Virtual hepatic resection using three-dimensional reconstruction of helical computed tomography angioportograms

Objective To establish the accuracy of virtual hepatic resection using thre e-dimensional (3D) models constructed from computed tomography angioportogr aphy (CTAP) images in determining the liver volume (LV) resected during res ectional liver surgery. Summary Background Data The ability to measure LV before surgery could be u seful in determining the extent and nature of hepatic resection. Accurate a ssessment of LV and an estimate of liver function may also allow prediction of postoperative liver failure in patients undergoing resection, assist in volume-enhancing embolization procedures, help with the planning of staged hepatic resection for bilobar disease, and aid in selection of living-rela ted liver donors. Methods A retrospective study was conducted involving 27 patients scheduled for liver resection, Using mapping technology, 3D models were constructed from helical CTAP images. From these 3D models, tumor volume, total LV, and functional LV were calculated and were compared with body weight. The 3D l iver models were subjected to a virtual hepatectomy along established anato mical planes, and the resected LV was calculated. The resected volume predi cted by radiologists (unaware of the actual weight) was compared with the s pecimen weight measured after actual surgical resection. Results A significant correlation was found between body weight and functio nal LV but not total LV. The computer prediction of resected LV after virtu al hepatectomy of 3D models compared well with resected liver weight. Conclusion Virtual hepatectomy of 3D CTAP reconstructed images provides an accurate prediction of liver mass removed during subsequent hepatic resecti on. The authors intend to combine this technology with an assessment of liv er function to attempt to predict patients at risk for liver failure after hepatic resection.