J. O. Neumann

Deutsches Krebsforschungszentrum, Heidelberg, Baden-Wuerttemberg, Germany

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Publications (4)8.05 Total impact

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    ABSTRACT: The increasing complexity of hepato-biliary surgery, including major hepatic resections and living donor liver transplantation (LDLT), has lead to an increasing demand for sophisticated imaging modalities. Standard operation planning for hepatic resections and preoperative donor and recipient work-up for LDLT is based on two-dimensional computed tomography (CT) images and magnetic resonance imaging. However, even modern multidetector CT scanners are not able to perform routinely three-dimensional (3D) visualization needed for operation planning in liver surgery or LDLT. As a consequence, special-purpose computer-based operation planning systems have been developed that leverage the possibilities of modern image processing to improve surgical planning. The advances in technology enable surgeons to analyse and to visualize the anatomy of the human liver including the vascular structures within the human liver and define the exact volumetric data of the liver tissue to be resected or preserved. Furthermore, 3D visualization of the vessel architecture within the human liver allows a reliable estimation of the amount of liver tissue that could be at risk after resection because of inadequate hepatovenous drainage. Because of its clinical usefulness and real-time visualization capabilities we already use an operation planning system in selected patients prior to liver resection and before donor hepatectomy for LDLT as a standard.
    No preview · Article · May 2007 · Imaging Decisions MRI
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    ABSTRACT: Full right hepatic grafts are most frequently used for adult-to-adult living donor liver transplantation (LDLT). One of the major problems is venous drainage of segments 5 and 8. Thus, this study was designed to provide information on venous drainage of right liver lobes for operation-planning. Fifty-six CT data sets from routine clinical imaging were evaluated retrospectively using a liver operation-planning system. We defined and analyzed venous drainage segments and the impact of anatomic variations of the middle hepatic vein (MHV) on venous outflow from segments 5 and 8. MHV variations led to significant shifts of segment 5 drainage between the middle and right hepatic vein. In cases with the most frequent MHV branching pattern (n = 33), a virtual hepatectomy closely right to the MHV intersected drainage vessels that provided drainage for 30% of the potential graft, not taking into account potential veno-venous shunts. In individuals with inferior MHV branches that extend far into segments 5 and 6 (n = 10), the overall graft volume at risk of impaired venous drainage increased by 5% (p < 0.001). If this is confirmed in clinical trials and correlated with intraoperative findings, the use of liver operation-planning systems would be beneficial to improve overall outcome after right lobe LDLT.
    Full-text · Article · Jul 2006 · American Journal of Transplantation
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    ABSTRACT: To investigate and describe the volume, position and shape of venous segments within the human liver and define their spatial correlation to the Couinaud segments (CS) and to the portal vein segments (PVS). This study was based on 64 routinely acquired CT scans of patients undergoing hepatic surgery. The final analysis included 19 patients. All 19 CT data sets were transformed into 3D liver models. Three venous segments were postulated reflecting the left, middle, and right hepatic vein. Each venous segment was furthermore divided in two venous subsegments. Volume, position and shape of these venous segments/subsegments were calculated and, finally, compared with the volume, position and shape of the Couinaud segments and the portal vein segments. The right hepatic vein covers with 539.8 +/- 119.5 ml (47.1%) the largest part of total liver volume followed by the middle hepatic vein 372.7 +/- 151.1 ml (32.5%) and the left hepatic vein 248 +/- 75.9 ml (20.4%). The Couinaud liver segments and portal vein segments 2, 3, 5, 7, and 8 have consistent positional assignments within the three venous segments. Only the CS 4a, 4b, and 6 showed significantly different positions compared to the PVS 4a, 4b, and 6 (P < 0.03). The venous subsegments have a broad volumetric distribution reaching from 79 to 337 ml. There is no positional correlation of venous subsegments compared to Couinaud segments or portal vein segments at all (kappa < 0.75). In contrast, the venous segments/subsegments which can be assigned to either liver halve and either liver lobe have an identical volume, shape and position compared to the corresponding Couinaud liver segments (kappa > 0.75). The venous segments distinguish liver areas divided by the left and middle hepatic vein in exactly the same pattern as Couinaud segments and portal vein segments do. However, the comparison of shape and position of venous subsegments showed no correlation with both liver segmental approaches.
    No preview · Article · Mar 2005 · European Journal of Radiology
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    ABSTRACT: Die exakte Definition von Lebervenensegmenten und deren Lagebeziehung zu den klassischen Couinaud-Segmenten spielt vor dem Hintergrund der Leberlebendspende eine zunehmende Bedeutung im klinischen Alltag. Unter Zuhilfenahme des vom DKFZ entwickelten Operationsplanungsprogramm LENA werteten wir die CT-Daten von 64 Patienten aus, bei denen in Vorbereitung auf eine Leberresektion routinemäßig eine CT-Untersuchung durchgeführt wurde. Das Drainagegebiet der rechten Lebervene umfasst mit 47,1% das größte Volumen. Die mittlere Lebervene drainiert 32,5% und die linke Lebervene 20,4%. Innerhalb dieser venösen Segmente nehmen die Couinaud- und portalen Segmente 2, 3, 5, 7 und 8 identische räumliche Positionen ein. Das Drainagengebiet der venösen Subsegmente reicht von 79,3 ml bis zu 337 ml. Es besteht keine Lageübereinstimmung zwischen venösen Subsegmenten und Couinaud/portalen Segmenten (kappa0,8).
    Full-text · Conference Paper · Jan 2005

Publication Stats

53 Citations
8.05 Total Impact Points


  • 2007
    • Deutsches Krebsforschungszentrum
      • Division of Medical and Biological Informatics
      Heidelberg, Baden-Wuerttemberg, Germany
  • 2005
    • Universität Heidelberg
      • Department of Spine Surgery
      Heidelburg, Baden-Württemberg, Germany