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Concepts for Liver Segment Classification: Neither Old Ones nor New Ones, but a Comprehensive One.

Fasel JH, Schenk A - J Clin Imaging Sci (2013)

Bottom Line: Concepts dealing with the subdivision of the human liver into independent vascular and biliary territories are applied routinely in radiological, surgical, and gastroenterological practice.Despite Couinaud's widely used eight-segments scheme, opinions on the issue differ considerably between authors.Possible clinical implications are addressed.

View Article: PubMed Central - PubMed

Affiliation: Department of Cellular Physiology and Metabolism, University Medical Center, Geneva, Switzerland.

ABSTRACT
Concepts dealing with the subdivision of the human liver into independent vascular and biliary territories are applied routinely in radiological, surgical, and gastroenterological practice. Despite Couinaud's widely used eight-segments scheme, opinions on the issue differ considerably between authors. The aim of this article is to illustrate the scientific basis for understanding and harmonizing inconsistencies between seemingly contradictory observations. Possible clinical implications are addressed.

No MeSH data available.


Platzer and Maurer's concept:[34] 4 sectors, no segments in the right hemiliver, but 3 in both the left lateral sector and left medial sector, as an example. a) Original illustration, (b) reconstruction on our corrosion cast.
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Figure 7: Platzer and Maurer's concept:[34] 4 sectors, no segments in the right hemiliver, but 3 in both the left lateral sector and left medial sector, as an example. a) Original illustration, (b) reconstruction on our corrosion cast.

Mentions: Finally, one group of authors advocate the existence of more than 8 segments. Couinaud himself introduced a ninth segment in 1998,[2731] though he later abandoned this proposition.[32] Gupta et al.,[33] also reported nine territories (which they called sub-segments). In fact, their compartmentalization bears similarities with Couinaud's, but from the beginning they added the caudate lobe and caudate process together as territory number nine. They also numbered the segments in another order, but it was that credited to Couinaud[1] which gained general acceptance. Gans[25] interpreted Healey and Schroy's[28] division encompassing even 10 segments. Platzer and Maurer[34] observed 2-5 segments (often 3) solely within the LLS [Figure 7]. Elias and Petty[35] took the view the main portal territories were constant, with 4 for the LLS (superior, intermediate, inferior, and omental one), 6 for the LMS (venous, quadrate, paracystic, left and right caudate, and the caudate process), and 3 for the RHL central, inferior, and lateral territory). This view would have one consider 13 segments in the human liver. However, they did admit to “a certain arbitrariness” in establishing these segments.


Concepts for Liver Segment Classification: Neither Old Ones nor New Ones, but a Comprehensive One.

Fasel JH, Schenk A - J Clin Imaging Sci (2013)

Platzer and Maurer's concept:[34] 4 sectors, no segments in the right hemiliver, but 3 in both the left lateral sector and left medial sector, as an example. a) Original illustration, (b) reconstruction on our corrosion cast.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3823389&req=5

Figure 7: Platzer and Maurer's concept:[34] 4 sectors, no segments in the right hemiliver, but 3 in both the left lateral sector and left medial sector, as an example. a) Original illustration, (b) reconstruction on our corrosion cast.
Mentions: Finally, one group of authors advocate the existence of more than 8 segments. Couinaud himself introduced a ninth segment in 1998,[2731] though he later abandoned this proposition.[32] Gupta et al.,[33] also reported nine territories (which they called sub-segments). In fact, their compartmentalization bears similarities with Couinaud's, but from the beginning they added the caudate lobe and caudate process together as territory number nine. They also numbered the segments in another order, but it was that credited to Couinaud[1] which gained general acceptance. Gans[25] interpreted Healey and Schroy's[28] division encompassing even 10 segments. Platzer and Maurer[34] observed 2-5 segments (often 3) solely within the LLS [Figure 7]. Elias and Petty[35] took the view the main portal territories were constant, with 4 for the LLS (superior, intermediate, inferior, and omental one), 6 for the LMS (venous, quadrate, paracystic, left and right caudate, and the caudate process), and 3 for the RHL central, inferior, and lateral territory). This view would have one consider 13 segments in the human liver. However, they did admit to “a certain arbitrariness” in establishing these segments.

Bottom Line: Concepts dealing with the subdivision of the human liver into independent vascular and biliary territories are applied routinely in radiological, surgical, and gastroenterological practice.Despite Couinaud's widely used eight-segments scheme, opinions on the issue differ considerably between authors.Possible clinical implications are addressed.

View Article: PubMed Central - PubMed

Affiliation: Department of Cellular Physiology and Metabolism, University Medical Center, Geneva, Switzerland.

ABSTRACT
Concepts dealing with the subdivision of the human liver into independent vascular and biliary territories are applied routinely in radiological, surgical, and gastroenterological practice. Despite Couinaud's widely used eight-segments scheme, opinions on the issue differ considerably between authors. The aim of this article is to illustrate the scientific basis for understanding and harmonizing inconsistencies between seemingly contradictory observations. Possible clinical implications are addressed.

No MeSH data available.