Couinaud · Fígado

Couinaud liver segmentation with Brisbane terminology

vigente

Localizes liver parenchyma by portal territories and intersegmental hepatic-vein planes into segments I-VIII, with segment IV optionally resolved as IVa and IVb.

Índice de referência, não é suporte à decisão clínica. O RadCommons apresenta conteúdo de referência reescrito a partir de critérios publicados e com link para a fonte primária. Confira sempre a publicação primária vigente. Não é um dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

Escala de categorias

I II III IV IVa IVb V VI VII VIII

As figuras e tabelas estão na fonte primária. Abrir a fonte. O RadCommons reescreve e cita, não reproduz figuras protegidas por direitos autorais.

Procedência e vigência

Órgão emissor: Couinaud / IHPBA
Versão: Classic 8-segment model / Brisbane 2000 terminology
Ano: 1957
Família: léxico
Tipo de lógica: flat
Modalidade: CT, MRI
Fonte primária: The Brisbane 2000 Terminology of Liver Anatomy and Resections · doi:10.1016/S1365-182X(17)30755-4
Última verificação: 2026-07-24
Última checagem: 2026-08-12

Lógica de decisão

Forma estruturada (flat). Uma futura calculadora a lê; as categorias abaixo são a superfície legível.

Assign vascular territories, not just clock-face positions. Preserve multiple involved segments, anatomy variants, uncertainty, and the distinction between anatomic localization and treatment planning.

Mostrar a lógica estruturada (JSON)

