Overview
This lecture discusses the measurement of liver volume in cirrhotic portal hypertensive patients using double helix-spiral CT, its correlation with clinical parameters, and its clinical significance in predicting surgical outcomes.
Clinical Importance of Liver Volume Measurement
- Accurate assessment of liver reserve in cirrhosis is key for surgical decisions and prognosis evaluation.
- Liver volume measurement is as clinically relevant as Child’s classification for assessing hepatic function.
- Technological advancements now allow in vivo liver volume measurement via double helix-spiral CT.
Study Methods
- 25 cirrhotic portal hypertensive patients and 30 controls were studied.
- Liver volume measured with double helix-spiral CT and 3D imaging software.
- Portal-systemic shunting rate was assessed using radiolabeled tracer and imaging.
- Portal vein flow measured by Doppler ultrasound; portal pressure by venous centesis.
Results and Correlations
- Average liver volume in controls: ~1071 cm³; in cirrhotic patients: ~797 cm³ (significantly reduced, p<0.05).
- Liver volume positively correlated with height but not with body weight in adults.
- Lower liver volumes were associated with higher Child class (worse liver function), especially significant between Child B and Child C.
- No significant correlation between liver volume and portal-systemic shunt index, portal flow, or portal pressure.
- Cirrhotic patients with liver volume <750 cm³ had higher rates of postoperative encephalopathy and one-year mortality after portal-caval shunt surgery.
Clinical Implications
- Liver volume is an objective marker of hepatic reserve and aids in surgical planning.
- Patients with very low liver volume (<750 cm³) have increased risk after shunt procedures.
- Liver volume should be considered alongside Child’s classification for surgical decision-making.
Key Terms & Definitions
- Cirrhotic Portal Hypertension — High blood pressure in the portal vein system due to liver cirrhosis.
- Liver Volume — The total size of the liver, measured here by 3D CT imaging.
- Child’s Classification — A scoring system to assess severity of liver disease.
- Portal-Systemic Shunting Index (SI) — Ratio measuring how much blood bypasses the liver due to shunts.
- Portal Flow — The amount of blood flowing through the portal vein.
- Postoperative Encephalopathy — Brain dysfunction occurring after surgery, often due to poor liver function.
Action Items / Next Steps
- Review how to interpret CT-based liver volume measurement.
- Study the relationship between liver volume, Child’s classification, and surgical outcomes.
- Understand limitations of liver volume as a sole indicator for portal hypertension prognosis.