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      Lobar and segmental liver atrophy associated with hilar cholangiocarcinoma and the impact of hilar biliary anatomical variants: a pictorial essay

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          Abstract

          The radiological features of lobar and segmental liver atrophy and compensatory hypertrophy associated with biliary obstruction are important to recognise for diagnostic and therapeutic reasons. Atrophied lobes/segments reduce in volume and usually contain crowded dilated bile ducts extending close to the liver surface. There is often a “step” in the liver contour between the atrophied and non-atrophied parts. Hypertrophied right lobe or segments enlarge and show a prominently convex or “bulbous” visceral surface. The atrophied liver parenchyma may show lower attenuation on pre-contrast computed tomography (CT) and CT intravenous cholangiography (CT-IVC) and lower signal intensity on T1-weighted magnetic resonance imaging (MRI). Hilar biliary anatomical variants can have an impact on the patterns of lobar/segmental atrophy, as the cause of obstruction (e.g. cholangiocarcinoma) often commences in one branch, leading to atrophy in that drainage region before progressing to complete biliary obstruction and jaundice. Such variants are common and can result in unusual but explainable patterns of atrophy and hypertrophy. Examples of changes seen with and without hilar variants are presented that illustrate the radiological features of atrophy/hypertrophy.

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          Liver segmentation in living liver transplant donors: comparison of semiautomatic and manual methods.

          To compare the accuracy and repeatability of a semiautomatic segmentation algorithm with those of manual segmentation for determining liver volume in living liver transplant donors at magnetic resonance (MR) imaging. The institutional review board approved this retrospective study and waived the requirement for informed consent. The semiautomatic segmentation algorithm is based on geometric deformable models and the level-set technique. It entails (a) placing initialization circle(s) on each image section, (b) running the algorithm, (c) inspecting and possibly manually modifying the contours obtained with the segmentation algorithm, and (d) placing lines to separate the liver segments. For 18 living donors (eight men and 10 women; mean age, 34 years; age range, 25-46 years), two observers each performed two semiautomatic and two manual segmentations on contrast material-enhanced T1-weighted MR images. Each measurement was timed. Actual graft weight was measured during surgery. The time needed for manual and that needed for semiautomatic segmentation were compared. Accuracy and repeatability were evaluated with the Bland-Altman method. Mean interaction time was reduced from 25 minutes with manual segmentation to 5 minutes with semiautomatic segmentation. The mean total time for the semiautomatic process was 7 minutes 20 seconds. Differences between the actual volume and the estimated volume ranged from -223 to +123 mL for manual segmentation and from -214 to +86 mL for semiautomatic segmentation. The 95% limits of agreement for the ratio of actual graft volume to estimated graft volume were 0.686 and 1.601 for semiautomatic segmentation and 0.651 and 1.957 for manual segmentation. Semiautomatic segmentation improved estimation in 15 of 18 cases. Inter- and intraobserver repeatability was higher with semiautomatic segmentation. Use of the semiautomatic segmentation algorithm substantially reduces the time needed for volumetric measurement of liver segments while improving both accuracy and repeatability. (c) RSNA, 2004
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            Preoperative measurement of segmental liver volume of donors for living related liver transplantation.

            Segmental liver volume determination by computed tomographic scan was carried out preoperatively in nine donors for living related liver transplantation. The calculated volume was compared with the graft size actually obtained by three types of donor hepatectomy. The volume of the left lateral segment (175 to 241 ml) and the left lobe (310 to 490 ml) varied markedly among the donors. The ratio of the left lobar to total liver volume also showed a wide range of values (23.2% to 35.9%). The value of the left lobar volume did not correlate positively with the donor's body weight, suggesting that graft size cannot be predicted only on the basis of the donor's body size. Segmental graft liver volume was estimated by use of computed tomographic scan, with acceptable accuracy on comparison with the graft volume actually obtained. In living related liver transplantation, the type of donor hepatectomy should be selected on the basis of the segmental liver volume of the donor in addition to the recipient's body size so that liver failure can be prevented in recipients and the donor's safety can be assured as far as possible.
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              Hepatic lobar atrophy: association with ipsilateral portal vein obstruction.

              This study was performed to evaluate the association between hepatic lobar atrophy, bile duct obstruction, and portal vein obstruction. Thirty cases of hepatic lobar atrophy identified on angiography with CT during arterial portography from August 1992 to March 1995 were retrospectively reviewed by two independent observers. Cases were evaluated for vascular patency and bile duct obstruction. Malignant diagnoses were present in 28 of 30 patients. Twenty-two patients (73%) had atrophy in the left lobe and eight patients (27%) had right lobar atrophy. Portal vein obstruction was unilateral and confined to the atrophic lobe in 26 patients (87%). In contrast, bile duct obstruction was bilateral in 23 patients (77%) and in only four patients (13%) was it isolated to the atrophic lobe. The correlation between atrophy and portal vein obstruction was significant, with 90% sensitivity, 97% specificity, and 96% positive predictive value (p < .00001). For the correlation between atrophy and biliary obstruction, the sensitivity of angiography with CT during arterial portography was 90%, specificity was 23%, and positive predictive value was 54% (p = .17). Hepatic lobar atrophy usually occurs in the setting of combined biliary and portal vein obstruction. A significant correlation exists between hepatic lobar atrophy and ipsilateral portal vein obstruction.
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                Author and article information

                Contributors
                Brendon.Friesen@southernhealth.org.au
                Journal
                Insights Imaging
                Insights Imaging
                Insights into Imaging
                Springer-Verlag (Berlin/Heidelberg )
                1869-4101
                26 May 2011
                26 May 2011
                October 2011
                : 2
                : 5
                : 525-531
                Affiliations
                [1 ]Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria 3050 Australia
                [2 ]Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria 3050 Australia
                [3 ]Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria 3050 Australia
                [4 ]Department of Diagnostic Imaging, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168 Australia
                Article
                100
                10.1007/s13244-011-0100-9
                3259339
                22347972
                d5ff09fb-e97c-429e-a349-7c12eb991955
                © European Society of Radiology 2011
                History
                : 1 December 2010
                : 19 February 2011
                : 2 May 2011
                Categories
                Pictorial Review
                Custom metadata
                © European Society of Radiology 2011

                Radiology & Imaging
                hypertrophy,liver,atrophy,cholestasis,bile duct diseases
                Radiology & Imaging
                hypertrophy, liver, atrophy, cholestasis, bile duct diseases

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