249 ± 206 [14-771] cc in the DDLT group and 138 ± 92cc [39-375] in the LDLT group. The mean calculations were significantly higher than liver weights in the LDLT group only (p=0.04). The radiologists overestimated the surgeons’ assessment in 24 cases, the differences exceeding 6% in some cases. The type of software used significantly impacted results in the DDLTgroup. Conclusions: Despite its unanimously recognised utility, we highlight significant discrepancies between estimated and real liver volumes. The global overestimation may lead to leave of too small remnant liver, with potentially dramatic consequences. In case of border-line estimations, we recommend a repetition of the evaluation by another operator (surgeon + radiologist working in concert).
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11
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Denadai R, Buzzo CL, Raposo-Amaral CA, Raposo-Amaral CE. Facial Contour Symmetry Outcomes after Site-Specific Facial Fat Compartment Augmentation with Fat Grafting in Facial Deformities. Plast Reconstr Surg 2019; 143:544-556. [PMID: 30688900 DOI: 10.1097/prs.0000000000005220] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The purposes of this study were to evaluate facial symmetry after the first fat grafting session in patients with unilateral facial contour deformities and to identify independent predictors of 12-month postoperative facial symmetry. METHODS A prospective analysis was conducted of consecutive patients (n = 167) that underwent fat grafting to restore facial contour symmetry. Computerized photogrammetric facial symmetry analyses were performed. Bivariate and multivariate analyses were executed to identify independent predictors of 12-month postoperative facial symmetry. RESULTS There were significant (all p < 0.05) postoperative facial symmetry enhancements (preoperative less than postoperative) after facial fat grafting. The facial symmetry was maintained (all p > 0.05) from 3 to 12 months postoperatively, with a 12-month facial symmetry of 91.2 ± 6.9 percent (ranging from 79.8 to 99.3 percent). Sixty-six complementary facial fat grafts (39.5 percent) were performed for residual asymmetry. Age, Parry-Romberg syndrome, previous facial bone surgery at the site that received fat grafting, and injected volume were independently negative (all p < 0.05) predictors of 12-month postoperative facial symmetry. CONCLUSION A significant improvement of facial contour symmetry was obtained after the first facial fat grafting session, but a subset of patients required complementary fat graft procedures for residual asymmetry, with age, Parry-Romberg syndrome, previous bone surgery, and injected volume affecting postoperative facial contour symmetry. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Rafael Denadai
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital
| | - Celso Luiz Buzzo
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital
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12
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Denadai R, Raposo-Amaral CA, Buzzo CL, Raposo-Amaral CE. Autologous Free Fat Grafting for Management of the Facial Contour Asymmetry. J Craniofac Surg 2018; 29:878-886. [PMID: 29481506 DOI: 10.1097/scs.0000000000004369] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purposes of this study were to report autologous free fat grafting as the workhorse procedure to augment the facial soft-tissue envelope and restore facial contour symmetry of patients with asymmetric facial malformations; to detail the SOBRAPAR Hospital algorithm for soft-tissue reconstruction of patients with facial contour asymmetry; and to assess facial symmetry after fat grafting. METHODS A retrospective analysis of consecutive patients (n = 178) who underwent fat grafting to restore the facial contour symmetry according to the SOBRAPAR Hospital algorithm between 2009 and 2016 was conducted. Computerized photogrammetric quantitative and qualitative facial symmetry analyses were performed. RESULTS There were significant (all P < 0.05) postoperative quantitative facial symmetry enhancement and an overall qualitative facial symmetry enhancement, with a mean fat graft procedures per patient of 1.6 ± 0.7, ranging of 1 to 3. CONCLUSION A significant improvement of facial contour symmetry was obtained in a subset of patients using fat grafting according to the SOBRAPAR Hospital algorithm.
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Affiliation(s)
- Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Brazil
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13
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Zou H, Xue H, Tao Y. Liver Three-Dimensional Reconstruction Accurately Predicts Remnant Liver Volume for HBV-Related Hepatocellular Carcinoma Prior to Hepatectomy. Indian J Surg 2017. [DOI: 10.1007/s12262-017-1645-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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14
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van Vugt JLA, Levolger S, Gharbharan A, Koek M, Niessen WJ, Burger JWA, Willemsen SP, de Bruin RWF, IJzermans JNM. A comparative study of software programmes for cross-sectional skeletal muscle and adipose tissue measurements on abdominal computed tomography scans of rectal cancer patients. J Cachexia Sarcopenia Muscle 2017; 8:285-297. [PMID: 27897414 PMCID: PMC5697014 DOI: 10.1002/jcsm.12158] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 08/01/2016] [Accepted: 09/13/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The association between body composition (e.g. sarcopenia or visceral obesity) and treatment outcomes, such as survival, using single-slice computed tomography (CT)-based measurements has recently been studied in various patient groups. These studies have been conducted with different software programmes, each with their specific characteristics, of which the inter-observer, intra-observer, and inter-software correlation are unknown. Therefore, a comparative study was performed. METHODS Fifty abdominal CT scans were randomly selected from 50 different patients and independently assessed by two observers. Cross-sectional muscle area (CSMA, i.e. rectus abdominis, oblique and transverse abdominal muscles, paraspinal muscles, and the psoas muscle), visceral adipose tissue area (VAT), and subcutaneous adipose tissue area (SAT) were segmented by using standard Hounsfield unit ranges and computed for regions of interest. The inter-software, intra-observer, and inter-observer agreement for CSMA, VAT, and SAT measurements using FatSeg, OsiriX, ImageJ, and sliceOmatic were calculated using intra-class correlation coefficients (ICCs) and Bland-Altman analyses. Cohen's κ was calculated for the agreement of sarcopenia and visceral obesity assessment. The Jaccard similarity coefficient was used to compare the similarity and diversity of measurements. RESULTS Bland-Altman analyses and ICC indicated that the CSMA, VAT, and SAT measurements between the different software programmes were highly comparable (ICC 0.979-1.000, P < 0.001). All programmes adequately distinguished between the presence or absence of sarcopenia (κ = 0.88-0.96 for one observer and all κ = 1.00 for all comparisons of the other observer) and visceral obesity (all κ = 1.00). Furthermore, excellent intra-observer (ICC 0.999-1.000, P < 0.001) and inter-observer (ICC 0.998-0.999, P < 0.001) agreement for all software programmes were found. Accordingly, excellent Jaccard similarity coefficients were found for all comparisons (mean ≥ 0.964). CONCLUSIONS FatSeg, OsiriX, ImageJ, and sliceOmatic showed an excellent agreement for CSMA, VAT, and SAT measurements on abdominal CT scans. Furthermore, excellent inter-observer and intra-observer agreement were achieved. Therefore, results of studies using these different software programmes can reliably be compared.
