Assessment of liver volume variation to evaluate liver function Cong Tong 1 * , Xinsen Xu 1 * , Chang Liu (✉) 1 , Tianzheng Zhang 2 , Kai Qu 1 1 Department of Hepatobiliary Surgery, the First Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, Xi’an 710061, China; 2 Department of Surgery, Shaanxi Xianyang 215 Hospital, Xianyang 712000, China © Higher Education Press and Springer-Verlag Berlin Heidelberg 2012 Abstract In order to assess the value of liver volumetry in cirrhosis and acute liver failure (ALF) patients, we explored the correlation between hepatic volume and severity of the hepatic diseases. The clinical data of 48 cirrhosis patients with 60 normal controls and 39 ALF patients were collected. Computed tomography-derived liver volume (CTLV) and body surface area (BSA) of normal controls were calculated to get a regression formula for standard liver volume (SLV) and BSA. Then CTLV and SLV of all patients were calculated and grouped by Child-Turcotte-Pugh classification for cirrhosis patients and assigned according to prognosis of ALF patients for further comparison. It turned out that the mean liver volume of the control group was 1 058 Æ 337 cm 3 . SLV was correlated with BSA according to the regression formula. The hepatic volume of cirrhosis patients in Child A, B level was not reduced, but in Child C level it was significantly reduced with the lowest liver volume index (CTLV/ SLV). Likewise, in the death group of ALF patients, the volume index was significantly lower than that of the survival group. Based on volumetric study, we proposed an ROC (receiver operating characteristic) analysis to predict the prognosis of ALF patients that CTLV/SLV < 83.9% indicates a poor prognosis. In conclusion, the CTLV/SLVratio, which reflects liver volume variations, correlates well with the liver function and progression of cirrhosis and ALF. It is also a very useful marker for predicting the prognosis of ALF. Keywords liver volume variation; cirrhosis; acute liver failure (ALF) Introduction Child-Turcotte-Pugh classification is a widely accepted empirical approach for assessment of severity of cirrhosis while the model for end-stage liver disease (MELD) score is widely-employed prognostic markers for acute liver failure (ALF). However, besides serologic indices and laboratory parameters, it has been reported that liver atrophy is also an important factor to evaluate liver function of cirrhosis and ALF. Saygili et al. [1] considered the radiologic evaluation as an important constituent in liver function evaluation and demonstrated the value of computed tomography (CT) and magnetic resonance imaging (MRI) for assessing severity of liver cirrhosis secondary to viral hepatitis. Similarly, with regard to ALF, Sekiyama et al. [2] also verified the value of liver volume measurement in ALF patients that the computed tomography-derived liver volume (CTLV) of survivors of ALF was significantly greater than that of non-survivors. Therefore it seems to be certain that liver volume associates with the liver function and progression of cirrhosis and ALF. However, CTLV alone cannot reflect individual physical differences such as body weight and height, and it is therefore necessary to standardize individual liver volume in the healthy state. Fortunately, Nicolas et al. [3] proposed a formula using body surface area (BSA) and body weight to predict total liver volume in western adults. Inspired by his idea, we collected the data of CTLVand BSA of normal adults to calculate a regression formula that would predict liver volume more accurately for Chinese, which was defined as standard liver volume (SLV). Then we measured the liver volume of both cirrhosis and ALF patients with CT, and explored the correlation between liver volume variations (CTLV/SLV) and liver function. We found that the CTLV/ SLV ratio correlated well with Child classification in cirrhosis and was in accordance with the prognosis of ALF, based on which we established a CTLV/SLV prognostic formula for ALF utilizing the ROC (receiver operating characteristic) analysis. RESEARCH ARTICLE Received February 28, 2012; accepted August 10, 2012 Correspondence: liuchangdoctor@163.com * These authors contributed equally to this study and share first authorship. Front. Med. DOI 10.1007/s11684-012-0223-5