Measure the future liver remnant (FLR) volume as a percentage of the total functional liver on CT volumetry before and 3–6 weeks after portal vein embolisation; hypertrophy and the kinetic growth rate decide whether major hepatectomy can proceed.
Orient first
- Thresholds: FLR ≥ 20–25% in a normal liver, ≥ 30% after chemotherapy, ≥ 40% in cirrhosis (verify the surgeons' thresholds).
- Kinetic growth rate over about 2% per week predicts safety.
- Portal anatomy variants (trifurcation, right posterior from the main portal vein) change the approach.
Acquire the study
- Portal venous phase CT with thin sections for volumetry; repeat at 3–6 weeks after embolisation.
The manoeuvre
- Portal venous anatomy on coronal reformats: bifurcation, trifurcation, segment IV supply.
- Volumetry: FLR segments and total liver volume in mL, excluding tumour; FLR as % of total or of standardised liver volume.
- After PVE: FLR volume in mL and %, degree of hypertrophy, kinetic growth rate per week.
- Non-target embolisation into the FLR portal branches; tumour progression during the wait.
- Complications: portal thrombosis, subcapsular haematoma.
What confirms it
- FLR percentage and growth reported against the surgical threshold.
What licenses you to exclude it
- Not applicable — a volumetric read.
The classic misread
- Including tumour in the functional liver volume.
- Missing embolic material in the FLR branches.