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Affiliation(s)
- Jeroen L A van Vugt
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Stef Levolger
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Arvind Gharbharan
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Marcel Koek
- Department of Radiology and Medical Informatics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Wiro J Niessen
- Department of Radiology and Medical Informatics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.,Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
| | - Jacobus W A Burger
- Department of Surgical Oncology, Erasmus MC - Daniel den Hoed Cancer Institute, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ron W F de Bruin
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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15
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Coimbra FJF, Ribeiro HSDC, Marques MC, Herman P, Chojniak R, Kalil AN, Wiermann EG, Cavallero SRDA, Coelho FF, Fernandes PHDS, Silvestrini AA, Almeida MFA, de Araújo ALE, Pitombo M, Teixeira HM, Waechter FL, Ferreira FG, Diniz AL, D'Ippolito G, D'Ippolito G, Begnami MDFDS, Prolla G, Balzan SMP, de Oliveira TB, Szultan LA, Lendoire J, Torres OJM. FIRST BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 1: PRE-TREATMENT EVALUATION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:222-30. [PMID: 26734788 PMCID: PMC4755170 DOI: 10.1590/s0102-6720201500040002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/11/2015] [Indexed: 02/07/2023]
Abstract
Background : Liver metastases of colorectal cancer are frequent and potentially fatal event
in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized
epidemiological data and results of the various treatment modalities established.
Method: Was realized deep discussion on detecting and staging metastatic colorectal
cancer, as well as employment of imaging methods in the evaluation of response to
instituted systemic therapy. Results : The next step was based on the definition of which patients would have their
metastases considered resectable and how to expand the amount of patients elegible
for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors,
validated to be taken into account in clinical practice.
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Affiliation(s)
| | | | | | - Paulo Herman
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
| | - Rubens Chojniak
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Marcos Pitombo
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
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16
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Lodewick TM, Arnoldussen CW, Lahaye MJ, van Mierlo KM, Neumann UP, Beets-Tan RG, Dejong CH, van Dam RM. Fast and accurate liver volumetry prior to hepatectomy. HPB (Oxford) 2016; 18:764-72. [PMID: 27593594 PMCID: PMC5011086 DOI: 10.1016/j.hpb.2016.06.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/05/2016] [Accepted: 06/11/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Volumetric assessment of the liver is essential in the prevention of postresectional liver failure after partial hepatectomy. Currently used methods are accurate but time-consuming. This study aimed to test a new automated method for preoperative volumetric liver assessment. METHODS Patients who underwent a contrast enhanced portovenous phase CT-scan prior to hepatectomy in 2012 were included. Total liver volume (TLV) and future remnant liver volume (FRLV) were measured using TeraRecon Aquarius iNtuition(®) (autosegmentation) and OsiriX(®) (manual segmentation) software by two observers for each software package. Remnant liver volume percentage (RLV%) was calculated. Time needed to determine TLV and FRLV was measured. Inter-observer variability was assessed using Bland-Altman plots. RESULTS Twenty-seven patients were included. There were no significant differences in measured volumes between OsiriX(®) and iNtuition(®). Moreover, there were significant correlations between the OsiriX(®) observers, the iNtuition(®) observers and between OsiriX(®) and iNtuition(®) post-processing systems (all R(2) > 0.97). The median time needed for complete liver volumetric analysis was 18.4 ± 4.9 min with OsiriX(®) and 5.8 ± 1.7 min using iNtuition(®) (p < 0.001). CONCLUSION Both OsiriX(®) and iNtuition(®) liver volumetry are accurate and easily applicable. However, volumetric assessment of the liver with iNtuition(®) auto-segmentation is three times faster compared to manual OsiriX(®) volumetry.
