Assessment of hepatic functional reserve by cirrhosis grading and liver volume measurement using CT.

Aim: To explore a method for quantitative assessment of hepatic functional reserve by combining computed tomography (CT) volumetry with CT grading of liver cirrhosis before liver resection in patients with hepatocellular carcinoma.

Methods: CT images of 55 patients undergoing liver resection were studied prospectively. The degree of liver cirrhosis was referred as "CT grade" and the percentage of remnant liver volume (PRLV) [PRLV = predicted RLV/predicted total liver volume (PTLV) multiply 100%; PTLV (mL) = 121.75 + 16.49 multiply body mass (kg)] were calculated by adding slice by slice of CT liver images. The postoperative RLV, pathologic stages of liver fibrosis in non-tumor area and survival time in these cases were analyzed.

Results: There was a significant difference in survival time between the group with PRLV <= 50% and the group with PRLV > 50% (c2 = 4.988, P = 0.026), and between the group with CT grade 0/1 and the group with CT grade 2/3 (c2 = 5.429, P = 0.026). With combination of the both parameters, an oblique line was identified according to the distribution of 32 survivors versus 23 deceased subjects. The mortality rate above the line was 7.1% (1/14), and that below the line was 53.7% (22/41), indicating a significant difference between the two rates (c2 = 9.281, P = 0.002, P < 0.05).

Conclusion: PRLV and CT grades are significantly correlated with hepatic functional reserve. The predicted line using these two parameters is useful in candidates undergoing liver resection for judging hepatic functional reserve.