Portal vein embolization using a Histoacryl/Lipiodol mixture before right liver resection

Purpose: The purpose of this retrospective study was to evaluate the efficacy and safety of percutaneous transhepatic portal vein embolization (PVE) of the right liver lobe using Histoacryl/Lipiodol mixture to induce contralateral liver hypertrophy before right-sided (or extended right-sided) hepatectomy in patients with primarily unresectable liver tumors. Methods: Twenty-one patients (9 females and 12 males) underwent PVE due to an insufficient future liver remnant; 17 showed liver metastases and 4 suffered from biliary cancer. Imaging was performed prior to and 4 weeks after PVE. Surgery was scheduled for 1 week after a CT or MRI control. The primary study end point was technical success, defined as complete angiographical occlusion of the portal vein. The secondary study end point was evaluation of liver hypertrophy by CT and MRI volumetry and transfer to operability. Results: In all the patients, PVE could be performed with a with a Histoacryl/Lipiodol mixture (n = 20) or a Histoacryl/ Lipiodol mixture with microcoils (n = 1). No procedure-related complications occurred. The volume of the left liver lobe increased significantly (p < 0.0001) by 28% from a mean of 549 ml to 709 ml. Eighteen of twenty-one patients (85.7%) could be transferred to surgery, and the intended resection could be performed as planned in 13/18 (72.3%) patients. Conclusion: Preoperative right-sided PVE using a Histoacryl/Lipiodol mixture is a safe technique and achieves a sufficient hypertrophy of the future liver remnant in the left liver lobe

Specific CT 3D rendering of the treatment zone after Irreversible Electroporation (IRE) in a pig liver model: the “Chebyshev Center Concept” to define the maximum treatable tumor size

Background: Size and shape of the treatment zone after Irreversible electroporation (IRE) can be difficult to depict due to the use of multiple applicators with complex spatial configuration. Exact geometrical definition of the treatment zone, however, is mandatory for acute treatment control since incomplete tumor coverage results in limited oncological outcome. In this study, the “Chebyshev Center Concept” was introduced for CT 3d rendering to assess size and position of the maximum treatable tumor at a specific safety margin. Methods: In seven pig livers, three different IRE protocols were applied to create treatment zones of different size and shape: Protocol 1 (n = 5 IREs), Protocol 2 (n = 5 IREs), and Protocol 3 (n = 5 IREs). Contrast-enhanced CT was used to assess the treatment zones. Technique A consisted of a semi-automated software prototype for CT 3d rendering with the “Chebyshev Center Concept” implemented (the “Chebyshev Center” is the center of the largest inscribed sphere within the treatment zone) with automated definition of parameters for size, shape and position. Technique B consisted of standard CT 3d analysis with manual definition of the same parameters but position. Results: For Protocol 1 and 2, short diameter of the treatment zone and diameter of the largest inscribed sphere within the treatment zone were not significantly different between Technique A and B. For Protocol 3, short diameter of the treatment zone and diameter of the largest inscribed sphere within the treatment zone were significantly smaller for Technique A compared with Technique B (41.1 ± 13.1 mm versus 53.8 ± 1.1 mm and 39.0 ± 8.4 mm versus 53.8 ± 1.1 mm; p &lt; 0.05 and p &lt; 0.01). For Protocol 1, 2 and 3, sphericity of the treatment zone was significantly larger for Technique A compared with B. Conclusions: Regarding size and shape of the treatment zone after IRE, CT 3d rendering with the “Chebyshev Center Concept” implemented provides significantly different results compared with standard CT 3d analysis. Since the latter overestimates the size of the treatment zone, the “Chebyshev Center Concept” could be used for a more objective acute treatment control

Accuracy of estimation of graft size for living-related liver transplantation: first results of a semi-automated interactive software for CT-volumetry.

ObjectivesTo evaluate accuracy of estimated graft size for living-related liver transplantation using a semi-automated interactive software for CT-volumetry.Materials and methodsSixteen 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.ResultsLiver 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 (PConclusionsCT-volumetry performed with P can predict accurately graft size for living-related liver transplantation while improving workflow compared with TR

Iodine removal in intravenous dual-energy CT-cholangiography: Is virtual non-enhanced imaging effective to replace true non-enhanced imaging?