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Affiliation(s)
- Toine M. Lodewick
- Department of Surgery, Maastricht University Medical Center & NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands,Department of Surgery, University Hospital Aachen, Division of General, Visceral and Transplantation Surgery, Aachen, Germany,Correspondence Toine M. Lodewick, Department of Surgery, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. Tel: +31 43 3881547, +31 43 3875473.Department of SurgeryMaastricht UniversityPO Box 616Maastricht6200 MDThe Netherlands
| | | | - Max J. Lahaye
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kim M.C. van Mierlo
- Department of Surgery, Maastricht University Medical Center & NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Ulf P. Neumann
- Department of Surgery, Maastricht University Medical Center & NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands,Department of Surgery, University Hospital Aachen, Division of General, Visceral and Transplantation Surgery, Aachen, Germany
| | - Regina G. Beets-Tan
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Cornelis H.C. Dejong
- Department of Surgery, Maastricht University Medical Center & NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands,Department of Surgery, University Hospital Aachen, Division of General, Visceral and Transplantation Surgery, Aachen, Germany
| | - Ronald M. van Dam
- Department of Surgery, Maastricht University Medical Center & NUTRIM School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands,Department of Surgery, University Hospital Aachen, Division of General, Visceral and Transplantation Surgery, Aachen, Germany
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17
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Denadai R, Raposo-Amaral CA, Buzzo CL, Raposo-Amaral CE. Isolated Autologous Free Fat Grafting for Management of Facial Contour Asymmetry in a Subset of Growing Patients With Craniofacial Microsomia. Ann Plast Surg 2016; 76:288-294. [PMID: 25954839 DOI: 10.1097/sap.0000000000000533] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To report autologous free fat grafting as an isolated procedure to manage facial contour asymmetry of a subset of growing patients with craniofacial microsomia (CFM). METHODS A retrospective analysis of CFM patients (n = 11) with low socioeconomic and intellectual status, poor oral hygiene, living far from our center, Pruzansky-Kaban I/II mandibles, without functional concerns, and with no craniofacial skeletal surgery who underwent isolated free fat grafting between 2012 and 2013 was conducted. Surgeon and parent/patient satisfaction were elicited. Computerized photogrammetric quantitative and qualitative facial symmetry analyses were performed. RESULTS All patients underwent isolated autologous free fat grafting to restore the facial contour symmetry. Surgeon and patient/parent were mostly satisfied. There were significant (all P < 0.05) postoperative quantitative facial symmetry enhancement and an overall qualitative facial symmetry enhancement. CONCLUSIONS A significant improvement of facial symmetry was obtained in this subset of growing CFM patients using only isolated free fat grafting.
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Affiliation(s)
- Rafael Denadai
- From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
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18
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Azagury DE, Dua MM, Barrese JC, Henderson JM, Buchs NC, Ris F, Cloyd JM, Martinie JB, Razzaque S, Nicolau S, Soler L, Marescaux J, Visser BC. Image-guided surgery. Curr Probl Surg 2015; 52:476-520. [PMID: 26683419 DOI: 10.1067/j.cpsurg.2015.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Dan E Azagury
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Monica M Dua
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - James C Barrese
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Jaimie M Henderson
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Nicolas C Buchs
- Department of Surgery, University Hospital of Geneva, Clinic for Visceral and Transplantation Surgery, Geneva, Switzerland
| | - Frederic Ris
- Department of Surgery, University Hospital of Geneva, Clinic for Visceral and Transplantation Surgery, Geneva, Switzerland
| | - Jordan M Cloyd
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - John B Martinie
- Department of Surgery, Carolinas Healthcare System, Charlotte, NC
| | - Sharif Razzaque
- Department of Surgery, Carolinas Healthcare System, Charlotte, NC
| | - Stéphane Nicolau
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Luc Soler
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Jacques Marescaux
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Brendan C Visser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA.
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19
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Björnsson B, Lundgren L. A Personal Computer Freeware as a Tool for Surgeons to Plan Liver Resections. Scand J Surg 2015; 105:153-7. [PMID: 26420775 DOI: 10.1177/1457496915607802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/25/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS The increase in liver surgery and the proportion of resections done on the margin to postoperative liver failure make preoperative calculations regarding liver volume important. Earlier studies have shown good correlation between calculations done with ImageJ and specimen weight as well as volume calculations done with more robust systems. The correlation to actual volumes of resected liver tissue has not been investigated, and this was the aim of this study. MATERIAL AND METHODS A total of 30 patients undergoing well-defined liver resections were included in this study. Volumes calculated with ImageJ were compared to volume measurements done after the retrieval of resected liver tissue. RESULTS AND CONCLUSIONS A strong correlation between calculated and measured liver volume was found with sample concordance correlation coefficient (ρc) = 0.9950. The knowledge on the nature of liver resections sets liver surgeons in a unique position to be able to accurately predict the volumes to be resected and, therefore, also the volume that will remain after surgery. This becomes increasingly important with the evolvement of methods to extend the boundaries of liver surgery. ImageJ is a reliable tool to preoperatively assess liver volume.
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Affiliation(s)
- B Björnsson
- Department of Surgery and Department of Experimental Medicine, Linköping University, Linköping, Sweden
| | - L Lundgren
- Department of Surgery and Department of Experimental Medicine, Linköping University, Linköping, Sweden
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Oshiro Y, Yano H, Mitani J, Kim S, Kim J, Fukunaga K, Ohkohchi N. Novel 3-dimensional virtual hepatectomy simulation combined with real-time deformation. World J Gastroenterol 2015; 21:9982-9992. [PMID: 26379403 PMCID: PMC4566391 DOI: 10.3748/wjg.v21.i34.9982] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/07/2015] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To develop a novel 3-dimensional (3D) virtual hepatectomy simulation software, Liversim, to visualize the real-time deformation of the liver.
METHODS: We developed a novel real-time virtual hepatectomy simulation software program called Liversim. The software provides 4 basic functions: viewing 3D models from arbitrary directions, changing the colors and opacities of the models, deforming the models based on user interaction, and incising the liver parenchyma and intrahepatic vessels based on user operations. From April 2010 through 2013, 99 patients underwent virtual hepatectomies that used the conventional software program SYNAPSE VINCENT preoperatively. Between April 2012 and October 2013, 11 patients received virtual hepatectomies using the novel software program Liversim; these hepatectomies were performed both preoperatively and at the same that the actual hepatectomy was performed in an operating room. The perioperative outcomes were analyzed between the patients for whom SYNAPSE VINCENT was used and those for whom Liversim was used. Furthermore, medical students and surgical residents were asked to complete questionnaires regarding the new software.
