Potential value of contrast-enhanced intraoperative ultrasonography during partial hepatectomy for metastases : An essential investigation before resection?

• Published in: Annals of surgery Vol. 243; no. 2; pp. 236 - 240
• Main Authors: LEEN, Edward, CECCOTTI, Piercarlo, HORGAN, Paul G, MOUG, Susan J, GLEN, Paul, MACQUARRIE, John, ANGERSON, Wilson J, ALBRECHT, Thomas, HOHMANN, Joachim, OLDENBURG, Anja, RITZ, Jorg Peter
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01-02-2006
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Contrast Media; Female; General aspects; Hepatectomy - methods; Humans; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Liver, biliary tract, pancreas, portal circulation, spleen; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative; Neoplasm Metastasis - diagnostic imaging; Neoplasm Staging - methods; Original; Phospholipids; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Statistics, Nonparametric; Sulfur Hexafluoride; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Sonography; Medicine; Resection; Treatment; Partial; Surgery; Echography; Intraoperative; Malignant tumor; Metastasis; Essential; Hepatectomy
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/01.sla.0000197708.77063.07

The aim of the study was to assess the clinical value of contrast-enhanced intraoperative ultrasound (CE-IOUS) as a novel tool in the hepatic staging of patients undergoing liver resection.
Sixty patients scheduled to undergo liver resection for metastatic disease were studied. Preoperative staging with contrast-enhanced CT and/or MR scans was performed within 2 to 6 weeks of operation. Following exploration, intraoperative ultrasound (IOUS) was performed using an HDI-5000 scanner (Philips) and a finger-probe with pulse inversion harmonic (PIH) capability. CE-IOUS in the PIH mode was performed in a standardized protocol (low MI: 0.02-0.04) after intravenous injection of 3-4 mL of SonoVue (Bracco spa, Milan); all detected lesions on precontrast and postcontrast scans were counted and mapped. Any alteration in surgical management was documented following CE-IOUS compared with IOUS.
Three patients were excluded due to disseminated disease on exploration. CE-IOUS was significantly more sensitive than CT/MR and IOUS in detecting liver metastases (96.1% versus 76.7% and 81.5%, respectively) (P<0.05); it altered surgical management in 29.8% (17 of 57) of cases, due to 1) additional metastases in 19.3% (11 of 57), 2) less metastases in 3.5% (2 of 57), 3) benign lesions wrongly diagnosed as metastasis on IOUS/CT in 5.3% (3 of 57), and 4) vascular proximity in 1.8% (1 of 57). Management was unchanged in 70.2% (40 of 57) despite additional lesions detected in 3.5% (2 of 57) and benign lesion wrongly diagnosed on IOUS and CT as metastasis in 1.8% (1 of 57). CE-IOUS altered combined IOUS/CT/MR staging in 35.1%.
These preliminary results suggest CE-IOUS is an essential tool prior to liver resection for metastases.