{
  "categories": [
    {
      "outcome_code": "I",
      "section": "caudate",
      "position": "dorsal_adjacent_to_IVC",
      "portal_tier": "independent"
    },
    {
      "outcome_code": "II",
      "section": "left_lateral",
      "position": "superior",
      "portal_tier": "above_transverse_portal_plane"
    },
    {
      "outcome_code": "III",
      "section": "left_lateral",
      "position": "inferior",
      "portal_tier": "below_transverse_portal_plane"
    },
    {
      "outcome_code": "IV",
      "section": "left_medial",
      "position": "whole_segment_or_level_unresolved",
      "subdivisions": [
        "IVa",
        "IVb"
      ]
    },
    {
      "outcome_code": "IVa",
      "parent_code": "IV",
      "section": "left_medial",
      "position": "superior",
      "portal_tier": "above_transverse_portal_plane"
    },
    {
      "outcome_code": "IVb",
      "parent_code": "IV",
      "section": "left_medial",
      "position": "inferior",
      "portal_tier": "below_transverse_portal_plane"
    },
    {
      "outcome_code": "V",
      "section": "right_anterior",
      "position": "inferior",
      "portal_tier": "below_transverse_portal_plane"
    },
    {
      "outcome_code": "VI",
      "section": "right_posterior",
      "position": "inferior",
      "portal_tier": "below_transverse_portal_plane"
    },
    {
      "outcome_code": "VII",
      "section": "right_posterior",
      "position": "superior",
      "portal_tier": "above_transverse_portal_plane"
    },
    {
      "outcome_code": "VIII",
      "section": "right_anterior",
      "position": "superior",
      "portal_tier": "above_transverse_portal_plane"
    }
  ],
  "applicability": {
    "use_for": "Anatomic localization of liver parenchyma, focal lesions, vascular territories and segment-oriented interventions on cross-sectional imaging.",
    "classification_unit": "lesion_or_parenchymal_territory; multiple segment codes may be required",
    "required_inputs": [
      "relationship_to_portal_venous_branches",
      "relationship_to_middle_right_and_left_hepatic_veins",
      "relationship_to_IVC_and_hilum",
      "level_relative_to_the_transverse_portal_plane",
      "presence_of_anatomic_variant_or_mass_effect"
    ],
    "preferred_basis": "Follow the portal territory and three-dimensional vascular relationships rather than assigning a segment from surface morphology or lesion centroid alone."
  },
  "anatomic_principles": {
    "intrasegmental_structures": "Portal venous branches travel with hepatic arterial and biliary branches inside the supplied segmental territory.",
    "intersegmental_structures": "The major hepatic veins generally course in planes between portal territories and serve as practical imaging landmarks, but the vascular boundaries are three-dimensional and variable.",
    "functional_midplane": "The middle-hepatic-vein plane from the gallbladder fossa toward the IVC separates functional right liver (V-VIII) from functional left liver (II-IV); this is not the external falciform division.",
    "right_intersectional_plane": "The right-hepatic-vein plane separates the right anterior section (V,VIII) from the right posterior section (VI,VII).",
    "original_Couinaud_left_scissura": "The left-hepatic-vein/left-portal-scissura model separates original Couinaud's left posterior sector (II) from the left anterior or paramedian sector (III,IV).",
    "Brisbane_left_section_rule": "Brisbane does not use that left hepatic-vein sector boundary for its sections: the falciform-ligament/umbilical-fissure plane separates the left lateral section (II,III) from the left medial section (IV).",
    "transverse_portal_plane": {
      "superior": [
        "II",
        "IVa",
        "VII",
        "VIII"
      ],
      "inferior": [
        "III",
        "IVb",
        "V",
        "VI"
      ]
    },
    "segment_I_exception": "Segment I is the caudate territory, commonly receives portal inflow from both sides and drains directly to the IVC through short hepatic veins; it is not assigned by the superior/inferior pairing rule."
  },
  "section_map": [
    {
      "section": "left_lateral",
      "segment_codes": [
        "II",
        "III"
      ]
    },
    {
      "section": "left_medial",
      "segment_codes": [
        "IV",
        "IVa",
        "IVb"
      ]
    },
    {
      "section": "right_anterior",
      "segment_codes": [
        "V",
        "VIII"
      ]
    },
    {
      "section": "right_posterior",
      "segment_codes": [
        "VI",
        "VII"
      ]
    },
    {
      "section": "caudate",
      "segment_codes": [
        "I"
      ]
    }
  ],
  "terminology_models": {
    "original_Couinaud_sectors": [
      {
        "sector": "left_posterior",
        "segment_codes": [
          "II"
        ]
      },
      {
        "sector": "left_anterior_or_paramedian",
        "segment_codes": [
          "III",
          "IV",
          "IVa",
          "IVb"
        ]
      },
      {
        "sector": "right_anterior",
        "segment_codes": [
          "V",
          "VIII"
        ]
      },
      {
        "sector": "right_posterior",
        "segment_codes": [
          "VI",
          "VII"
        ]
      }
    ],
    "Brisbane_2000_sections": [
      {
        "section": "left_lateral",
        "segment_codes": [
          "II",
          "III"
        ]
      },
      {
        "section": "left_medial",
        "segment_codes": [
          "IV",
          "IVa",
          "IVb"
        ]
      },
      {
        "section": "right_anterior",
        "segment_codes": [
          "V",
          "VIII"
        ]
      },
      {
        "section": "right_posterior",
        "segment_codes": [
          "VI",
          "VII"
        ]
      }
    ],
    "safety_rule": "Do not use sector and section as synonyms on the left side; name the convention when surgical anatomy depends on it."
  },
  "assignment_rules": [
    "First determine functional right versus left using the middle-hepatic-vein plane and portal inflow.",
    "On the right, determine anterior versus posterior section using the right-hepatic-vein plane and supplying portal branch.",
    "On the left, distinguish original Couinaud sectors from Brisbane sections: use the left hepatic scissura for the former and the falciform/umbilical-fissure division for the latter.",
    "Then determine superior versus inferior level relative to the portal bifurcation and segmental portal branches.",
    "For segment IV, return IVa or IVb when the craniocaudal subdivision is supported; retain IV when the whole segment is involved or the subdivision cannot be resolved.",
    "If a lesion crosses a vascular boundary, report every involved segment and identify the dominant portal territory only when demonstrable."
  ],
  "reporting_contract": [
    "report_segment_or_segments_and_lobe_or_section",
    "state_IVa_or_IVb_when_resolved_without_discarding_parent_segment_context",
    "describe_relationship_to_portal_pedicles_hepatic_veins_IVC_hilum_and_bile_ducts_when_relevant",
    "state_boundary_crossing_and_anatomic_variants",
    "use_right_and_left_as_functional_hemilivers_not_surface_lobes",
    "do_not_convert_location_alone_into_resectability_or_treatment"
  ],
  "Brisbane_resection_context": {
    "single_segment": "segmentectomy",
    "two_contiguous_segments": "bisegmentectomy",
    "left_lateral_section": "II_and_III",
    "left_medial_section": "IV_including_IVa_and_IVb",
    "right_anterior_section": "V_and_VIII",
    "right_posterior_section": "VI_and_VII",
    "right_hepatectomy_or_hemihepatectomy": "V_through_VIII",
    "left_hepatectomy_or_hemihepatectomy": "II_through_IV",
    "segment_I_rule": "When segment I is included with another named resection, state with_resection_of_segment_1 or extended_to_segment_1 explicitly.",
    "notation_rule": "Brisbane terminology favors Arabic Sg numbers; RadCommons retains Roman outcome codes for API compatibility and exposes the exact mapping here."
  },
  "version_context": [
    {
      "date": "1957",
      "status": "origin",
      "detail": "Couinaud described the classic segmental model in Le foie: etudes anatomiques et chirurgicales."
    },
    {
      "date": "1999",
      "status": "anatomic_reassessment",
      "detail": "Couinaud supported portal plus hepatic-vein segmentation from a 110-cast anatomic series (PMID 10805544; DOI 10.1159/000018770)."
    },
    {
      "date": "2000",
      "status": "terminology_standardization",
      "detail": "The IHPBA Brisbane consensus standardized hemiliver, section, segment and resection terminology (DOI 10.1016/S1365-182X(17)30755-4)."
    },
    {
      "date": "2020_consensus_published_2021",
      "status": "adjacent_update",
      "detail": "Tokyo terminology added definitions for anatomic segmentectomy and subsegmentectomy without replacing the base Couinaud segment map (DOI 10.1002/jhbp.1091)."
    }
  ],
  "uncertainty_and_limits": [
    "Portal and hepatic venous branching varies, hepatic-vein planes are approximations, and large lesions or prior surgery can distort landmarks; state uncertainty rather than forcing one segment.",
    "Some later Couinaud and Brisbane literature uses Sg9 for a paracaval caudate portion. This RadCommons decision system preserves the classic I-VIII output set; when a source uses Sg9, retain that source terminology and request the institutional convention instead of silently mapping it to I or VIII.",
    "A segment code provides no biological prognosis and does not by itself determine technical resectability, future liver remnant, operative approach, ablation safety, or oncologic management."
  ],
  "supporting_sources": [
    {
      "role": "primary_anatomic_reassessment",
      "citation": "Couinaud C. Dig Surg. 1999;16:459-467",
      "doi": "10.1159/000018770",
      "pmid": "10805544"
    },
    {
      "role": "IHPBA_consensus",
      "citation": "Strasberg et al. HPB. 2000;2:333-339",
      "doi": "10.1016/S1365-182X(17)30755-4"
    },
    {
      "role": "open_anatomic_and_resection_context",
      "citation": "Orcutt et al. Front Surg. 2016;3:14",
      "doi": "10.3389/fsurg.2016.00014",
      "pmcid": "PMC4786552"
    },
    {
      "role": "current_adjacent_terminology",
      "citation": "Nagino et al. J Hepatobiliary Pancreat Sci. 2021",
      "doi": "10.1002/jhbp.1091"
    }
  ],
  "source_locator": "IHPBA Brisbane 2000 consensus, DOI 10.1016/S1365-182X(17)30755-4, Figures 1-4 and division/resection terminology; Couinaud 1999, PMID 10805544, portal and hepatic-vein segmentation; Orcutt et al., PMC4786552, Figures 1-2 and segment-oriented resection text; Tokyo 2020 consensus, DOI 10.1002/jhbp.1091, definitions 1-2."
}

Categorias num relance

Cat.	Significado	Conduta	Risco	Fonte
I	Segment I (caudate) Caudate territory dorsal to the main portal pedicle and adjacent to the retrohepatic IVC. Segment I commonly receives portal pedicles from both right and left sides and drains directly to the IVC through short hepatic veins.	Report the caudate relationship to the IVC, short hepatic veins, portal pedicles and hilum when intervention is contemplated. Under Brisbane terminology, explicitly add 'with resection of segment 1' or 'extended to segment 1' when it accompanies another named resection.	The I code has no biological prognosis. Its direct IVC drainage and dorsal vascular relationships can affect technical planning, but they do not provide a quantified operative or ablation-risk category.	okfonte Couinaud 1999, PMID 10805544, portal plus suprahepatic segmentation; Anatomy of Hepatic Resectional Surgery, PMC4994882, Couinaud segments text and Fig 7; Brisbane context in PMC4786552, segment-1 naming rule.
II	Segment II (left lateral, superior) Superior left-sided segment above the transverse left portal plane. In original Couinaud sector terminology II is the left posterior sector; in Brisbane terminology it joins III as the left lateral section, lateral to the falciform/umbilical-fissure division.	Use II for the demonstrated segmental portal territory and state if a lesion crosses into III, IV or I. II plus III constitutes a Brisbane left lateral sectionectomy; a segment number alone does not establish resectability or select an operation.	Segment II carries no intrinsic oncologic or procedural-risk score. Risk depends on lesion extent, vascular and biliary relationships, access, liver reserve and the planned intervention.	okfonte IHPBA Brisbane 2000 consensus, DOI 10.1016/S1365-182X(17)30755-4, second- and third-order divisions; PMC4994882, Couinaud segments and Brisbane terminology; PMC4786552, Figs 1-2.
III	Segment III (left lateral, inferior) Inferior left-sided segment below the transverse left portal plane. Brisbane groups III with II as the left lateral section, whereas original Couinaud sector terminology groups III with IV in the left anterior or paramedian sector.	Report III from its portal territory and preserve any extension into II, IV or the hilum. II plus III is a Brisbane left lateral section; do not use the original left sector and Brisbane left section names interchangeably.	Segment III is an anatomic location, not a prognosis. The segment label does not quantify surgical morbidity, safe ablation margin, liver-remnant adequacy, or tumor behavior.	okfonte IHPBA Brisbane 2000 consensus, second-order left lateral section and third-order segment terminology; PMC4994882, Couinaud segments text explaining the original II versus III/IV sectors and Brisbane II/III versus IV sections.
IV	Segment IV (left medial, whole or level unresolved) Whole left medial segment or segment IV involvement for which a superior-versus-inferior subdivision is not resolved. Brisbane places IV between the functional midplane on the right and the falciform/umbilical-fissure division on the left; it can be subdivided into IVa and IVb.	Return IV when the whole segment is involved or IVa/IVb cannot be assigned confidently; otherwise use the resolved subsegment. Describe proximity to the middle hepatic vein, hilar plate, left portal pedicle and bile ducts rather than treating IV as a complete planning statement.	IV conveys location only. Central vascular or hilar relationships may change technical complexity, but the parent code provides no calibrated procedural, liver-failure, or oncologic risk.	okfonte Brisbane 2000 consensus, left medial section and segment nomenclature; PMC4994882, Couinaud segments and Brisbane terminology, including variable IVa/IVb branching; PMC4786552, segment-oriented planning context.
IVa	Segment IVa (left medial, superior) Superior subdivision of segment IV, above the transverse portal plane within the Brisbane left medial section. IVa/IVb separation follows left portal-pedicle branching and may be indistinct or variable.	Use IVa only when the superior portal territory can be supported on imaging; otherwise retain IV and state uncertainty. Report middle-hepatic-vein, hilar, portal and biliary relationships for intervention planning.	IVa has no independent biological prognosis or validated technical-risk class. Posterosuperior position and vascular relationships must be described directly rather than inferred from the code.	okfonte PMC4994882, Couinaud segments text and Fig 5: segment IV may be divided into IVA superiorly and IVB inferiorly, with variable branching; Brisbane 2000 consensus for left medial-section terminology.
