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

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.

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.

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).

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.