RESULTS: There were no obvious discrepancies (i.e., the emergence of branches in the portal vein or hepatic vein or the depth and direction of the resection line) between our simulation and the actual surgery during the resection process. The median operating time was 304 min (range, 110 to 846) in the VINCENT group and 397 min (range, 232 to 497) in the Liversim group (P = 0.30). The median amount of intraoperative bleeding was 510 mL (range, 18 to 5120) in the VINCENT group and 470 mL (range, 130 to 1600) in the Liversim group (P = 0.44). The median postoperative stay was 12 d (range, 6 to 100) in the VINCENT group and 13 d (range, 9 to 21) in the Liversim group (P = 0.36). There were no significant differences in the preoperative outcomes between the two groups. Liversim was not found to be clinically inferior to SYNAPSE VINCENT. Both students and surgical residents reported that the Liversim image was almost the same as the actual hepatectomy.
CONCLUSION: Virtual hepatectomy with real-time deformation of the liver using Liversim is useful for the safe performance of hepatectomies and for surgical education.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Bile Duct Neoplasms/diagnostic imaging
- Bile Duct Neoplasms/pathology
- Bile Duct Neoplasms/surgery
- Blood Loss, Surgical
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- Cholangiocarcinoma/diagnostic imaging
- Cholangiocarcinoma/pathology
- Cholangiocarcinoma/surgery
- Computer Graphics
- Computer Simulation
- Education, Medical/methods
- Female
- Hepatectomy/adverse effects
- Hepatectomy/education
- Hepatectomy/methods
- Humans
- Imaging, Three-Dimensional
- Internship and Residency
- Length of Stay
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Male
- Middle Aged
- Operative Time
- Radiographic Image Interpretation, Computer-Assisted
- Retrospective Studies
- Software Design
- Students, Medical/psychology
- Surgeons/psychology
- Surgery, Computer-Assisted/adverse effects
- Surgery, Computer-Assisted/methods
- Surveys and Questionnaires
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- User-Computer Interface
- Visual Perception
- Young Adult
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Wang XQ, Liu Z, Lv WP, Luo Y, Yang GY, Li CH, Meng XF, Liu Y, Xu KS, Dong JH. Safety validation of decision trees for hepatocellular carcinoma. World J Gastroenterol 2015; 21:9394-9402. [PMID: 26309366 PMCID: PMC4541392 DOI: 10.3748/wjg.v21.i31.9394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 03/11/2015] [Accepted: 04/17/2015] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate a different decision tree for safe liver resection and verify its efficiency.
METHODS: A total of 2457 patients underwent hepatic resection between January 2004 and December 2010 at the Chinese PLA General Hospital, and 634 hepatocellular carcinoma (HCC) patients were eligible for the final analyses. Post-hepatectomy liver failure (PHLF) was identified by the association of prothrombin time < 50% and serum bilirubin > 50 μmol/L (the “50-50” criteria), which were assessed at day 5 postoperatively or later. The Swiss-Clavien decision tree, Tokyo University-Makuuchi decision tree, and Chinese consensus decision tree were adopted to divide patients into two groups based on those decision trees in sequence, and the PHLF rates were recorded.
RESULTS: The overall mortality and PHLF rate were 0.16% and 3.0%. A total of 19 patients experienced PHLF. The numbers of patients to whom the Swiss-Clavien, Tokyo University-Makuuchi, and Chinese consensus decision trees were applied were 581, 573, and 622, and the PHLF rates were 2.75%, 2.62%, and 2.73%, respectively. Significantly more cases satisfied the Chinese consensus decision tree than the Swiss-Clavien decision tree and Tokyo University-Makuuchi decision tree (P < 0.01，P < 0.01); nevertheless, the latter two shared no difference (P = 0.147). The PHLF rate exhibited no significant difference with respect to the three decision trees.
CONCLUSION: The Chinese consensus decision tree expands the indications for hepatic resection for HCC patients and does not increase the PHLF rate compared to the Swiss-Clavien and Tokyo University-Makuuchi decision trees. It would be a safe and effective algorithm for hepatectomy in patients with hepatocellular carcinoma.
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Do Diametric Measurements Provide Sufficient and Reliable Tumor Assessment? An Evaluation of Diametric, Areametric, and Volumetric Variability of Lung Lesion Measurements on Computerized Tomography Scans. JOURNAL OF ONCOLOGY 2015; 2015:632943. [PMID: 26064117 PMCID: PMC4441994 DOI: 10.1155/2015/632943] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/15/2015] [Indexed: 11/18/2022]
Abstract
Diametric analysis is the standard approach utilized for tumor measurement on medical imaging. However, the availability of newer more sophisticated techniques may prove advantageous. An evaluation of diameter, area, and volume was performed on 64 different lung lesions by three trained users. These calculations were obtained using a free DICOM viewer and standardized measuring procedures. Measurement variability was then studied using relative standard deviation (RSD) and intraclass correlation. Volumetric measurements were shown to be more precise than diametric. With minimal RSD and variance between different users, volumetric analysis was demonstrated as a reliable measurement technique. Additionally, the diameters were used to calculate an estimated area and volume; thereafter the estimated area and volume were compared against the actual measured values. The results in this study showed independence of the estimated and actual values. Estimated area deviated an average of 43.5% from the actual measured, and volume deviated 88.03%. The range of this variance was widely scattered and without trend. These results suggest that diametric measurements cannot be reliably correlated to actual tumor size. Access to appropriate software capable of producing volume measurements has improved drastically and shows great potential in the clinical assessment of tumors. Its applicability merits further consideration.
