Abstract
Introduction
Hepatic resection is performed for various benign and malignant liver tumors. Over the last several decades, there have been improvements in the surgical technique and postoperative care of patients undergoing liver surgery. Despite this, liver failure following an extended hepatic resection remains a critical potential postoperative complication. Patients with underlying parenchymal liver diseases are at particular risk of liver failure due to impaired liver regeneration with an associated mortality risk as high as 60 to 90%. In addition, live donor liver transplantation requires a thorough presurgical assessment of the donor liver to minimize the risk of postoperative complications.
Results and Conclusion
Recently, cross-sectional imaging assessment of diffuse liver diseases has gained momentum due to its ability to provide both anatomical and functional assessments of normal and abnormal tissues. Various imaging techniques are being employed to assess diffuse liver diseases including magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound (US). MRI has the ability to detect abnormal intracellular and molecular processes and tissue architecture. CT has a high spatial resolution, while US provides real-time imaging, is inexpensive, and readily available. We herein review current state-of-the-art techniques to assess the underlying non-tumorous liver. Specifically, we summarize current approaches to evaluating diffuse liver diseases including fatty liver alcoholic or non-alcoholic (NAFLD, AFLD), hepatic fibrosis (HF), and iron deposition (ID) with a focus on advanced imaging techniques for non-invasive assessment along with their implications for patient management. In addition, the role of and techniques to assess hepatic volume in hepatic surgery are discussed.
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Abbreviations
- HR:
-
Hepatic resection
- LF:
-
Liver failure
- LT:
-
Liver transplantation
- LDLT:
-
Living donor liver transplantation
- NAFLD:
-
Non-alcoholic fatty liver disease
- AFLD:
-
Alcoholic fatty liver disease
- HF:
-
Hepatic fibrosis
- ID:
-
Iron deposition
- MRI:
-
Magnetic resonance imaging
- CT:
-
Computed tomography
- US:
-
Ultrasound
- HS:
-
Hepatic steatosis
- DM:
-
Diabetes mellitus
- SH:
-
Steatohepatitis
- NASH:
-
Non-alcoholic steatohepatitis
- MRS:
-
Magnetic resonance spectroscopy
- FSE:
-
Fast spin echo
- SE:
-
Spin echo
- CSI:
-
Chemical shift imaging
- ALT:
-
Alanine transaminase
- AST:
-
Aspartate transaminase
- HCV:
-
Hepatitis C virus
- TE:
-
Transient elastography
- ALD:
-
Alcoholic liver disease
- ARFI:
-
Acoustic radiation force impulse
- AUC:
-
Area under curve
- MRE:
-
Magnetic resonance elastography
- APRI:
-
Aspartate transaminase to platelet ratio index
- ROI:
-
Region of interest
- USE:
-
Ultrasound elastography
- CLD:
-
Chronic liver disease
- HTN:
-
Hypertension
- OLT:
-
Orthotopic liver transplant
- PH:
-
Primary hemochromatosis
- SH:
-
Secondary hemochromatosis
- TS:
-
Transferrin saturation
- SIR:
-
Signal intensity ratio
- HIC:
-
Hepatic iron concentration
- CI:
-
Confidence interval
- FLR:
-
Future liver remnant
- CTV:
-
Computed tomography volumetry
- ICC:
-
Intraclass coefficient
- SLV:
-
Standard liver volume
- BW:
-
Body weight
- BSA:
-
Body surface area
- SAIP:
-
Software-assisted image postprocessing
- ICG:
-
Indocyanine green
- sFLR:
-
Standard future liver remnant
- ICU:
-
Intensive care unit
- PVE:
-
Portal vein embolization
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Supplemental Figure 1.
Assessment of liver function for safe hepatic resection using clinical, laboratory, and ICG parameters. Used with permission M. Makuuchi, T. Kosuge, T. Takayama, S. Yamazaki, T. Kakazu, S. Miyagawa, S. Kawasaki, 1993 Surgery for Small Liver Cancers. Semin Surg Oncol 9 4 298 304 (GIF 106 kb)
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Pandey, P., Pandey, A., Dillhoff, M. et al. Assessing the Non-tumorous Liver: Implications for Patient Management and Surgical Therapy. J Gastrointest Surg 22, 344–360 (2018). https://doi.org/10.1007/s11605-017-3562-3
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DOI: https://doi.org/10.1007/s11605-017-3562-3