**7. Human Digital Liver Database**

**6. Measurement of liver volume from neonates to the elderly**

volume of Chinese patients of different ages, from neonates to the elderly.

**Age N Liver volume (cm³)** <1 Month 28 140.0339 ± 50.0707 1–3 Months 26 191.1462 ± 38.9132 4–6 Months 31 261.5065 ± 70.9437 7–9 Months 22 273.1917 ± 50.0732 10–12 Months 33 305.4692 ± 36.3323 1–2 Years 56 374.3617 ± 65.8447 2–3 Years 66 440.8111 ± 71.4779 3–4 Years 58 500.0037 ± 103.2837 4–5 Years 49 549.4533 ± 84.6325 5–6 Years 33 639.4677 ± 126.7067 6–7 Years 44 722.0357 ± 140.8796 7–8 Years 44 824.6372 ± 137.9766 8–9 Years 32 844.4633 ± 93.6353 9–10 Years 37 935.8571 ± 189.1018 10–11 Years 29 985.0464 ± 121.0802 11–12 Years 27 1048.9250 ± 167.5279 12–13 Years 29 1118.4593 ± 155.2817 13–14 Years 22 1125.0250 ± 147.9899 14–18 Years 30 1323.8862 ± 226.3454 18–30 Years 42 1361.8682 ± 205.3783 30–40 Years 74 1381.1037 ± 300.3834 40–50 Years 139 1423.7647 ± 216.9305 50–60 Years 197 1343.2768 ± 246.6878 60–70 Years 181 1284.4183 ± 190.7129 70–80 Years 106 1263.1282 ± 170.2464 80–100 Years 21 1089.3429 ± 199.0259

66 Liver Research and Clinical Management

Total 1456

**Table 1.** Standard liver volume range (X ± S, cm<sup>3</sup>

).

Total liver volume, the basic unit of liver function, is an important factor to evaluate the resectability of liver cancer. There have been many studies of the total liver volume and necessary remnant liver volume in adult patients but only a few reports regarding liver volume in children. Because measured total liver volume has been proposed as the golden standard of liver volume for preoperative surgical plan, we tried to summarize the average total liver

The Human Digital Liver Database (HDLD) was established by the Affiliated Hospital of Qingdao University and Hisense Company, aiming to collect digital liver from neonates, children, adults, and the elderly, from normal livers, livers with cancer, and simulated livers resected using Hisense CAS. The link of the HDLD is http://www.hdldb.net, which now is only available in Chinese (the English version is being translated now). The HDLD will show the digital liver in image and video form. All visitors could study the updated clinical cases at any angle of reconstructed 3D digital liver, including the vascular system, anatomical differences in the liver, and the correlation between vascular and liver tumors. The HDLD will also provide the intra-operation video comparing to the preoperative surgical plan, to help doctors and medical students better understand the anatomy and surgical procedure of pediatric liver resection, especially for patients with giant liver tumors (**Figure 9**).

#### **7.1. Normal children and adult digital liver database**

Vascular anatomical variation and total liver volume are two of the more important factors that surgeons consider when making surgical plans. We have collected thousands of CT scan data from across the nation. We would like to establish a digital liver database showing the reconstructed digital liver and separate these digital livers into different groups according to the anatomical variations in liver vasculature and liver volume (**Figure 9**). The Dong's Digital Liver Classification was established based on our collection of digital livers. We believe that a normal digital liver database may serve as an important reference for surgeons all around world.

**Figure 9.** The Human Digital Liver Database.

#### **7.2. Liver tumor database and simulated liver surgery**

The liver tumor database shows the reconstructed digital liver image and simulated liver resection according to the surgeon's preoperative plan, and the intraoperative video of clinical cases, aiming to share the experience gained by staff at our center freely around the world. With the help of Hisense CAS, the successful surgical resection of liver tumors in pediatric patients has improved in our center. With the 3D simulation, we have found that we can clearly understand the anatomical variation in intrahepatic vasculature, the correlation of vasculature with liver tumors, and calculate the remnant liver volume of the simulated liver easily. In the database, we would like to show some difficult cases, such as those with very large liver tumors and those with vascular variation.

plan was developed using 3D simulation software to safeguard RHV. The enucleation of

Imaging Evaluation of Liver Tumors in Pediatric Patients http://dx.doi.org/10.5772/intechopen.73855 69

After laparotomy, the fluid was aspirated using a 20 G needle from the cystic components of HMH to reduce its volume, thereby facilitating surgical resection. The resection line at the rim of HMH, which was indicated by virtual hepatectomy was made using the electrotome. The hepatic portal occlusion was used to reduce the risk of bleeding. The hepatic parenchyma was dissected using the CUSA system. The intrahepatic vessels were dissected to be safeguarded or else ligated and divided, a matter that had been assessed by the virtual hepatectomy. After 20 min, the HMH was removed with surrounding rim of normal liver tissue. The right hepatic vein was successfully safeguarded. The remnant liver volume was about 210 ml, which approximately equaled the automatically calculated remnant liver volume (230.1 ml). There was no anatomical discrepancy between the operation and the 3D simulation. The convalescence was uneventful. Histopathology confirmed the diagnosis of mesenchymal hamar-

In summary, three-dimensional (3D) imaging could significantly improve the resection rate of pediatric tumors and increase the safety of the surgery. Dong's digital liver classification system and human digital liver classification system will be useful for surgeons all around

HMH for the case was performed after adequate preoperative preparation.

**Figure 11.** Comparison of 3D simulation and intraoperative liver anatomy.

toma (**Figure 12**).

the world.