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23
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3D-assisted quantitative assessment of orbital volume using an open-source software platform in a Taiwanese population. PLoS One 2015; 10:e0119589. [PMID: 25774683 PMCID: PMC4361687 DOI: 10.1371/journal.pone.0119589] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/29/2015] [Indexed: 12/31/2022] Open
Abstract
Orbital volume evaluation is an important part of pre-operative assessments in orbital trauma and congenital deformity patients. The availability of the affordable, open-source software, OsiriX, as a tool for preoperative planning increased the popularity of radiological assessments by the surgeon. A volume calculation method based on 3D volume rendering-assisted region-of-interest computation was used to determine the normal orbital volume in Taiwanese patients after reorientation to the Frankfurt plane. Method one utilized 3D points for intuitive orbital rim outlining. The mean normal orbital volume for left and right orbits was 24.3±1.51 ml and 24.7±1.17 ml in male and 21.0±1.21 ml and 21.1±1.30 ml in female subjects. Another method (method two) based on the bilateral orbital lateral rim was also used to calculate orbital volume and compared with method one. The mean normal orbital volume for left and right orbits was 19.0±1.68 ml and 19.1±1.45 ml in male and 16.0±1.01 ml and 16.1±0.92 ml in female subjects. The inter-rater reliability and intra-rater measurement accuracy between users for both methods was found to be acceptable for orbital volume calculations. 3D-assisted quantification of orbital volume is a feasible technique for orbital volume assessment. The normal orbital volume can be used as controls in cases of unilateral orbital reconstruction with a mean size discrepancy of less than 3.1±2.03% in females and 2.7±1.32% in males. The OsiriX software can be used reliably by the individual surgeon as a comprehensive preoperative planning and imaging tool for orbital volume measurement and computed tomography reorientation.
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Valeri G, Mazza FA, Maggi S, Aramini D, La Riccia L, Mazzoni G, Giovagnoni A. Open source software in a practical approach for post processing of radiologic images. LA RADIOLOGIA MEDICA 2015; 120:309-323. [PMID: 25024063 DOI: 10.1007/s11547-014-0437-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this paper is to evaluate the use of open source software (OSS) to process DICOM images. MATERIALS AND METHODS We selected 23 programs for Windows and 20 programs for Mac from 150 possible OSS programs including DICOM viewers and various tools (converters, DICOM header editors, etc.). The programs selected all meet the basic requirements such as free availability, stand-alone application, presence of graphical user interface, ease of installation and advanced features beyond simple display monitor. Capabilities of data import, data export, metadata, 2D viewer, 3D viewer, support platform and usability of each selected program were evaluated on a scale ranging from 1 to 10 points. RESULTS Twelve programs received a score higher than or equal to eight. Among them, five obtained a score of 9: 3D Slicer, MedINRIA, MITK 3M3, VolView, VR Render; while OsiriX received 10. CONCLUSIONS OsiriX appears to be the only program able to perform all the operations taken into consideration, similar to a workstation equipped with proprietary software, allowing the analysis and interpretation of images in a simple and intuitive way. OsiriX is a DICOM PACS workstation for medical imaging and software for image processing for medical research, functional imaging, 3D imaging, confocal microscopy and molecular imaging. This application is also a good tool for teaching activities because it facilitates the attainment of learning objectives among students and other specialists.
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Schadde E, Ardiles V, Slankamenac K, Tschuor C, Sergeant G, Amacker N, Baumgart J, Croome K, Hernandez-Alejandro R, Lang H, de Santibaňes E, Clavien PA. ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors compared with conventional-staged hepatectomies: results of a multicenter analysis. World J Surg 2015; 38:1510-9. [PMID: 24748319 DOI: 10.1007/s00268-014-2513-3] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Portal vein occlusion to increase the size of the future liver remnant (FLR) is well established, using portal vein ligation (PVL) or embolization (PVE) followed by resection 4-8 weeks later. Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) combines PVL and complete parenchymal transection, followed by hepatectomy within 1-2 weeks. ALPPS has been recently introduced but remains controversial. We compare the ability of ALPPS versus PVE or PVL for complete tumor resection. METHODS A retrospective review of all patients undergoing ALPPS or conventional staged hepatectomies using PVL or PVE at four high-volume HPB centres between 2003 and 2012 was performed. Patients with primary liver tumors and liver metastases were included. Primary endpoint was complete tumor resection. Secondary endpoints include 90-day mortality, complications, FLR increase, time to resection, and tumor recurrence. RESULTS Forty-eight patients with ALPPS were compared with 83 patients with conventional-staged hepatectomies. Eighty-three percent (40/48 patients) of ALPPS patients achieved complete resection compared with 66 % (55/83 patients) in PVE/PVL (odds ratio 3.34, p = 0.027). Ninety-day mortality in ALPPS and PVE/PVL was 15 and 6 %, respectively (p = 0.2). Extrapolated growth rate was 11 times higher in ALPPS (34.8 cc/day; interquartile range (IQR) 26-49) compared with PVE/PVL (3 cc/day; IQR2-6; p = 0.001). Tumor recurrence at 1 year was 54 versus 52 % for ALPPS and PVE/PVL, respectively (p = 0.7). CONCLUSIONS This study provides evidence that ALPPS offers a better chance of complete resection in patients with primarily unresectable liver tumors at the cost of a high mortality. The technique is promising but should currently not be used outside of studies and registries.
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Affiliation(s)
- Erik Schadde
- Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Santos J, Batista MDC, Foley S, Paulo G, McEntee MF, Rainford L. Paediatric CT optimisation utilising Catphan® 600 and age-specific anthropomorphic phantoms. RADIATION PROTECTION DOSIMETRY 2014; 162:586-596. [PMID: 24567497 DOI: 10.1093/rpd/ncu018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of the study is to perform phantom-based optimisation of paediatric computed tomography (CT) protocols and quantify the impact upon radiation dose and image noise levels. The study involved three Portuguese paediatric centres. Currently employed scanning protocols for head and chest examinations and combinations of exposure parameters were applied to a Catphan(®)600 phantom to review the CT dose impact. Contrast-noise ratio (CNR) was quantified using Radia Diagnostic(®) tool. Imaging parameters, returning similar CNRs (<1) and dose savings were applied to three paediatric anthropomorphic phantoms. OsiriX software based on standard deviation pixel values facilitated image noise analysis. Currently employed protocols and age categorisation varied between centres. Manipulation of exposure parameters facilitated mean dose reductions of 33 and 28 % for paediatric head and chest CT examinations, respectively. The majority of the optimised CT examinations resulted in image noise similar to currently employed protocols. Dose reductions of up to 33 % were achieved with image quality maintained.
