The effect of Glisson's capsule on the superficial elasticity measurements of the liver.

In the past decade, novel tools for surgical planning and disease diagnosis have been developed to detect the liver's mechanical properties. Some tools utilize superficial indentation type measurements to determine the elasticity of the liver parenchyma and to assume material homogeneity. In fact, the liver is a soft tissue covered with a connective sheathing that is called Glisson's capsule. This article quantifies the effect of this capsule on the measured or "effective" elastic modulus obtained by indentation with a spherical geometry. Two sets of parametric computational studies in which the Glisson capsule thickness and elasticity were varied, demonstrated the relationship between the measured elastic response and the underlying parenchymal elastic response. Previously reported in vivo indentation data on the human liver were utilized to determine the elasticity of its parenchyma. The results indicated a linear relationship between the effective (measured) elastic response and the underlying parenchyma for the Glisson capsule thicknesses considered. When previously published human liver indentation data were analyzed, the measured elastic modulus was nearly 6.9% greater than the underlying parenchyma elastic modulus. Although the analyzed data were obtained from a single liver and yet displayed a significant variation, the Glisson capsule elasticity induced a significant but systematic error as well. The Glisson capsule thickness error was negligible for capsule parameters associated with a normal liver. Based on this work, an emphasis on the Glisson capsule's contribution to the mechanical response of the liver would enhance the clinical potential of indentation-based novel tools for liver care.