Skip to main content
SpringerLink
Log in

Preoperative Assessment with Functional Studies of the Liver

  • Chapter
  • First Online:
Venous Embolization of the Liver

  • 1314 Accesses

Abstract

Whereas imaging studies such as CT or MRI allow volumetric assessment of the liver segments, only indirect information is provided concerning the quality of the liver parenchyma and its actual functional capacity. Assessment of liver function is therefore crucial in the preoperative work-up of patients who require extensive liver resection and in whom PVE is considered. As the regenerative capacity of the liver is related to the quality of liver parenchyma, the success of PVE largely depends on parameters of liver function. This chapter deals with several tests for the measurement of liver function. Passive liver function tests include biochemical parameters and clinical grading systems such as the Child-Pugh and MELD scores. Dynamic quantitative tests of liver function can be based on clearance capacity tests such as the ICG clearance test, galactose elimination capacity, and lidocaine clearance test. Although widely used, discrepancies have been reported of the ICG clearance test in relation with clinical outcome. Nuclear imaging studies have the advantage of providing simultaneous morphologic (visual) and physiologic (quantitative functional) information of the liver. In addition, regional (segmental) differences in liver function can be determined. The use of SPECT-CT cameras enables measurements of volume and function of the future remnant liver. 99mTc-galactosl serum albumin (GSA) scintigraphy and 99mTc-mebrofenin hepatobiliary scintigraphy potentially identify patients at risk for post-resectional liver failure who might benefit from PVE. Bioenergetic tests are based on the energy state of the liver and the availability of ATP. The caffeine clearance test, aminopyrine breath test and MEGX test measure the microsomal or cytosolic capacity of the liver. As there is not one test that can measure all the components of liver function, liver functional reserve remains to be estimated from a combination of clinical parameters and quantitative liver function tests.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Van den Broek MA, Olde Damink SW, Dejong CH, et al. Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int. 2008;28(6):767-780.

    Article  PubMed  Google Scholar 

  2. Vetelainen RL, van Vliet AK, Gouma DJ, van Gulik TM. Steatosis as a risk factor in liver surgery. Ann Surg. 2007;245(1):20-30.

    Article  PubMed  Google Scholar 

  3. Mullin EJ, Metcalfe MS, Maddern GJ. How much liver resection is too much? Am J Surg. 2005;190(1):87-89.

    Article  PubMed  Google Scholar 

  4. Abdalla EK, Vauthey JN. Chemotherapy prior to hepatic resection for colorectal liver metastases: helpful until harmful? Dig Surg. 2008;25(6):421-429.

    Article  PubMed  CAS  Google Scholar 

  5. Morris-Stiff G, Gomez D, Prasad R. Quantitative assessment of hepatic function and its relevance to the liver surgeon. J Gastrointest Surg. 2009;13:374-385.

    Article  PubMed  CAS  Google Scholar 

  6. Nagasue N, Yukaya H, Ogawa Y, Kohno H, Nakamura T. Human liver regeneration after major hepatic resection. A study of normal liver and livers with chronic hepatitis and cirrhosis. Ann Surg. 1987;206(1):30-39.

    Article  PubMed  CAS  Google Scholar 

  7. Ribero D, Abdalla EK, Madoff DC, Donadon M, Loyer EM, Vauthey JN. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome. Br J Surg. 2007;94:1386-1394.

    Article  PubMed  CAS  Google Scholar 

  8. Mann DV. Assessment of liver function. In: Lau J, ed. Hepatocellular Carcinoma. Republic of Singapore: World Scientific Publishing Co. Pte Ltd; 2008:51-83.

    Google Scholar 

  9. Schindl MJ, Millar AM, Redhead DN, et al. The adaptive response of the reticuloendothelial system to major liver resection in humans. Ann Surg. 2006;243(4):507-514.

    Article  PubMed  Google Scholar 

  10. Van de Kerkhove MP, Hoekstra R, Chamuleau RAFM, Van Gulik TM. Clinical application of bioartificial liver support systems. Ann Surg. 2004;240:216-230.

