Fast and accurate liver volumetry prior to hepatectomy

Background: Volumetric assessment of the liver is essential in the prevention of postresectional liver failure after partial hepatectomy. Currently used methods are accurate but time-consuming. This study aimed to test a new automated method for preoperative volumetric liver assessment. Methods: Patients who underwent a contrast enhanced portovenous phase CT-scan prior to hepatectomy in 2012 were included. Total liver volume (TLV) and future remnant liver volume (FRLV) were measured using TeraRecon Aquarius iNtuition (R) (autosegmentation) and OsiriX (R) (manual segmentation) software by two observers for each software package. Remnant liver volume percentage (RLV%) was calculated. Time needed to determine TLV and FRLV was measured. Inter-observer variability was assessed using Bland-Altman plots. Results: Twenty-seven patients were included. There were no significant differences in measured volumes between OsiriX (R) and iNtuition (R). Moreover, there were significant correlations between the OsiriX (R) observers, the iNtuition (R) observers and between OsiriX (R) and iNtuition (R) post-processing systems (all R-2 > 0.97). The median time needed for complete liver volumetric analysis was 18.4 +/- 4.9 min with OsiriX (R) and 5.8 +/- 1.7 min using iNtuition (R) (p <0.001). Conclusion: Both OsiriX (R) and iNtuition (R) liver volumetry are accurate and easily applicable. However, volumetric assessment of the liver with iNtuition (R) auto-segmentation is three times faster compared to manual OsiriX (R) volumetry.