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Accuracy of Volumetric Measurements After Virtual Right Hepatectomy in Potential Donors Undergoing Living Adult Liver Transplantation

Ihab R. Kamel1, Jonathan B. Kruskal1, Gisele Warmbrand1, S. Nahum Goldberg1, Elizabeth A. Pomfret2,3 and Vassilios Raptopoulos1

1 Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA 02215.
2 Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215.
3 Present address: Institute of Liver Transplantation, Lahey Clinic Medical Center, 41 Mall Rd., Burlington, MA 01805.



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  		Fig. 1. —32-year-old male potential liver donor. Hand-tracing of liver outline on axial CT scan acquired during portal venous phase shows isolation of liver from surrounding tissues of similar attenuation, such as stomach and spleen. With hand-tracing, care is exercised to exclude vascular structures such as inferior vena cava (arrowhead), extrahepatic portal vein (arrow), and major fissures such as fissure for ligamentum teres.

 


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  		Fig. 2. —32-year-old male potential liver donor. Three-dimensional model of liver in frontal projection, was generated using commercially available software after hand-tracing liver outline on axial images, as shown in Figure 1. Model shows size, shape, and surface contour of liver. These will determine if graft can be safely accommodated in recipient's abdominal cavity.

 


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  		Fig. 3A. —32-year-old male potential liver donor. Three-dimensional model of right lobe of liver, hepatic veins, and portal vein in frontal projection showing hepatectomy plane immediately to right of middle hepatic vein (arrow).

 


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  		Fig. 3B. —32-year-old male potential liver donor. Same model as in A, seen from inferior projection.

 


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  		Fig. 4. —Scatterplot shows total liver volume (mL) determined by observers 1 and 2 for 52 potential donors. Note tight correlation between measurements obtained by 2 observers (r = 0.996; p < 0.0001).

 


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  		Fig. 5. —Scatterplot shows right lobe liver volume (mL) determined by each observer compared with graft weight (gm). Note tight correlation between measured volume and graft weight (r = 0.898 and 0.879 for observers 1 and 2, respectively; p < 0.001). + = observer 1, {square} = observer 2.

 

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