    Article  PubMed  Google Scholar 

  11. Demetriou AA, Brown RS Jr, Busuttil RW, et al. Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Ann Surg. 2004;239(5):660-667, discussion 667-670.

    Article  PubMed  Google Scholar 

  12. Nanashima A, Yamaguchi H, Shibasaki S, et al. Measurement of serum hyaluronic acid level during the perioperative period of liver resection for evaluation of functional liver reserve. J Gastroenterol Hepatol. 2001;16(10):1158-1163.

    Article  PubMed  CAS  Google Scholar 

  13. Schneider PD. Preoperative assessment of liver function. Surg Clin North Am. 2004;84:355-373.

    Article  PubMed  Google Scholar 

  14. Nagashima I, Takada T, Okinaga K, et al. A scoring system for the assessment of the risk of mortality after partial hepatectomy in patients with chronic liver dysfunction. J Hepatobiliary Pancreat Surg. 2005;12:44-48.

    Article  PubMed  Google Scholar 

  15. Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC. Predictive indices of morbidity and mortality after liver resection. Ann Surg. 2006;243:373-379.

    Article  PubMed  Google Scholar 

  16. Paumgartner G. The handling of indocyanine green by the liver. Schweiz Med Wochenschr. 1975;105:1-30.

    PubMed  CAS  Google Scholar 

  17. Okuchi O, Kaneko T, Sugimoto H, Inoue S, Takeda S, Nakao A. ICG pulse spectrophotometry for perioperative liver function in hepatectomy. J Surg Res. 2002;103(1):109-113.

    Article  Google Scholar 

  18. Akita H, Sasaki Y, Yamada T, et al. Real-time intraoperative assessment of residual liver functional reserve using pulse dye densitrometry. World J Surg. 2008;32(12):2668-2674.

    Article  PubMed  Google Scholar 

  19. Cui Y, Konig J, Leier I, Buchholz U, Keppler D. Hepatic uptake of bilirubin and its conjugates by the human organic anion transporter SLC21A6. J Biol Chem. 2001;276:9626-9630.

    Article  PubMed  CAS  Google Scholar 

  20. Trauner M, Meier PJ, Boyer JL. Molecular pathogenesis of cholestasis. N Engl J Med. 1998;339:1217-1227.

    Article  PubMed  CAS  Google Scholar 

  21. Fan ST, Lai ECS, Lo CM, Ng IOL, Wong J. Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Arch Surg. 1995;130:198-203.

    Article  PubMed  CAS  Google Scholar 

  22. Watanabe Y, Kumon K. Assessment by pulse dye-densitometry indocyanine green (ICG) clearance test of hepatic function of patients before cardiac surgery: its value as a predictor of serious postoperative liver dysfunction. J Cardiothorac Vasc Anesth. 1999;13:299-303.

    Article  PubMed  CAS  Google Scholar 

  23. Lau H, Man K, Fan ST, et al. Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. Br J Surg. 1997;84:1255-1259.

    Article  PubMed  CAS  Google Scholar 

  24. Lam CM, Fan ST, Lo CM, Wong J. Major hepatectomy for hepatocellular carcinoma in patients with an unsatisfactory indocyanine green clearance test. Br J Surg. 1999;86:1012-1017.

    Article  PubMed  CAS  Google Scholar 

  25. Kwon AH, Ha-Kawa SK, Uetsuji S, Inoue T, Matsui Y, Kamiyama Y. Preoperative determination of the surgical procedure for hepatectomy using technetium-99 m-galactosyl human serum albumin (99mTc-GSA) liver scintigraphy. Hepatology. 1997;25:426-429.

    Article  PubMed  CAS  Google Scholar 

  26. Uesaka N, Nimura Y, Nagino M. Changes in hepatic lobar function after right portal vein embolization: an appraisal by biliary indocyanine green excretion. Ann Surg. 1996;223:77-83.