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Affiliation(s)
- Joana Santos
- Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Radiologia, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal
| | - Maria do Carmo Batista
- Departamento de Física Médica, Dr. Campos Costa, Consultório de Tomografia Computorizada S.A, Porto, Portugal
| | - Shane Foley
- School of Medicine & Medical Science, Health Science Centre, University College Dublin, Belfield Dublin 4, Ireland
| | - Graciano Paulo
- Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Radiologia, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal
| | - Mark F McEntee
- Faculty of Health Sciences, The University of Sydney, Cumberland Campus, Sydney, Australia
| | - Louise Rainford
- School of Medicine & Medical Science, Health Science Centre, University College Dublin, Belfield Dublin 4, Ireland
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Time-to-peak values can estimate hepatic functional reserve in patients undergoing surgical resection: a comparison between perfusion CT and indocyanine green retention test. J Comput Assist Tomogr 2014; 38:733-41. [PMID: 24834884 DOI: 10.1097/rct.0000000000000102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the potential usefulness of perfusion computed tomography (CT) for the estimation of hepatic functional reserve in patients scheduled for surgical resection and to compare the results with those of the indocyanine green retention test results. METHODS Thirty-one patients with hepatobiliary malignancies were included. Perfusion CT and indocyanine green retention test were performed on the same day, and their results were compared using Pearson correlation test. RESULTS A strong correlation was found between perfusion CT time-to-peak values and indocyanine green retention rate at 15 minutes and indocyanine green plasma disappearance rate values (R, 0.789 and -0.790; R, 0.832 and -0.823, respectively; P < 0.0001). CONCLUSIONS Perfusion CT may be useful for the preoperative noninvasive estimation of hepatic functional reserve for patients undergoing liver resection.
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Mokry T, Bellemann N, Müller D, Lorenzo Bermejo J, Klauß M, Stampfl U, Radeleff B, Schemmer P, Kauczor HU, Sommer CM. Accuracy of estimation of graft size for living-related liver transplantation: first results of a semi-automated interactive software for CT-volumetry. PLoS One 2014; 9:e110201. [PMID: 25330198 PMCID: PMC4201494 DOI: 10.1371/journal.pone.0110201] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 09/17/2014] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nadine Bellemann
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Müller
- Philips Healthcare Germany, Hamburg, Germany
| | - Justo Lorenzo Bermejo
- Department of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Miriam Klauß
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrike Stampfl
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Boris Radeleff
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Schemmer
- Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christof-Matthias Sommer
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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D’Onofrio M, De Robertis R, Demozzi E, Crosara S, Canestrini S, Pozzi Mucelli R. Liver volumetry: Is imaging reliable? Personal experience and review of the literature. World J Radiol 2014; 6:62-71. [PMID: 24778768 PMCID: PMC4000610 DOI: 10.4329/wjr.v6.i4.62] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/11/2014] [Accepted: 03/14/2014] [Indexed: 02/06/2023] Open
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.
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Kianmanesh R, Piardi T, Tamby E, Parvanescu A, Bruno O, Palladino E, Bouché O, Msika S, Sommacale D. Liver angulometry: a simple method to estimate liver volume and ratios. HPB (Oxford) 2013; 15:976-84. [PMID: 23472855 PMCID: PMC3843616 DOI: 10.1111/hpb.12079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 01/21/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Volumetry is standard method for evaluating the volumes of the right liver (RL), left liver (LL), left lateral segments (LLS), total liver (TL) and future liver remnant (FLR). The aim of this study was to report a simple technique based on measurements of liver angles (angulometry) that can be used to predict liver ratios. METHODS Fifty computed tomography (CT) scans obtained in subjects with normal liver were studied. Four CT scan levels were preselected: level 1 passed by the upper part of the hepatic veins; level 2 passed by the left portal vein branch division; level 3 passed by the right portal vein branch division, and level 4 passed by the gallbladder bed. Left and right tangent lines passing the liver edges were drawn and joined to the centre of the vertebra defining the TL angle. Two lines through, respectively, the plane of the middle hepatic vein and the left portal branches determined the angles of the RL, LL and LLS. Volumetric and angulometric data obtained on levels 2 and 3 in 50 different subjects were compared. RESULTS Level 2 CT scans represented the most accurate way of obtaining angulometric measurements. The mean ± standard deviation (SD) angles of the TL and LL were 134 ± 12 ° and 55 ± 12 °, respectively. The mean ± SD percentages of the TL represented by the LL in angulometry and volumetry were 38 ± 7% and 36 ± 6%, respectively (non-significant difference). The mean ± SD percentages of the TL represented by the LLS in angulometry and volumetry were 25 ± 4% and 20 ± 3%, respectively (P < 0.05). The mean ± SD overestimation of the percentage of the TL represented by the LLS in angulometry was 2.7 ± 7.0%. CONCLUSIONS Angulometry is a simple and accurate technique that can be used to estimate the ratio of the FLR to TL volume on one or two CT (or magnetic resonance imaging) slices. It can be helpful for clinicians, especially before right or extended right hepatectomy and after right portal vein occlusion techniques.
