Accuracy and significance of computed tomographic scan assessment of hepatic volume in patients undergoing liver transplantation
Accuracy and significance of computed tomographic scan assessment of hepatic volume in patients undergoing liver transplantation
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DOI：
10.1097/00007890-200002270-00014
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发表时间：
2000-02-27
期刊：
影响因子：
6.2
通讯作者：
Min, AD
中科院分区：
文献类型：
--
作者：
Schiano, TD;Bodian, C;Min, AD
背景资料。肝体积小被认为是肝硬变预后不良的因素，通常是晚期肝病的征兆。许多移植中心在肝移植前常规进行肝脏体积的放射学评估。我们试图评估CT扫描在肝脏体积分析中的准确性和意义，将CT得出的肝脏体积估计值与相应的肝脏移植组织的体积估计值进行关联。对至1995年间在西奈山医学中心接受肝移植的所有17岁或17岁以上的患者进行了图表回顾。所有患者均接受常规CT扫描并测量肝脏体积(CTLV)。受体肝体积(RLV)定义为切除所有附着的韧带、门静脉结构和胆囊后肝移植块的重量。移植前根据年龄、性别、身高和体重计算预期肝脏体积。根据肝病的病因将患者分为三组：(1)肝细胞性(例如，病毒性肝炎，与酒精有关)，(2)胆汁淤积性(例如，原发性胆汁性肝硬变)，(3)隐源性。用CTLV与RLV的比值作为衡量CT容积分析准确性的指标。共研究579例患者(组1=376例，组2=139例，组3=)。在年龄、凝血酶原时间和总胆红素方面，三组患者的年龄、凝血酶原时间和总胆红素在统计学上相似。第1~3组肝体积中位数分别为1308ml(338~3847)、1651ml(641~3861)和1210ml(348~2575)，CTLV/RLV比值中位数分别为1.02(0.50~2.31)、1.05(0.52~2.22)和1.05(0.50~1.56)。当RLV较小时，CTLV往往高估RLV。相比之下，当RLV很大时，它往往被低估。食道静脉曲张出血病史、脑病或腹水病史、实验室检查等临床特征不影响CT容量分析的准确性。不管慢性肝病的病因是什么，CT对肝脏体积的估计似乎与肝移植块的实际重量密切相关。在CT体积分析的极端情况下，实际肝脏体积往往被低估或高估。对于终末期肝病患者，胆汁淤积症患者的CT和实际肝脏体积均大于肝细胞疾病患者。
Background. A small liver volume is considered to be a poor prognostic factor in cirrhosis, often indicative of advanced liver disease. Radiologic assessment of liver volume before liver transplant is routinely performed in many transplant centers. We sought to assess the accuracy and significance of computed tomographic (CT) scanning in hepatic volumetric analysis by correlating CT-derived estimation of liver volume with that of corresponding liver explants.Methods. A chart review of all patients aged 17 years or older undergoing liver transplant at Mount Sinai Medical Center between 1989 and 1995 was performed. Each patient underwent conventional CT scanning with measurement of liver volume (CTLV). Recipient liver volume (RLV) was defined as weight of liver explant after all attached ligaments, portal structures, and gallbladder were dissected free. Expected liver volume was calculated pretransplant based on age, gender, height, and weight. Patients were categorized into three groups based on etiology of liver disease: (1) hepatocellular (e.g., viral hepatitis, alcohol-related), (2) cholestatic (e.g., primary biliary cirrhosis), and (3) cryptogenic. The ratio of CTLV to RLV was used as a measure of the accuracy of CT volumetric analysis.Results. A total of 579 patients was studied (group 1=376, group 2=139, group 3=64). All three groups were statistically similar with regard to age, prothrombin time and total bilirubin. Median CT liver volume was 1308 ml (range: 338-3847), 1651 ml (range: 641-3861), and 1210 ml (range: 348-2575) in groups 1-3, respectively; median ratio of CTLV to RLV was 1.02 (range: 0.50-2.31), 1.05 (range: 0.52-2.22), and 1.05 (range: 0.50-1.56) for groups 1-3, respectively. When RLV was small, it tended to be overestimated by CTLV. In contrast, when RLV was large, it was often underestimated. Clinical features such as history of esophageal variceal bleed, encephalopathy or ascites, and laboratory data did not influence accuracy of CT volumetric analysis.Conclusions. CT-derived estimation of liver volume appears to correlate closely with actual weight of liver explant regardless of the etiology of chronic liver disease. With extremes in CT volumetric analysis, actual liver volume tends to be under- or overestimated. For patients with end-stage liver disease, both CT-derived and actual liver volume are greater in cholestatic than in hepatocellular disorders.