    Article  PubMed  CAS  Google Scholar 

  27. Chijiiwa K, Watanabe M, Nakano K, Noshiro H, Tanaka M. Biliary indocyanine green excretion as a predictor of hepatic adenosine triphosphate levels in patients with obstructive jaundice. Am J Surg. 2000;179:161-166.

    Article  PubMed  CAS  Google Scholar 

  28. Van Gulik TM, Van den Esschert JW, De Graaf W, et al. Controversies in the use of portal vein embolization (PVE). Dig Surg. 2008;25(6):436-444.

    Article  PubMed  Google Scholar 

  29. Wakabayashi H, Okada S, Maeba T, Maeta H. Effect of preoperative portal vein embolization on major hepatectomy for advanced-stage hepatocellular carcinomas in injured livers: a preliminary report. Surg Today. 1997;27:403-410.

    Article  PubMed  CAS  Google Scholar 

  30. De Graaf W, van den Esschert JW, van Lienden KP, van Gulik TM. Induction of tumor growth after preoperative portal vein embolization; is it a real problem? Ann Surg Oncol. 2009;16:423-430.

    Article  PubMed  Google Scholar 

  31. Akaki S, Mitsumori A, Kanazawa S, et al. Technetium-99 m-DTPA-galactosyl human serum albumin liver scintigraphy evaluation of regional CT/MRI attenuation/signal intensity differences. J Nucl Med. 1998;39:529-532.

    PubMed  CAS  Google Scholar 

  32. Sawamura T, Kawasato S, Shiozaki Y, et al. Decrease of a hepatic binding protein specific for asialoglycoproteins with accumulation of serum asialoglycoproteins in galactosamine-treated rats. Gastroenterology. 1981;81:527-533.

    PubMed  CAS  Google Scholar 

  33. Vera DR, Krohn KA, Stadalnik RC, et al. Tc-99 m-galactosyl-neoglycoalbumin: in vivo characterization of receptor-mediated binding to hepatocytes. Radiology. 1984;151:191-196.

    PubMed  CAS  Google Scholar 

  34. Kokudo N, Vera DR, Makuuchi M. Clinical application of TcGSA. Nucl Med Biol. 2003;30:845-849.

    Article  PubMed  CAS  Google Scholar 

  35. Sasaki N, Shiomi S, Iwata Y, et al. Clinical usefulness of scintigraphy with 99mTc-galactosyl-human serum albumin for prognosis of cirrhosis of the liver. J Nucl Med. 1999;40:1652-1656.

    PubMed  CAS  Google Scholar 

  36. Kwon AH, Ha-Kawa SK, Uetsuji S, et al. Use of technetium 99 m diethylenetriamine-pentaacetic acid-galactosyl-human serum albumin liver scintigraphy in the evaluation of preoperative and postoperative hepatic functional reserve for hepatectomy. Surgery. 1995;117:429-434.

    Article  PubMed  CAS  Google Scholar 

  37. Nanashima A, Yamaguchi H, Shibasaki S, et al. Relationship between indocyanine green test and technetium-99 m galactosyl serum albumin scintigraphy in patients scheduled for hepatectomy: clinical evaluation and patient outcome. Hepatol Res. 2004;28:184-190.

    Article  PubMed  Google Scholar 

  38. Mimura T, Hamazaki K, Sakai H, et al. Evaluation of hepatic functional reserve in rats with obstructive jaundice by asyaloglycoprotein receptor. Hepatogastroenterology. 2001;48:777-782.

    PubMed  CAS  Google Scholar 

  39. Tanaka A, Shinohara H, Hatano E, et al. Perioperative changes in hepatic function as assessed by asialoglycoprotein receptor indices by technetium 99 m galactosyl human serum albumin. Hepatogastroenterology. 1999;46:369-375.

    PubMed  CAS  Google Scholar 

  40. Mitsumori A, Nagaya I, Kimoto S, et al. Preoperative evaluation of hepatic functional reserve following hepatectomy by technetium-99 m galactosyl human serum albumin liver scintigraphy and computed tomography. Eur J Nucl Med. 1998;25:1377-1382.

