Osirix md workstation

All images were analyzed on a clinical Osirix MD workstation (Pixmeo) using Metavol software (http://www.metavol.org/) (18 (link)).
The tumor volume was calculated based on the volume measured on the CT images. ¹⁸F-FMISO uptake by the tumor was evaluated quantitatively using the maximum standardized uptake value (SUV_max), tumor-to-liver ration (TLR), tumor-to-muscle ration (TMR), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). A polygonal volume of interest (VOI), which included the entire lesion in the axial, sagittal, and coronal planes, was also examined. The parameters were defined as the following: SUV_max, the SUV of the single highest voxel in the tumor; TMR, the ratio of SUV_max of the tumor to the mean SUV of the gluteal muscle; TLR, the SUV_max of the tumor/the mean SUV of the liver; MTV, the volume of the tumor that exhibited FDG uptake; and TLG, the mean SUV of the tumor × MTV. To determine the MTV, images of the tumor were segmented using a fixed-threshold (SUV, 0.4), referring to the past report (19 (link)). The threshold value was determined by measuring 40% of the mean SUV_max of all tumors (mean ± SEM, 1.07±0.28).

As evaluation of the PHLF risk is usually based on volumetric calculations, the total liver volume and FLR volume (FLR-V) were retrospectively (post-surgery) calculated for each patient using the CT images of the SPECT/CT data with an OsiriX MD workstation (Pixmeo^®, Bernex, Switzerland), according to the surgery plan decided after HBS evaluation. The FLR-V threshold of 30% was used to compare the performances of CT volumetry and HBS, performed before surgery, for PHLF prediction. This threshold was chosen because it should better take into account the chemotherapy-related parenchyma damage.