Mitsuo Shimada, MD, Shuichi Iwahashi, MD, Yuji Morine, MD, Satoru Imura, MD, Tetsuya Ikemoto, MD, Yu Saito, MD, Hiroki Teraoku, MD, Jun Higashijima, MD. Tokushima University
Aim: We have reported a possibility of “One-stop shop” simulation for liver surgery by MRI using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB-MRI) (Emerging technology, SAGES 2017)., which is characterized by (1) one-time examination, (2) no-radiation exposure, (3) demonstration of liver vasculatures including biliary tract, (4) diagnosis of tumors, (5) volumetry and (6) estimation of liver functional reserve in each segment. The aim of this study is to investigate usefulness of “One-stop shop” simulation for liver surgery using EOB-MRI.
Methods:
Accuracy of liver vasculatures: 3D-reconstruction of dynamic EOB-MRI imaging was done by SYNAPSE VINCENT software (FUJIFILM Medical Co., Ltd., Japan), using a manual tracing method. Visualization of hepatic vessels in EOB-MRI was compared with that in dynamic CT in 10 patients.
Assessment of liver functional reserve: The standardized signal intensity (SI) of each segment was calculated by SI of each segment divided by SI of the right erector spine muscle. The standardized total liver functional volume (TLFV) was calculated by ∑ [k=1 to 8] (standardized SI of segment (k) × volume of segment (k)) divided by body surface area. The following formula of resection limit was established using 28 normal liver cases (70% of the liver is resectable) and 5 unresectable cirrhotic patients such as recipients of liver transplantation (0% of the liver is resectable). The estimated resection limit (%) = 70% × (the standardized TLFV of the patient – 962)/1,076. This formula was validated using other 30 patients who underwent hepatectomy.
Results:
Accuracy of liver vasculatures: The liver simulation by EOB-MRI succeeded in demonstrating hepatic vasculatures including biliary tract, diagnosis of hepatic tumors, and volumetry without any radiation exposure. Regarding the vessel anatomy at hilar area, biliary tract was more clearly visualized in EOB-MRI. Regarding the hepatic artery, right and left hepatic arteries were well visualized in all cases, however, small-sized middle hepatic artery was visualized in only one out of 10 patients.
Assessment of liver functional reserve: As a result of validation of the 30 patients, one patient having resection volume with over the resection limit died of liver failure, however, the other 29 cases within their resection limits did not suffer from liver failure.
Conclusion: “One-stop shop” liver surgery simulation could contribute to safety of liver surgery such as laparoscopic hepatectomy, because of no radiation exposure, accurate assessment of anatomical variations especially biliary tract, and helping decision making of resection volume.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86744
Program Number: P294
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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