    Article  PubMed  CAS  Google Scholar 

  41. Kwon AH, Matsui Y, Ha-Kawa SK, et al. Functional hepatic volume measured by technetium-99 m-galactosyl-human serum albumin liver scintigraphy: comparison between hepatocyte volume and liver volume by computed tomography. Am J Gastroenterol. 2001;96:541-546.

    Article  PubMed  CAS  Google Scholar 

  42. Kim YK, Nakano H, Yamaguchi M, et al. Prediction of postoperative decompensated liver function by technetium-99 m galactosyl-human serum albumin liver scintigraphy in patients with hepatocellular carcinoma complicating chronic liver disease. Br J Surg. 1997;84:793-796.

    Article  PubMed  CAS  Google Scholar 

  43. Takeuchi S, Nakano H, Kim YK, et al. Predicting survival and post-operative complications with Tc-GSA liver scintigraphy in hepatocellular carcinoma. Hepatogastroenterology. 1999;46:1855-1861.

    PubMed  CAS  Google Scholar 

  44. Kokudo N, Vera DR, Tada K, et al. Predictors of successful hepatic resection: prognostic usefulness of hepatic asialoglycoprotein receptor analysis. World J Surg. 2002;26:1342-1347.

    Article  PubMed  Google Scholar 

  45. Satoh K, Yamamoto Y, Nishiyama Y, et al. 99mTc-GSA liver dynamic SPECT for the preoperative assessment of hepatectomy. Ann Nucl Med. 2003;17:61-67.

    Article  PubMed  Google Scholar 

  46. Akaki S, Okumura Y, Sasai N, et al. Hepatectomy ­simulation discrepancy between radionuclide receptor imaging and CT volumetry: influence of decreased unilateral portal venous flow. Ann Nucl Med. 2003;17:23-29.

    Article  PubMed  Google Scholar 

  47. Hirai I, Kimura W, Fuse A, et al. Evaluation of preoperative portal embolization for safe hepatectomy, with special reference to assessment of nonembolized lobe function with 99mTc-GSA SPECT scintigraphy. Surgery. 2003;133:495-506.

    Article  PubMed  Google Scholar 

  48. Kwon AH, Matsui Y, Kaibori M, et al. Functional hepatic regeneration following hepatectomy using galactosyl-human serum albumin liver scintigraphy. Transplant Proc. 2004;36:2257-2260.

    Article  PubMed  Google Scholar 

  49. Hwang EH, Taki J, Shuke N, et al. Preoperative assessment of residual hepatic functional reserve using 99mTc-DTPA-Galacttosyl-human serum albumin dynamic SPECT. J Nucl Med. 1999;40(10):1644-1651.

    PubMed  CAS  Google Scholar 

  50. Sugai Y, Komatani A, Hosoya T, et al. Response to percutaneous transhepatic portal embolization: new proposed parameters by 99mTc-GSA SPECT and their usefulness in prognostic estimation after hepatectomy. J Nucl Med. 2000;41:421-425.

    PubMed  CAS  Google Scholar 

  51. Kubo S, Shiomi S, Tanaka H, et al. Evaluation of the effect of portal vein embolization on liver function by (99 m)tc-galactosyl human serum albumin scintigraphy. J Surg Res. 2002;107:113-118.

    PubMed  Google Scholar 

  52. Nishiyama Y, Yamamoto Y, Hino I, et al. 99mTc galactosyl human serum albumin liver dynamic SPET for pre-operative assessment of hepatectomy in relation to percutaneous transhepatic portal embolization. Nucl Med Commun. 2003;24:809-817.

    Article  PubMed  CAS  Google Scholar 

  53. Nanashima A, Yamaguchi H, Shibasaki S, et al. Relationship between CT volumetry and functional liver volume using technetium-99 m galactosyl serum albumin scintigraphy in patients undergoing preoperative portal vein embolization before major hepatectomy: a preliminary study. Dig Dis Sci. 2006;51:1190-1195.

    Article  PubMed  Google Scholar 

  54. Krishnamurthy S, Krishnamurthy GT. Technetium-99 m-iminodiacetic acid organic anions: review of biokinetics and clinical application in hepatology. Hepatology. 1989;9:139-153.

