Planning principles for radical surgical intervention for liver alveococcosis based on computed and magnetic resonance imaging

Aim. To develop the planning principles for radical surgical intervention for liver alveococcosis based on the computed and magnetic resonance imaging data.

Materials and methods. The data of computed tomography and magnetic resonance imaging, as well as the results of treatment of 189 patients with liver alveococcosis in 2011–2020 were analyzed.

Results. A sequence of data analysis of CT-scan and magnetic resonance imaging, consisting of several stages, is proposed. CT-scan and magnetic resonance imaging data of all patients were analyzed according to the developed algorithm, which was adapted to the planning stages of surgical treatment. The accuracy of CT-scan and magnetic resonance imaging in determining the localization of the parasitic process by sections and predicting the need for a two-stage resection of the liver, the use of total vascular isolation technique was 100%. The accuracy of CT-scan in the defining of anatomical variants of extrahepatic arteries and the presence of a significant accessory right hepatic vein of the liver was 98.6%, type of division of the portal vein – 97.2%. Radiation semiotics of the relationship of parasitic masses with the main vessels of the liver and the inferior vena cava were determined. The accuracy of CT-scan in the diagnosis of involvement of the hepatic arteries, portal and hepatic veins was 96.9%, 91.2% and 91.4%, respectively. In predicting circular resection of the inferior vena cava we recommend to use the cut-off of contact of parasitic masses around it more than 180 ° (AUC = 0.950). With borderline volumes of liver remnant (30–35%), prolonged hyperbilirubinemia, suspected development of secondary biliary cirrhosis, magnetic resonance imaging with gadoxetic acid makes it possible to assess the functional state of the parenchyma. This may require additional preoperative therapy, planning a two-stage resection or the process may be considered unresectable in the diagnosis of severe fibrosis.

Conclusion. The developed CT-scan/ magnetic resonance imaging data analysis algorithm allows to determine the clinical and surgical group of patients with liver alveococcosis and to plan the type of surgical intervention. Additional option of magnetic resonance imaging with gadoxetic acid in evaluating of functional state of liver remnant allows you to adjust surgical tactics in a number of clinical situations.

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