To evaluate whether virtual non-enhanced imaging (VNI) is effective to replace true non-enhanced imaging (TNI) applying iodine removal in intravenous dual-energy CT-cholangiography

Dual-energy computed-tomography cholangiography in potential donors for living-related liver transplantation: initial experience

To report our initial experience with dual-energy computed-tomography (CT) cholangiography in potential donors for living-related liver transplantation

Semi-automated Interactive Software (P) – Image Example.

<p>A Transverse image of the portal-venous phase – automated outline of the entire liver after manual correction of false-positive and false-negative extractions. B Manual positioning of the anatomical landmark “first bifurcation of the right portal vein” (blue circle) according to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0110201#pone-0110201-g001" target="_blank">Fig. 1A</a>. C Automated definition of segments of Couinaud for right liver - transverse image. D Automated definition of segments of Couinaud for left liver - sagittal image. E Volume rendering (coronal view) with automated definition of segments of Couinaud of the entire liver. F List of volumes for the different segments of Couinaud. G Transverse image of the portal-venous phase – automated outline of the entire liver after manual correction of false-positive and false-negative extractions. H Volume rendering (coronal view) with automated definition of vessels (liver veins in light blue and portal veins in dark blue). Note: in each live liver donor, CT-volumetry of the entire liver was performed to ensure that the postoperative liver volume, calculated on the basis of Fig. 5F, is adequate.</p

Patient Demographics.

<p>Note: given numbers are mean±SD (range).</p><p>Patient Demographics.</p

Semi-automated Interactive Software for CT-volumetry (P) – Manual Positioning of 9 Anatomical Landmarks to Define the Segments of Couinaud (Schematic Illustration; Courtesy of Philips Healthcare Germany, Hamburg, Germany).

<p>A first bifurcation of the right portal vein (black circle). B inferior caval vein (black circle). C right hepatic vein (black circle). D middle hepatic vein (black circle). E left hepatic vein (black circle). F superficial ligamentum venosum (black circle). G deep ligamentum venosum (black circle). H end of left portal vein (black circle). I left liver tip (black circle) Note: after automated outline of the entire liver with correction of false-positive and false-negative extractions, and then after manual positioning of the 9 anatomical landmarks, volumes of transplanted liver segments are obtained.</p

Effects of laparoscopy, laparotomy, and respiratory phase on liver volume in a live porcine model for liver resection

Background!#!Hepatectomy, living donor liver transplantations and other major hepatic interventions rely on precise calculation of the total, remnant and graft liver volume. However, liver volume might differ between the pre- and intraoperative situation. To model liver volume changes and develop and validate such pre- and intraoperative assistance systems, exact information about the influence of lung ventilation and intraoperative surgical state on liver volume is essential.!##!Methods!#!This study assessed the effects of respiratory phase, pneumoperitoneum for laparoscopy, and laparotomy on liver volume in a live porcine model. Nine CT scans were conducted per pig (N = 10), each for all possible combinations of the three operative (native, pneumoperitoneum and laparotomy) and respiratory states (expiration, middle inspiration and deep inspiration). Manual segmentations of the liver were generated and converted to a mesh model, and the corresponding liver volumes were calculated.!##!Results!#!With pneumoperitoneum the liver volume decreased on average by 13.2% (112.7 ml ± 63.8 ml, p &amp;lt; 0.0001) and after laparotomy by 7.3% (62.0 ml ± 65.7 ml, p = 0.0001) compared to native state. From expiration to middle inspiration the liver volume increased on average by 4.1% (31.1 ml ± 55.8 ml, p = 0.166) and from expiration to deep inspiration by 7.2% (54.7 ml ± 51.8 ml, p = 0.007).!##!Conclusions!#!Considerable changes in liver volume change were caused by pneumoperitoneum, laparotomy and respiration. These findings provide knowledge for the refinement of available preoperative simulation and operation planning and help to adjust preoperative imaging parameters to best suit the intraoperative situation

Intraoperative Weights and Volumes of Transplanted Liver Segments.

<p>Note: *statistically significant differences between the 3 different techniques were evaluated applying ANOVA for repeated measures; mean of 4 reads (Read 1 and Read 2 for Observer 1 as well as Read 1 and Read 2 for Observer 2); given numbers are mean±SD (range).</p><p>Intraoperative Weights and Volumes of Transplanted Liver Segments.</p