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World J Radiol. Sep 28, 2026; 18(9): 123720
Published online Sep 28, 2026. doi: 10.4329/wjr.123720
Comparing the reliability of three software programmes for manual and (semi-)automatic volumetry in healthy livers
Ariadne L van der Velden, Robrecht R M M Knapen, Sinéad James, Hossein Rahmani, Ralph Brecheisen, Sander M J van Kuijk, Joachim E Wildberger, Ronald M van Dam, Christiaan van der Leij
Ariadne L van der Velden, Robrecht R M M Knapen, Hossein Rahmani, Joachim E Wildberger, Christiaan van der Leij, Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht 6229 HX, Limburg, Netherlands
Ariadne L van der Velden, Robrecht R M M Knapen, Sinéad James, Hossein Rahmani, Ronald M van Dam, Christiaan van der Leij, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht 6229 ER, Limburg, Netherlands
Sinéad James, Ralph Brecheisen, Ronald M van Dam, Department of Surgery, Maastricht University Medical Center+, Maastricht 6229 HX, Limburg, Netherlands
Sander M J van Kuijk, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht 6229 HX, Limburg, Netherlands
Joachim E Wildberger, CARIM, Institute for Cardiovascular Diseases, Maastricht University, Maastricht 6229 ER, Limburg, Netherlands
Ronald M van Dam, Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen 45147, Germany
Co-first authors: Ariadne L van der Velden and Robrecht R M M Knapen.
Author contributions: Van der Velden AL and Knapen RRMM performed the data selection, extraction and statistical analysis, drafted the manuscript as co-first authors; van der Velden AL, Knapen RRMM and van der Leij C designed the research study; James S contributed to the academic English writing and editing as a native English speaker, retrieved ethical approval of the medical ethical board; Rahmani H, Brecheisen R, van Kuijk SMJ, Wildberger JE, van Dam RM, and Van der Leij C critically revised and edited the manuscript; van Kuijk SMJ contributed to the methodology design and performed the statistical review; all authors reviewed and approved the final manuscript.
AI contribution statement: No AI tools were used for development of the manuscript. The authors take full responsibility for the scientific content of the manuscript.
Institutional review board statement: The local medical ethics committee approved the study protocol and waived the need for obtaining informed consent (No. 2023-0185).
Informed consent statement: The need for patient consent was waived.
Conflict-of-interest statement: Wildberger JE reports institutional conflicts of interests at Clinical Trial Center Maastricht and Department of Radiology and Nuclear Medicine for Abbott, Anaconda Biomed, Asklepios, Bayer, Becton & Dickinson Medical, Bentley, Boston, Brainlab, GE Healthcare, Gleamer, Hologic, Inari Medical, Johnson & Johnson, LCRB, Medtronic, Merit Medical Systems, Microvention, Nico-Lab, Nova Techs, Oldelft Benelux, Ontario Association of Radiologists, Penumbra, Philips, Screenpoint Medical, Siemens, Stryker, Tajpan Sro, and speakers bureau for Bayer, Siemens (paid to institution). van Dam RM reports the following conflicts of interests for research grants and study materials from Abbott Laboratories, Guerbet. All are outside the submitted work. van der Leij C reports the following conflict of interest for research grant received from Innovative Health Initiative, European Union. Outside the submitted work. The other authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Corresponding author: Christiaan van der Leij, Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht 6229 HX, Limburg, Netherlands.
christiaan.vander.leij@mumc.nl
Received: May 27, 2026
Revised: July 24, 2026
Accepted: August 25, 2026
Published online: September 28, 2026
Processing time: 124 Days and 16.4 Hours
BACKGROUND
Multiple software programs are available for manual or (semi-)automated liver segmentation. Although manual segmentation has traditionally been the standard, it is time-intensive and susceptible to inter-observer variability. Conversely, (semi-)automated approaches have been shown to reduce segmentation time, but the availability and use of different software tools can introduce variability in liver volumetry outcomes.
AIM
To evaluate the reliability of three segmentation software programs (Synapse 3D (Fujifilm), OsiriX® (Pixmea), and Syngo.via (Siemens Healthineers)) for liver volumetry.
METHODS
Patients (≥ 18 years) with abdominal computed tomography images without liver pathology were included. Total liver volume (TLV) and segment II/III volume – a surrogate for the future liver remnant (FLR) – were measured. Two blinded independent researchers performed volumetric assessments. The intraclass correlation coefficient (ICC) was calculated for interobserver variability for the first 30 scans between both researchers. This was also performed for intra-observer variability between the software programs in 200 randomly selected patients (52.5% male; mean age: 63.5 years).
RESULTS
Mean TLV’s reported by Synapse 3D, Syngo.via and OsiriX® were 1705 ± 462 mL, 1672 ± 463 mL, and 1627 ± 449 mL, respectively. Mean segment II/III volumes reported were 304 ± 115 mL, 282 ± 109 mL, and 277 ± 108 mL, respectively. The highest interobserver agreement (n = 30) was for TLV with Synapse 3D (ICC: 0.999; 95%CI: 0.998-0.999), and highest intraobserver ICC was between Synapse 3D and Syngo.via for TLV (ICC: 0.997; 95%CI: 0.985-0.999). Mean standardized FLR for Synapse 3D, Syngo.via and OsiriX® were 18.6%, 17.2%, and 16.9%, respectively.
CONCLUSION
Although absolute volumes varied slightly, the standardized FLR remained comparable across the software programs, indicating that all three are suitable for reliable computed tomography liver volumetry.
Core Tip: This study compared three software programs (semi-automatic and manual) for computed tomography-based liver volumetry in 200 patients. Total liver volume and segment II/III volume – used as a surrogate for the future liver remnant – showed excellent interobserver agreement and strong agreement between all three software programs. Although Synapse 3D, Syngo.via, and OsiriX® produced small systematic differences in absolute volume estimates, the standardized future liver remnant remained comparable. These findings indicate that all three programs can provide reliable liver volumetry, while highlighting that absolute measurements should be interpreted in relation to the software used.