IVb	Segment IVb (left medial, inferior) Inferior subdivision of segment IV, below the transverse portal plane within the Brisbane left medial section. It corresponds to the inferior medial left-liver territory and includes the quadrate region in conventional surface anatomy.	Use IVb only when the inferior portal territory is resolved; otherwise retain IV. Report relationships to the gallbladder fossa, hilum, segmental portal and biliary branches, and middle hepatic vein when relevant to planning.	IVb is an anatomic descriptor without a calibrated prognosis. Proximity to hilar, biliary or vascular structures is more informative for technical risk than the segment label itself.	okfonte PMC4994882, Couinaud segments text and Fig 5 (IVB inferior to the left portal plane and variable subdivision); Brisbane 2000 consensus, left medial section.
V	Segment V (right anterior, inferior) Inferior segment of the right anterior section, generally between the middle- and right-hepatic-vein planes and below the transverse right portal plane. V pairs with VIII in the Brisbane right anterior section.	Report V plus any extension across the middle hepatic, right hepatic or transverse portal boundaries. V with VIII forms the right anterior section, but location alone does not determine sectionectomy, ablation, or resectability.	Segment V has no inherent malignancy or procedural-risk value. Actual risk depends on vascular and biliary proximity, lesion size and extent, liver reserve, and the proposed intervention.	okfonte Couinaud 1999, portal and hepatic-vein segmentation; Brisbane 2000 consensus, right anterior section; PMC4994882, Couinaud segments text (V inferior, VIII superior); PMC4786552, Figs 1-2.
VI	Segment VI (right posterior, inferior) Inferior segment of the right posterior section, posterolateral to the right-hepatic-vein plane and below the transverse right portal plane. VI pairs with VII in the Brisbane right posterior section.	Report VI and any boundary crossing, especially toward V, VII, IVC or the right hepatic vein. VI with VII forms the right posterior section; the code is localization input, not an operative instruction.	Segment VI carries no calibrated patient or procedure risk. Access, portal and hepatic venous anatomy, biliary relationships, lesion burden and functional reserve remain separate determinants.	okfonte Brisbane 2000 consensus, right posterior section; PMC4994882, Couinaud segments text (VI inferior, VII superior); PMC4786552, segmental anatomy and resection terminology.
VII	Segment VII (right posterior, superior) Superior segment of the right posterior section, posterolateral to the right-hepatic-vein plane and above the transverse right portal plane. VII pairs with VI in the Brisbane right posterior section.	Report VII with its relationship to the right hepatic vein, IVC, diaphragm and adjacent segments, including any boundary crossing. Do not infer a surgical approach or feasibility from the posterosuperior label alone.	VII has no intrinsic outcome score. Its posterosuperior location can affect access and planning, but patient-specific technical risk requires direct vascular, biliary, lesion and liver-reserve assessment.	okfonte Brisbane 2000 consensus, right posterior section; PMC4994882, Couinaud segments text (VII superior, VI inferior) and hepatic venous landmarks; PMC4786552, Fig 1.
VIII	Segment VIII (right anterior, superior) Superior segment of the right anterior section, generally between the middle- and right-hepatic-vein planes and above the transverse right portal plane. VIII pairs with V in the Brisbane right anterior section.	Report VIII and whether the lesion reaches IV, V, VII, the hepatic veins, IVC, hilum or dome. V with VIII forms the right anterior section, but this grouping does not itself choose resection or ablation.	VIII is a location code rather than a risk category. Central or posterosuperior relationships may influence access and vascular control, but no numeric prognosis follows from VIII itself.	okfonte Couinaud 1999, portal and hepatic-vein segmentation; Brisbane 2000 consensus, right anterior section; PMC4994882, Couinaud segments text (VIII superior, V inferior); PMC4786552, Figs 1-2.

Histórico de versões

Data	Evento	Detalhe	Situação
2026-07-25	revised	Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. evidência	aguardando revisão
2021-11-29	revised	The Tokyo 2020 consensus added definitions for anatomic segmentectomy and subsegmentectomy while retaining the base segmental anatomy.	confirmado
2000-05-01	revised	The IHPBA Brisbane consensus standardized liver anatomy and resection terminology around the Couinaud segment map.	confirmado
1957-01-01	published	Couinaud published the classic segmental liver model in Le foie: etudes anatomiques et chirurgicales.	confirmado

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