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World J Radiol. Apr 28, 2014; 6(4): 62-71
Published online Apr 28, 2014. doi: 10.4329/wjr.v6.i4.62
Liver volumetry: Is imaging reliable? Personal experience and review of the literature
Mirko D’Onofrio, Riccardo De Robertis, Emanuele Demozzi, Stefano Crosara, Stefano Canestrini, Roberto Pozzi Mucelli
Mirko D’Onofrio, Riccardo De Robertis, Emanuele Demozzi, Stefano Crosara, Stefano Canestrini, Roberto Pozzi Mucelli, Department of Radiology, G.B. Rossi Hospital, University of Verona, 37134 Verona, Italy
Author contributions: All authors equally contributed to this paper. D’Onofrio M and Pozzi Mucelli R designed the research and gave their final approval for submission; Demozzi E, Crosara S and Canestrini S performed the research and revised the paper; De Robertis R performed the research, wrote and revised the paper.
Correspondence to: Riccardo De Robertis, MD, Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy. riccardo.derobertis@hotmail.it
Telephone: +39-45-8124301 Fax: +39-45-8027490
Received: October 9, 2013
Revised: January 11, 2014
Accepted: March 13, 2014
Published online: April 28, 2014

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.

Keywords: Liver, Hepatectomy, Ultrasound, Computed tomography, Magnetic resonance imaging

Core tip: Imaging plays a fundamental role in the pre-operative volumetric evaluation of patients undergoing liver resection or transplantation. It seems that computed tomography and magnetic resonance imaging are reliable and substantially equivalent for this evaluation. Automatic or semi-automatic methods are efficient and less time-consuming than manual tracing methods. Further studies are needed to definitely evaluate the accuracy of commercially available software for liver volumetry.