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Affiliation(s)
- Reza Kianmanesh
- Department of Digestive Surgery, University of ReimsReims, France,Department of Digestive Surgery, Louis Mourier University Hospital Centre, University of Paris 7Paris, France
| | - Tullio Piardi
- Department of Digestive Surgery, University of ReimsReims, France
| | - Esther Tamby
- Department of Digestive Surgery, University of ReimsReims, France
| | - Alina Parvanescu
- Department of Digestive Surgery, Louis Mourier University Hospital Centre, University of Paris 7Paris, France
| | - Onorina Bruno
- Department of Liver Surgery, University of Paris 7Paris, France,Department of Radiology, Beaujon University Hospital Centre, University of Paris 7Paris, France
| | - Elisa Palladino
- Department of Digestive Surgery, University of ReimsReims, France
| | - Olivier Bouché
- Department of Digestive Oncology, Robert Debré University Hospital Centre, University of ReimsReims, France
| | - Simon Msika
- Department of Digestive Surgery, Louis Mourier University Hospital Centre, University of Paris 7Paris, France
| | - Daniele Sommacale
- Department of Digestive Surgery, University of ReimsReims, France,Department of Liver Surgery, University of Paris 7Paris, France
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Volumetric Gain of the Liver after Major Hepatectomy in Obese Patients. Ann Surg 2013; 258:696-702; discussion 702-4. [DOI: 10.1097/sla.0b013e3182a61a22] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Influence of Preoperative Chemotherapy on CT Volumetric Liver Regeneration Following Right Hemihepatectomy. World J Surg 2013; 38:497-504. [DOI: 10.1007/s00268-013-2278-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Phillips N, Tyagi A, Marks P, Nix P. Public disclosure of surgeon's results – pituitary surgery. Br J Neurosurg 2013; 28:368-73. [DOI: 10.3109/02688697.2013.847172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ariizumi SI, Takahashi Y, Kotera Y, Omori A, Yoneda G, Mu H, Katagiri S, Egawa H, Yamamoto M. Novel virtual hepatectomy is useful for evaluation of the portal territory for anatomical sectionectomy, segmentectomy, and hemihepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013. [PMID: 23179558 DOI: 10.1007/s00534-012-0573-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The novel technique of virtual hepatectomy is useful for evaluation of the portal territory of the liver, since this software program includes functions for liver surgery planning. We evaluated the accuracy of virtual hepatectomy for anatomical hepatectomy. METHODS Between 2010 and 2011, 92 patients with liver tumors underwent virtual hepatectomy preoperatively. The predicted liver volume was compared with the actual liver volume among patients who underwent anatomical sectionectomy, segmentectomy, and hemihepatectomy. RESULTS Ninety of 92 patients underwent anatomical hepatectomy on the basis of virtual hepatectomy. According to the surgical procedure, the predicted liver resection volume showed a strong correlation with the actual liver volume in patients who underwent sectionectomy (r = 0.985, p < 0.0001, n = 44, median error rate 9 %), segmentectomy (r = 0.949, p < 0.0001, n = 17, median error rate 12 %), and hemihepatectomy (r = 0.967, p < 0.0001, n = 29, median error rate 7 %). CONCLUSIONS The novel technique of virtual hepatectomy is useful for evaluation of the portal territory for anatomical sectionectomy, segmentectomy, and hemihepatectomy.
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Affiliation(s)
- Shun-Ichi Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Abstract
An exciting development
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Affiliation(s)
- U P Neumann
- Department of General, Visceral and Transplantation Surgery, University Hospital of the Rheinisch-Westfälische Technische Hochschule Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Volumetric analysis of remnant liver regeneration after major hepatectomy in bevacizumab-treated patients: a case-matched study in 82 patients. Ann Surg 2013; 256:755-61; discussion 761-2. [PMID: 23095619 DOI: 10.1097/sla.0b013e31827381ca] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The objective was to determine the liver regeneration capacity and morbidity and mortality rates after major hepatectomy for colorectal metastases in patients having undergone bevacizumab-based chemotherapy (bev+). PATIENTS AND METHODS Between 2006 and 2011, 41 patients underwent major hepatectomy within 3 months of bevacizumab and were matched with 41 patients operated on following systemic chemotherapy without bevacizumab (bev-). The matching criteria were the following: number of courses of chemotherapy, chemotherapy-free interval, age, and type of hepatectomy. After measurements of remnant liver volume (RLV) preoperatively and at 1 month (RLV1M), volumetric gain was calculated as absolute (RLV1M-RLV) or relative regeneration [(RLV1M-RLV/RLV)]. Ninety-day morbidity was rated according to the Clavien-Dindo classification. RESULTS There were 21 right, 9 extended right, and 11 left hepatectomies in each group. Groups were comparable in terms of matching criteria, body mass index, American Society of Anesthesiologists score, and RLV. No mortalities were observed. There were no intergroup differences in overall morbidity (56% in bev+ vs 34.1%; P = 0.075) or postoperative liver failure. A severe complication occurred in 5 bev+ (4 eviscerations) and 4 bev- (bile leakages) (P = 0.95). The median hospital stay was similar in both groups as were the degrees of absolute and relative liver regeneration (143% in bev+ vs 114%; P = 0.20). Liver regeneration was not influenced by the type of hepatectomy, the number of courses of chemotherapy, or age more than 65 years. CONCLUSIONS In a methodologically robust trial in the largest cohort reported up to date, bevacizumab did not impair liver regeneration after major hepatectomy-even in elderly patients or those with high exposure to chemotherapy.
