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Development and validation of a comprehensive new hepatobiliary software. Part II: segmental liver function

Krishnamurthy, Gerbail T.a; Krishnamurthy, Shakuntalaa; Milleson, Thomasa; Minnick, Douga; Brown, Paul H.b

Nuclear Medicine Communications: December 2009 - Volume 30 - Issue 12 - pp 945-955
doi: 10.1097/MNM.0b013e32832ed3ea
Original Articles

Objective: This study was undertaken to develop comprehensive new hepatobiliary software to quantify segmental and lobar liver function and to obtain FDA approval.

Methods: Hepatobiliary software written on JAVA platform and loaded on to a PC accepts 99mTc-HIDA dicom image data transferred from a γ camera. Liver boundary was determined by threshold-based auto edge detection and liver height at right midclavicular (RMCL) line. Geometric mean area of the physiologic right lobe, physiologic left lobe and total liver area were measured. Segmental liver function was determined using the 5th minute frame as the default (100%).

Results: In 24 control participants, mean (±SD) liver height at RMCL was 14.7±0.12 cm. Geometric mean area of the physiologic right lobe was 116±3 cm2, left lobe 96±4 cm2, and total liver area 212±3 cm2. Right upper lobe (segments 7 and 8) contributed 31±0.7%, right lower lobe (segments 5 and 6) 34±0.6%, left medial (segments 4A and 4B) 24±1%, left lateral (segments 2 and 3) 10±2%, and caudate lobe (segment 1) 1±0.02% of total liver function. In 23 patients, contrast three-dimensional computerized tomographic volume of the right lobe was 1194±419 ml, left lobe 434±221 ml, and total liver volume 1628±490 ml. Right lobe area was120±30 cm2, left lobe (plus caudate) 88±29 cm2 with total liver area of 208±51 cm2. Right upper lobe (segments 7 and 8) contributed 33±10%, right lower lobe (segments 5 and 6) 34±7%, left medial (segments 4A and 4B) 23±6%, left lateral (segments 2 and 3) 9±3%, and caudate lobe (segment 1) 1±0.4% of total liver function. There was good correlation of RMCL height, and area of right lobe and total liver with computerized tomographic liver volume. Correlation of percentage volume with percentage function was excellent.

Conclusion: New FDA approved software provides quantitative assessment of segmental, lobar, and total liver size and function from a planar 99mTc-HIDA cholescintigraphy and may enable universal standardization in nuclear hepatology. Quantification may aid surgeons in the determination of the amount of tissue resection during liver surgery.

aDepartment of Nuclear Medicine and Radiology, Tuality Community Hospital, Hillsboro

bDepartment of Radiology, Oregon Health and Sciences University, Portland, Oregon, USA

Correspondence to Gerbail T. Krishnamurthy, MD, Department of Nuclear Medicine, Tuality Community Hospital, 335 SE 8th Avenue, Hillsboro, OR 97123, USA

Tel: +1 503 681 1745; fax: +1 503 682 1949; e-mail:

Received 10 February 2009 Revised 13 May 2009 Accepted 31 May 2009

© 2009 Lippincott Williams & Wilkins, Inc.