    Article  PubMed  CAS  Google Scholar 

  55. Hendrikse NH, Kuipers F, Meijer C, et al. In vivo imaging of hepatobiliary transport function mediated by multidrug resistance associated protein and P-glycoprotein. Cancer Chemother Pharmacol. 2004;54:131-138.

    Article  PubMed  CAS  Google Scholar 

  56. Krishnamurthy S, Krishnamurthy GT, Lieberman D, et al. Scintigraphic criteria for the diagnosis of obstructive hepatobiliary diseases with Tc-99 m IDA. Clin Nucl Med. 1988;13:704-709.

    Article  PubMed  CAS  Google Scholar 

  57. Krishnamurthy GT, Lieberman DA, Brar HS. Detection, localization and quantitation of degree of common bile duct obstruction by scintigraphy. J Nucl Med. 1985;26:726-735.

    PubMed  CAS  Google Scholar 

  58. Heyman S. Hepatobiliary scintigraphy as a liver function test. J Nucl Med. 1994;35:436-437.

    PubMed  CAS  Google Scholar 

  59. Krishnamurthy GT, Krishnamurthy S. Nuclear Hepatology: A Textbook of Hepatobiliary Diseases. Berlin/Heidelberg/New York: Springer; 2000.

    Google Scholar 

  60. Lan JA, Chervu LR, Johansen KL, et al. Uptake of technetium 99 m hepatobiliary imaging agents by cultured rat hepatocytes. Gastroenterology. 1988;95:1625-1631.

    PubMed  CAS  Google Scholar 

  61. Ekman M, Fjalling M, Holmberg S, et al. IODIDA clearance rate: a method for measuring hepatocyte uptake function. Transplant Proc. 1992;24:387-388.

    PubMed  CAS  Google Scholar 

  62. Bennink RJ, Dinant S, Erdogan D, et al. Preoperative assessment of postoperative remnant liver function using hepatobiliary scintigraphy. J Nucl Med. 2004;45:965-971.

    PubMed  Google Scholar 

  63. Erdogan D, Heijnen BHM, Bennink RJ, et al. Preoperative assessment of liver function: a comparison of 99mTc-Mebrofenin scintigraphy with indocyanine green clearance test. Liver Int. 2004;24:117-123.

    Article  PubMed  CAS  Google Scholar 

  64. Dinant S, de Graaf W, Verwer BJ, et al. Risk assessment of posthepatectomy liver failure using hepatobiliary scintigraphy and CT volumetry. J Nucl Med. 2007;48(5):685-692.

    Article  PubMed  Google Scholar 

  65. Mori K, Ozawa K, Yamamoto Y, et al. Response of hepatic mitochondrial redox state to oral glucose load. Redox tolerance test as a new predictor of surgical risk in hepatectomy. Ann Surg. 1990;211(4):438-446.

    Article  PubMed  CAS  Google Scholar 

  66. Mann DV, Lam WW, Hjelm NM, et al. Metabolic control patterns in acute phase and regenerating human liver determined in vivo by 31-phosphorus magnetic resonance spectroscopy. Ann Surg. 2002;235(3):408-416.

    Article  PubMed  Google Scholar 

  67. Mann DV, Lam WW, Hjelm NM, et al. Human liver regeneration: hepatic energy economy is less efficient when the organ is diseased. Hepatology. 2001;34(3):557-565.

    Article  PubMed  CAS  Google Scholar 

  68. Armuzzi A, Candelli M, Zocco MA, et al. Review article: breath testing for human liver function assessment. Aliment Pharmacol Ther. 2002;16(12):1977-1996.

    Article  PubMed  CAS  Google Scholar 

  69. Herold C, Heinz R, Niedobitek G, Schneider T, Hahn EG, Schuppan D. Quantitative testing of liver function in relation to fibrosis in patients with chronic hepatitis B and C. Liver. 2001;21(4):260-265.