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Quantitative paraspinal muscle measurements: inter-software reliability and agreement using OsiriX and ImageJ. Phys Ther 2012; 92:853-64. [PMID: 22403091 DOI: 10.2522/ptj.20110380] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Variations in paraspinal muscle cross-sectional area (CSA) and composition, particularly of the multifidus muscle, have been of interest with respect to risk of, and recovery from, low back pain problems. Several investigators have reported on the reliability of such muscle measurements using various protocols and image analysis programs. However, there is no standard protocol for tissue segmentation, nor has there been an investigation of reliability or agreement of measurements using different software. OBJECTIVE The purpose of this study was to provide a detailed muscle measurement protocol and determine the reliability and agreement of associated paraspinal muscle composition measurements obtained with 2 commonly used image analysis programs: OsiriX and ImageJ. DESIGN This was a measurement reliability study. METHODS Lumbar magnetic resonance images of 30 individuals were randomly selected from a cohort of patients with various low back conditions. Muscle CSA and composition measurements were acquired from axial T2-weighted magnetic resonance images of the multifidus muscle, the erector spinae muscle, and the 2 muscles combined at L4-L5 and S1 for each participant. All measurements were repeated twice using each software program, at least 5 days apart. The assessor was blinded to all earlier measurements. RESULTS The intrarater reliability and standard error of measurement (SEM) were comparable for most measurements obtained using OsiriX or ImageJ, with reliability coefficients (intraclass correlation coefficients [ICCs]) varying between .77 and .99 for OsiriX and .78 and .99 for ImageJ. There was similarly excellent agreement between muscle composition measurements using the 2 software applications (inter-software ICCs = .81-.99). LIMITATIONS The high degree of inter-software measurement reliability may not generalize to protocols using other commercial or custom-made software. CONCLUSION The proposed method to investigate paraspinal muscle CSA, composition, and side-to-side asymmetry was highly reliable, with excellent agreement between the 2 software programs.
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Right Portal Vein Ligation Combined With In Situ Splitting Induces Rapid Left Lateral Liver Lobe Hypertrophy Enabling 2-Staged Extended Right Hepatic Resection in Small-for-Size Settings. Ann Surg 2012; 255:405-14. [DOI: 10.1097/sla.0b013e31824856f5] [Citation(s) in RCA: 930] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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de Jong MC, van Dam RM, Maas M, Bemelmans MHA, Olde Damink SWM, Beets GL, Dejong CHC. The liver-first approach for synchronous colorectal liver metastasis: a 5-year single-centre experience. HPB (Oxford) 2011; 13:745-52. [PMID: 21929676 PMCID: PMC3210977 DOI: 10.1111/j.1477-2574.2011.00372.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND For patients who present with synchronous colorectal carcinoma and colorectal liver metastasis (CRLM), a reversed treatment sequence in which the CRLM are resected before the primary carcinoma has been proposed (liver-first approach). The aim of the present study was to assess the feasibility and outcome of this approach for synchronous CRLM. METHODS Between 2005 and 2010, 22 patients were planned to undergo the liver-first approach. Feasibility and outcomes were prospectively evaluated. RESULTS Of the 22 patients planned to undergo the liver-first strategy, the approach was completed in 18 patients (81.8%). The main reason for treatment failure was disease progression. Patients who completed treatment and patients who deviated from the protocol had a similar location of the primary tumour, as well as comparable size, number and distribution of CRLM (all P > 0.05). Post-operative morbidity and mortality were 27.3% and 0% following liver resection and 44.4% and 5.6% after colorectal surgery, respectively. On an intention-to-treat-basis, overall 3-year survival was 41.1%. However, 37.5% of patients who completed the treatment had developed recurrent disease at the time of the last follow-up. CONCLUSIONS The liver-first approach is feasible in approximately four-fifths of patients and can be performed with peri-operative mortality and morbidity similar to the traditional treatment paradigm. Patients treated with this novel strategy derive a considerable overall-survival-benefit, although disease-recurrence-rates remain relatively high, necessitating a multidisciplinary approach.
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Affiliation(s)
- Mechteld C de Jong
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands,NUTRIM – School for Nutrition, Toxicology and Metabolism, Maastricht UniversityMaastricht, the Netherlands
| | - Ronald M van Dam
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Monique Maas
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands,Department of Radiology, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Marc HA Bemelmans
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Steven WM Olde Damink
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Geerard L Beets
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands
| | - Cornelis HC Dejong
- Department of Surgery, Maastricht University Medical CentreMaastricht, the Netherlands,NUTRIM – School for Nutrition, Toxicology and Metabolism, Maastricht UniversityMaastricht, the Netherlands
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DuBray BJ, Levy RV, Balachandran P, Conzen KD, Upadhya GA, Anderson CD, Chapman WC. Novel three-dimensional imaging technique improves the accuracy of hepatic volumetric assessment. HPB (Oxford) 2011; 13:670-4. [PMID: 21843269 PMCID: PMC3183453 DOI: 10.1111/j.1477-2574.2011.00350.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND With pre-operative prediction of liver volume becoming increasingly important to safely carry out complex hepatic resections, the aim of the present study was to validate the accuracy of a three-dimensional (3-D) liver surgery operative planning software in performing hepatic volumetry. METHODS Between 1999 and 2007, we performed 29 live donor liver resections for transplantation. Eleven patients had pre-operative volumetry performed by radiologists from either computed tomography (CT) or magnetic resonance (MR) imaging with documentation of the corresponding specimen weight. Retrospectively, images were uploaded into Scout™ where 3-D models of each case were generated to perform volumetry. A correlational analysis was performed followed by an accuracy comparison. RESULTS Estimations by both radiologists and Scout™ were significantly correlated with the specimen weights, P ≤ 0.0001. Compared with radiologists' volumetry, Scout™ significantly improved overall accuracy [per cent error (PE) 20.0% ± 5.3 vs. 32.9% ± 5.7, P=0.005], accuracy of CT-based estimations (PE 23.2% ± 6.7 vs. 37.2% ± 6.9, P=0.023) and accuracy of the left lateral section (PE 11.1% ± 3.9 vs. 26.6% ± 6.8, P=0.027). DISCUSSION This 3-D planning software is a valid tool for use in volumetry. Significance is greatest for CT-based models of the left lateral section. This approach gives surgeons the ability to assess volumetrics and actively plan resections.
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Kos B, Valič B, Miklavčič D, Kotnik T, Gajšek P. Pre- and post-natal exposure of children to EMF generated by domestic induction cookers. Phys Med Biol 2011; 56:6149-60. [DOI: 10.1088/0031-9155/56/19/001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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