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

AIM： 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. METHODS： 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） × 100%; PTLV （mL） = 121.75 ＋ 16.49 × 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. RESULTS： There was a significant difference in survival time between the group with PRLV ≤ 50% and the group with PRLV 〉 50% （X^2= 4.988, P = 0.026）, and between the group with CT grade 0/1 and the group with CT grade 2/3 （X^2= 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 （X^2 = 9.281, P = 0.002, P 〈 0.05）. CONCLUSION： 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.

Expectations for partial splenic arterial embolization simultaneous transcatheter arterial chemoembolization for hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is frequently complicated by cirrhosis,and it is not unusual for treatment options to be limited as a result of pancytopenia due to hypersplenism.Partial splenic embolization(PSE)has been performed for thrombocytopenia resulting from hypersplenism.However,the safety and effi cacy of concurrent transcatheter arterial chemoembolization(TACE)with PSE for HCC remain unclear.Thrombocytopenia has been improved,and treatment continued using concurrent PSE.In addition,the hepatic functional reserve could be maintained even after treatment for HCC.Concurrent TACE and PSE for HCC with thrombocytopenia can be expected to help maintain a hepatic reserve,and it may contribute to improving the prognosis of HCC.Hence,PSE could lead to an asplenic state.The appearance of Howell-Jolly bodies on a peripheral blood smear is reported useful for assessing splenic function.The appearance of Howell-Jolly bodies is associated with an increased risk for post-splenectomy sepsis/overwhelming post-splenectomy infection in patients with reduced splenic function.These bodies are frequently observed in peripheral erythrocytes after PSE,and when they are present,it is appropriate to administer the pneumococcal vaccine to prevent severe infection.The expectations for PSE combined with TACE for the treatment of HCC associated with cirrhosis are reviewed.