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Assessing the Non-tumorous Liver: Implications for Patient Management and Surgical Therapy

Journal of Gastrointestinal Surgery volume 22, pages 344–360 (2018)Cite this article

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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Affiliations

  1. Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA

    Pallavi Pandey, Ankur Pandey & Ihab R. Kamel

  2. Department of Surgery, The Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Mary Dillhoff, Carl Schmidt & Timothy M. Pawlik

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  1. Pallavi Pandey
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  2. Ankur Pandey
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Supplemental Figure 1.
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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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Keywords

  • Liver
  • Non-tumorous
  • Steatosis
  • Fibrosis
  • Imaging