Liver volumetry software: a narrative review of technical performance and clinical utility

Liver volumetry (LV) is essential in preoperative planning for liver resection and living donor liver transplantation, particularly in extended resections, where minimizing the risk of post-hepatectomy liver failure (PHLF) and ensuring donor safety are pivotal. Several software platforms have been developed to support LV, employing different segmentation techniques, from manual to semi-automated and fully automated, based on contrast-enhanced computed tomography (CT) or, less frequently, magnetic resonance imaging.

Manual tracing remains the reference standard but it is limited by high operator dependency, long execution times, and low reproducibility. Semi-automated tools reduce user variability and shorten processing time. Synapse has shown no evident learning curve, while Syngo.via requires user training. Hermes, integrating functional data from SPECT, offers superior prediction of PHLF but less precise correlation with actual graft weight in living donor liver transplantation. Automated platforms such as LiverVision, Myrian XP-Liver, and Vitrea have demonstrated strong agreement with manual or graft weight references and shorter execution times. However, most tools still require manual contouring, particularly for anatomical delineation and exclusion of vessels or biliary structures. Fully automated tools such as LISA remain experimental and lack clinical validation. Software comparison remains challenging and limited due to the absence of standardized validation protocols, metrics variations across studies, and the predominance of proprietary conditions.

The aim of this narrative review is to summarize the available features, performances and clinical applicability of 11 widely used LV tools. While emerging evidence supports their clinical utility, further multicenter studies using standardized methodologies are needed to clarify their relative advantages and promote consistent use in surgical practice.