    Article  PubMed  CAS  Google Scholar 

  70. Redaelli CA, Dufour JF, Wagner M, et al. Preoperative galactose elimination capacity predicts complications and survival after hepatic resection. Ann Surg. 2002;235(1):77-85.

    Article  PubMed  Google Scholar 

  71. Marchesini G, Bua V, Brunori A, et al. Galactose ­elimination capacity and liver volume in aging man. Hepatology. 1988;8(5):1079-1083.

    Article  PubMed  CAS  Google Scholar 

  72. Jover R, Carnicer F, Sanchez-Paya J, et al. Salivary caffeine clearance predicts survival in patients with liver cirrhosis. Am J Gastroenterol. 1997;92:1905-1908.

    PubMed  CAS  Google Scholar 

  73. Ercolani G, Grazi GL, Callivà R, et al. The lidocaine (MEGX) test as an index of hepatic function: its clinical usefulness in liver surgery. Surgery. 2000;127(4):464-471.

    Article  PubMed  CAS  Google Scholar 

  74. Huang YS, Chiang J, Wu J, Chang F, Lee S. Risk of hepatic failure after transcatheter arterial chemoembolization for hepatocellular carcinoma: predictive value of the monoethylglycinexylidide test. Am J Gastroenterol. 2002;97:1223-1227.

    Article  PubMed  Google Scholar 

  75. Oellerich M, Armstrong VW. The MEGX test: a tool for the real-time assessment of hepatic function. Ther Drug Monit. 2001;23:81-92.

    Article  PubMed  CAS  Google Scholar 

  76. Oellerich M, Burdelski M, Ringe B, et al. Functional state of the donor liver and early outcome of transplantation. Transplant Proc. 1991;23:1575-1578.

    PubMed  CAS  Google Scholar 

  77. Nonami T, Nakao A, Kurokawa T, et al. Blood loss and ICG clearance as best prognostic markers of post-hepatectomy liver failure. Hepatogastroenterology. 1999;46:1669-1672.

    PubMed  CAS  Google Scholar 

  78. Onodera Y, Takahashi K, Togashi T, Sugai Y, Tamaki N, Miyasaka K. Clinical assessment of hepatic functional reserve using 99mTc DTPA galactosyl human serum albumin SPECT to prognosticate chronic hepatic diseases–­validation of the use of SPECT and a new indicator. Ann Nucl Med. 2003;17:181-188.

    Article  PubMed  Google Scholar 

  79. Torzilli G, Makuuchi M, Inoue K, et al. No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients: is there a way? A prospective analysis of our approach. Arch Surg. 1999;134(9):984-992.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, NL-1105AZ, The Netherlands

    Thomas M. van Gulik

  2. Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Wilmar de Graaf M.D., Ph.D

  3. Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Roelof J. Bennink Ph.D.

Authors
  1. Thomas M. van Gulik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wilmar de Graaf M.D., Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roelof J. Bennink Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas M. van Gulik .

Editor information

Editors and Affiliations

  1. New York-Presbyterian Hospital, New York, 10032, New York, USA

    David C. Madoff

  2. University of Tokyo, Hongo 7-3-1, Tokyo, 113-8656, Japan

    Masatoshi Makuuchi

  3. School of Medicine, Dept. Surgery I, Nagoya University, Tsurumai-cho 65, Nagoya, Aichi-ken, 466-8550, Japan

    Masato Nagino

  4. M.D. Anderson Cancer Center, Dept. Surgical Oncology, University of Texas, Holcombe Blvd. 1515, Houston, 77030, Texas, USA

    Jean-Nicolas Vauthey

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag London Limited

About this chapter

Cite this chapter

van Gulik, T.M., de Graaf, W., Bennink, R.J. (2011). Preoperative Assessment with Functional Studies of the Liver. In: Madoff, D., Makuuchi, M., Nagino, M., Vauthey, JN. (eds) Venous Embolization of the Liver. Springer, London. https://doi.org/10.1007/978-1-84882-122-4_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-122-4_12

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-121-7

  • Online ISBN: 978-1-84882-122-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation