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Robinson E, Aderibigbe G, Agi C. Triplex sonographic evaluation of portal vein indices among adults in Port Harcourt, Nigeria. J Med Ultrasound 2022; 30:184-188. [DOI: 10.4103/jmu.jmu_142_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/30/2021] [Accepted: 08/17/2021] [Indexed: 11/04/2022] Open
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Nishie A, Ushijima Y, Takayama Y, Fujita N, Kubo Y, Ishimatsu K, Tsurumaru D, Kohjima M, Ishigami K. Hemodynamic Alteration in the Liver in Acute Hepatitis: A Quantitative Evaluation Using Computed Tomographic Perfusion. In Vivo 2021; 35:3537-3545. [PMID: 34697192 DOI: 10.21873/invivo.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We aimed to elucidate the hemodynamic alterations in the liver of patients with acute hepatitis (AH) using computed tomography perfusion imaging. PATIENTS AND METHODS For 14 patients with AH and nine patients with no disease (ND group), we compared the mean arterial blood flow (AF), portal blood flow (PF) and perfusion index (%) [PI=AF/(AF+PF) ×100] of the right and left liver lobes and investigated their relationship with clinical factors. RESULTS The mean PI of the right lobe in the AH group (30.5±10.0%) was significantly higher than that in the ND group (20.8±9.7%) (p=0.031). For all patients of the AH and ND groups, the PI of the right lobe was increased as the prothrombin time decreased (R=-0.56, p=0.006) and as the prothrombin time-international normalized ratio increased (R=0.48, p=0.02). CONCLUSION The PI of the right liver lobe may increase in AH and may be a predictive parameter for the severity of hepatic failure.
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Affiliation(s)
- Akihiro Nishie
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan; .,Department of Advanced Imaging and Interventional Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukihisa Takayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Kubo
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Ishimatsu
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Tsurumaru
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motoyuki Kohjima
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Chiorean L, Caraiani C, Radziņa M, Jedrzejczyk M, Schreiber-Dietrich D, Dietrich CF. Vascular phases in imaging and their role in focal liver lesions assessment. Clin Hemorheol Microcirc 2016; 62:299-326. [PMID: 26444602 DOI: 10.3233/ch-151971] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Liliana Chiorean
- Med. Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
- Département d’Imagerie Médicale, Clinique des Cévennes Annonay, France
| | - Cosmin Caraiani
- Department of Radiology and Computed Tomography, “Octavian Fodor” Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania; “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maija Radziņa
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - Maciej Jedrzejczyk
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
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Oğul H, Kantarcı M, Genç B, Pirimoğlu B, Cullu N, Kızrak Y, Yılmaz O, Karabulut N. Perfusion CT imaging of the liver: review of clinical applications. Diagn Interv Radiol 2015; 20:379-89. [PMID: 24834487 DOI: 10.5152/dir.2014.13396] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Perfusion computed tomography (CT) has a great potential for determining hepatic and portal blood flow; it offers the advantages of quantitative determination of lesion hemodynamics, distinguishing malignant and benign processes, as well as providing morphological data. Many studies have reported the use of this method in the assessment of hepatic tumors, hepatic fibrosis associated with chronic liver disease, treatment response following radiotherapy and chemotherapy, and hepatic perfusion changes after radiological or surgical interventions. The main goal of liver perfusion imaging is to improve the accuracy in the characterization of liver disorders. In this study, we reviewed the clinical application of perfusion CT in various hepatic diseases.
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Affiliation(s)
- Hayri Oğul
- Department of Radiology, Atatürk University, School of Medicine, Erzurum, Turkey.
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Kantarci M, Pirimoglu B, Ozturk G, Aydinli B, Ogul H, Okur A, Kizrak Y, Ozyigit O, Celik M. Clinical utility of hepatic-perfusion computerized tomography in living-donor liver transplantation: a preliminary study. Transplant Proc 2015; 47:399-407. [PMID: 25769581 DOI: 10.1016/j.transproceed.2014.11.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/10/2014] [Accepted: 11/25/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Vascular complications are a primary diagnostic consideration in liver transplant recipients, with an overall incidence of 9%. Cross-sectional imaging techniques provide information regarding vascular structure and luminal patency but can not quantitatively assess hepatocyte damage in the liver graft parenchyma. Perfusion computerized tomography (CT) is a recently developed method that allows for quantitative evaluation of hemodynamic changes in tissue. Our objective was to evaluate the clinical utility of perfusion CT in assessing vascular complications during living-donor liver transplantation (LDLT). METHODS The 33 recipients were divided into 3 groups according to Doppler ultrasonographic findings: hepatic arterial complication group, portal venous complication group, and hepatic venous complication group. Blood volume (BV), blood flow (BF), arterial liver perfusion (ALP), portal venous perfusion (PVP), and hepatic perfusion index (HPI) were calculated for the affected vascular territory regions. RESULTS Compared with normal liver parenchyma, BV, BF, ALP, and HPI were significantly lower in the hepatic arterial complication group. Although PVP and BV were significantly lower, ALP, HPI, and BF were higher in the affected vascular territory region than in normal liver parenchyma for the portal venous complication group. In the hepatic venous complication group, PVP was significantly higher and BF, ALP, and HPI significantly lower in the affected vascular territory regions than in normal liver parenchyma. CONCLUSIONS Perfusion CT imaging is a noninvasive technique that enables the quantitative evaluation of vascular complications in the graft parenchyma after LDLT and permits a quantitative evaluation of the treatment response.
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Affiliation(s)
- M Kantarci
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey.
| | - B Pirimoglu
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - G Ozturk
- Department of General Surgery, School of Medicine, Atatürk University, Erzurum, Turkey
| | - B Aydinli
- Department of General Surgery, School of Medicine, Atatürk University, Erzurum, Turkey
| | - H Ogul
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - A Okur
- Department of Radiology, Yozgat, School of Medicine, Bozok University, Bozok, Turkey
| | - Y Kizrak
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - O Ozyigit
- Department of Radiology, School of Medicine, Atatürk University, Erzurum, Turkey
| | - M Celik
- Department of Anesthesiology and Reanimation, School of Medicine, Atatürk University, Erzurum, Turkey
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Zhuang ZG, Zhang XB, Han JF, Beilner J, Deuerling-Zheng Y, Chi JC, Wang J, Qian LJ, Zhou Y, Xu JR. Hepatic blood volume imaging with the use of flat-detector CT perfusion in the angiography suite: comparison with results of conventional multislice CT perfusion. J Vasc Interv Radiol 2014; 25:739-46. [PMID: 24745904 DOI: 10.1016/j.jvir.2014.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 01/17/2014] [Accepted: 01/18/2014] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To prospectively determine the feasibility of flat-detector (FD) computed tomography (CT) perfusion to measure hepatic blood volume (BV) in the angiography suite in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Twenty patients with HCC were investigated with conventional multislice and FD CT perfusion. CT perfusion was carried out on a multislice CT scanner, and FD CT perfusion was performed on a C-arm angiographic system, before transarterial chemoembolization procedures. BV values of conventional and FD CT perfusion were measured within tumors and liver parenchyma. The arterial perfusion portion of CT perfusion BV was extracted from CT perfusion BV by multiplying it by a hepatic perfusion index. Relative values (RVs) for CT perfusion arterial BV and FD CT perfusion BV (FD BV) were defined by dividing BV of tumor by BV of parenchyma. Relationships between BV and RV values of these two techniques were analyzed. RESULTS In all patients, both perfusion procedures were technically successful, and all 33 HCCs larger than 10 mm were identified with both imaging methods. There were strong correlations between the absolute values of FD BV and CT perfusion arterial BV (tumor, r = 0.903; parenchyma, r = 0.920; both P < .001). Bland-Altman analysis showed a mean difference of -0.15 ± 0.24 between RVs for CT perfusion arterial BV and FD BV. CONCLUSIONS The feasibility of FD CT perfusion to assess BV values of liver tumor and surrounding parenchyma in the angiographic suite was demonstrated.
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Affiliation(s)
- Zhi-guo Zhuang
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xue-bin Zhang
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing-feng Han
- Healthcare Sector, Siemens Limited China, Shanghai, China
| | - Janina Beilner
- Healthcare Sector, Siemens Limited China, Shanghai, China
| | | | - Jia-chang Chi
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ji Wang
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-jun Qian
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-rong Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Zhuang ZG, Xu JR, Qian LJ, Xia Q, Chi JC. Computed tomography perfusion study of hemodynamic changes and portal hyperperfusion in a rabbit model of small-for-size liver. Hepatobiliary Pancreat Dis Int 2012; 11:74-80. [PMID: 22251473 DOI: 10.1016/s1499-3872(11)60128-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Portal hyperperfusion in the small-for-size (SFS) liver can threaten survival of rabbits. Therefore, it is important to understand the hemodynamic changes in the SFS liver. METHODS Twenty rabbits were divided into two groups: a control group and a modulation group. The control group underwent an extended hepatectomy. The modulation group underwent the same procedure plus splenectomy to reduce portal blood flow. CT perfusion examinations were performed on all rabbits before and after operation. Perfusion parameter values, especially portal vein perfusion (PVP), were analyzed. RESULTS PVP in the modulation group was lower than in the control group after operation (P=0.002). In the control group, postoperative PVP increased by 193.7+/-55.1% compared with preoperative PVP. A weak correlation was found between the increased percentage of PVP and resected liver-to-body weight ratio (RLBWR) (r=0.465, P=0.033). In the modulation group, postoperative PVP increased by 101.4+/-32.5%. No correlation was found between the increased percentage of PVP and RLBWR (r=0.167, P=0.644). Correlations were found between PVP and serum alanine aminotransferase, aspartate aminotransferase, and total bilirubin after surgery (P<0.05). CONCLUSION We successfully evaluated the characteristics of hemodynamic changes as well as the effects of splenectomy in the SFS liver in rabbits by the CT technique.
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Affiliation(s)
- Zhi-Guo Zhuang
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Kanda T, Yoshikawa T, Ohno Y, Fujisawa Y, Kanata N, Yamaguchi M, Seo Y, Yano Y, Koyama H, Kitajima K, Takenaka D, Sugimura K. Perfusion measurement of the whole upper abdomen of patients with and without liver diseases: initial experience with 320-detector row CT. Eur J Radiol 2011; 81:2470-5. [PMID: 22055684 DOI: 10.1016/j.ejrad.2011.10.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 10/10/2011] [Accepted: 10/14/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To report initial experience of upper abdominal perfusion measurement with 320-detector row CT (CTP) for assessment of liver diseases and therapeutic effects. MATERIALS AND METHODS Thirty-eight patients who were suspected of having a liver disease underwent CTP. There were two patients with liver metastases, two with hemangiomas, and four with cirrhosis (disease group). CTP was repeated for four patients with cirrhosis or hepatocellular carcinoma (HCC) after therapy. Hepatic arterial and portal perfusion (HAP and HPP) and arterial perfusion fraction (APF), and arterial perfusion (AP) of pancreas, spleen, stomach, and intra-portal HCC were calculated. For disease-free patients (normal group), the values were compared among liver segments and among pancreatic and gastric parts. The values were compared between groups and before and after therapy. RESULTS No significant differences were found in the normal group except between APFs for liver segments 3 and 5, and fundus and antrum. Mean HAP and APF for the disease group were significantly higher than for the normal group. APF increased after partial splenic embolization or creation of a transjugular intrahepatic portosystemic shunt. HPP increased and AP of intra-portal HCC decreased after successful radiotherapy. CONCLUSIONS 320-Detector row CT makes it possible to conduct perfusion measurements of the whole upper abdomen. Our preliminary results suggested that estimated perfusion values have the potential to be used for evaluation of hepatic diseases and therapeutic effects.
