The mechanical response of human liver and its relation to histology: an in vivo study

The mechanical response of human liver is characterized in vivo by means of intra-operative aspiration experiments. Mechanical characterization is combined with histological evaluation of liver tissue biopsies obtained from the resected liver at the site of mechanical testing. This procedure enables a quantitative analysis of the correlation between mechanical response and tissue micro-structure of normal and diseased liver. Ten organs were tested in vivo at multiple locations, as well as ex vivo immediately after resection. Biopsies were analyzed in terms of pathology and percentage of connective tissue content. The change of the mechanical parameters from in vivo to ex vivo has been determined, with an increase of 17% of the proposed stiffness index. The relationship between mechanical parameters and various pathologic conditions affecting the tissue samples has been quantified, with fibrosis leading to a response up to three times stiffer as compared with normal tissue. Increased stiffness can be detected by digital palpation (increased "consistency") and may suggest the presence of a tumor. The present observations suggest that stiffness increase cannot be attributed to the tumoral tissue itself, but rather to the fibrotic stroma that often arise within or adjacent to the tumor. Variation of the mechanical parameters as a function of connective tissue content has been evaluated based on the histological examinations and the results confirm a direct proportionality between stiffness index and connective tissue percentage. The approach described here might eventually lead to a diagnostic procedure and complement other clinical methods, like palpation and ultrasound examination of the liver.