Abdominal computed tomography (CT) or magnetic resonance imaging (MRI) was performed in each patient before PVE (24) (Figure 1). The portal phase was used to assess portal vein anatomy, hepatic segmentation as described by Couinaud, the extent of hepatic and extra-hepatic involvement by the malignancy, and the presence of tumor in the FLR (25). Total tumor volume (TV), FLR tumor volume (FLRTV), embolized liver tumor volume (ELTV), FLR volume (FLRV), total liver volume (TLV), and embolized liver volume (ELV) were measured after exclusion of the large vessels and major fissures. The percentage of FLR (%FLR) was computed as the tumor-free FLR volume over the tumor-free liver volume according to the following formula (26).

CT-based liver volumetry calculation before/after PVE with EVOH in a 74-year-old man with right-sided hepatocellular carcinoma showing important FLR hypertrophy after PVE. FLR was manually delimited on axial images at the portal venous phase and an automated algorithm interpolated all slices to obtain the volume of the region of interest (in pink) and a 3D volume rendering reconstruction (in green). (A,B) FLR before right PVE procedure was 534 mL (22% of the total liver volume). (C,D) FLR after right PVE procedure was 691 mL (41.6% of the total liver volume). The %FLR increase was 87.6% and the degree of hypertrophy of FLR was 19.4%. Beam hardening white artifacts after PVE related to EVOH copolymer liver distribution are well visualized in the right portal vein branches on axial images. No complication following PVE occurred. PVE, portal vein embolization; EVOH, ethylene-vinyl alcohol; FLR, future liver remnant.

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