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Affiliation(s)
- Tomonori Kanda
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe 650-0017, Japan. k
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Kim KW, Kim PN, Shin JH, Shin DH, Jeong WK, Won HJ, Shin YM, Lee WJ, Lee MG, Song GW, Hwang S, Lee SG. Acute outflow obstruction of hepatic veins in rabbits: quantitative analysis of hepatic perfusion with contrast-enhanced sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:635-642. [PMID: 21527611 DOI: 10.7863/jum.2011.30.5.635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To compare time-enhancement curve parameters of contrast-enhanced sonography in acute partial hepatic venous outflow obstruction with those of a baseline study. METHODS Contrast-enhanced sonography was performed in 11 rabbits with bolus administration of a sulfur hexafluoride contrast agent (0.1 mL/kg). After baseline scanning for 3 minutes, a 5.3F balloon catheter was placed into the left hepatic vein. Obstruction was artificially induced by 0.4-mL balloon inflation, and sonography was repeatedly performed thereafter. On images stored with 1-second intervals, 2 × 2-mm regions of interest were placed, and mean luminosity was measured. Time-enhancement curves were plotted, and contrast arrival times, peak enhancement values, peak enhancement times, 50% wash-out times, and 3-minute wash-out rates were obtained. Paired t tests were performed to evaluate the significance of differences in the parameters between baseline and obstruction. RESULTS On baseline sonography, the median contrast arrival time, peak enhancement value, peak enhancement time, 50% wash-out time, and 3-minute wash-out rate were 6 (range, 4-8; mean ± SD, 5.9 ± 1.2) seconds, 188.5 (104.7-209.5; 178.4 ± 33.1) arbitrary units, 19 (14-27; 19.8 ± 4.1) seconds, 75 (60-101; 78.2 ± 13.9) seconds, and 89.7% (81.3%-95.1%; 88.4% ± 4.9%), respectively. With obstruction, those values were 7 (5-12; 6.9 ± 2.3) seconds, 202.8 (98.2-215.1; 186.0 ± 39.3) arbitrary units, 31 (17-59; 32 ± 11.6) seconds, 101 (47-136; 96.2 ± 23.6) seconds, and 79.2% (66.2%-88.8%; 79.1% ± 7.6%). Compared with baseline, the peak enhancement time was significantly delayed from 19 to 31 seconds (P = .0027), 50% wash-out time significantly delayed from 75 to 101 seconds (P = .0209), and 3-minute wash-out rate significantly decreased from 89.7% to 79.2% (P < .0001) with obstruction, but there were no significant differences in contrast arrival times and peak enhancement values (P = .0756 and .2179). CONCLUSIONS Contrast-enhanced sonography can provide quantitative assessment of microbubble congestion in partial hepatic venous outflow obstruction. The peak enhancement time and 50% wash-out time are delayed and 3-minute wash-out rate is decreased in rabbits with artificially induced obstruction compared with a baseline study.
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Affiliation(s)
- Kyoung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2 Dong, Songpa-ku, Seoul 138-736, Korea
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Kanda T, Yoshikawa T, Ohno Y, Kanata N, Koyama H, Nogami M, Takenaka D, Sugimura K. Hepatic computed tomography perfusion: comparison of maximum slope and dual-input single-compartment methods. Jpn J Radiol 2010; 28:714-9. [DOI: 10.1007/s11604-010-0497-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 07/19/2010] [Indexed: 10/18/2022]
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Gonzalez HD, Liu ZW, Cashman S, Fusai GK. Small for size syndrome following living donor and split liver transplantation. World J Gastrointest Surg 2010; 2:389-94. [PMID: 21206720 PMCID: PMC3014520 DOI: 10.4240/wjgs.v2.i12.389] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 12/16/2010] [Accepted: 12/20/2010] [Indexed: 02/06/2023] Open
Abstract
The field of liver transplantation is limited by the availability of donor organs. The use of living donor and split cadaveric grafts is one potential method of expanding the donor pool. However, primary graft dysfunction can result from the use of partial livers despite the absence of other causes such as vascular obstruction or sepsis. This increasingly recognised phenomenon is termed “Small-for-size syndrome” (SFSS). Studies in animal models and humans have suggested portal hyperperfusion of the graft combined with poor venous outflow and reduced arterial flow might cause sinusoidal congestion and endothelial dysfunction. Graft related factors such as graft to recipient body weight ratio < 0.8, impaired venous outflow, steatosis > 30% and prolonged warm/cold ischemia time are positively predictive of SFSS. Donor related factors include deranged liver function tests and prolonged intensive care unit stay greater than five days. Child-Pugh grade C recipients are at relatively greater risk of developing SFSS. Surgical approaches to prevent SFSS fall into two categories: those targeting portal hyperperfusion by reducing inflow to the graft, including splenic artery modulation and portacaval shunts; and those aiming to relieve parenchymal congestion. This review aims to examine the controversial diagnosis of SFSS, including current strategies to predict and prevent its occurrence. We will also consider whether such interventions could jeopardize the graft by compromising regeneration.
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Affiliation(s)
- Hector Daniel Gonzalez
- Hector Daniel Gonzalez, Zi Wei Liu, Sophia Cashman, Giuseppe K Fusai, Centre for HPB Surgery and Liver Transplantation, Royal Free Hospital, Pond Street, NW3 2QG, London, United Kingdom
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