Edward Leen MD, Presenter: Nothing to Disclose

Piercarlo Ceccotti, Abstract Co-Author: Nothing to Disclose

Paul Glen, Abstract Co-Author: Nothing to Disclose

Susan Moug MBCHB, Abstract Co-Author: Nothing to Disclose

Thomas Albrecht MD, Abstract Co-Author: Nothing to Disclose

Paul Horgan MD, Abstract Co-Author: Nothing to Disclose

Accurate staging is crucial to the success of hepatic resection for malignancy. The aim of the study was to compare contrast enhanced (CE) intra-operative ultrasound (IOUS) with conventional IOUS, CT and MRI as a novel tool in the hepatic staging of patients undergoing liver resection.

53 consecutive patients scheduled to undergo liver resection for metastatic disease were studied. Pre-operative staging with CT and/or MR scans was performed within 2-6 weeks of operation. Intra-operative ultrasound (IOUS) was performed using an HDI-5000 scanner (Philips, Bothell, USA) and a finger-probe (CT8-4) with pulse inversion harmonic (PIH) capability. CE-IOUS in the PIH mode was performed in a standardised fashion (MI: 0.02-0.04) after bolus IV injection of 4 mL of SonoVue (Bracco spa, Milan, Italy). All detected lesions on pre and post contrast scans were counted and mapped using Couinaud classification. Any alteration in surgical management was documented following CE-IOUS compared with IOUS.

CE-IOUS was not performed in 3 patients due to disseminated disease; Surgical management remained unchanged following CE-IOUS in 35 of the remaining 50 patients (70%). However in 2 cases there were additional lesions but they did not entail any altered manoeuvre; in another patient, one of the lesions was accurately identified as a benign haemangioma on CE-IOUS. CE-IOUS altered surgical management in 15 of the 50 patients (30%) due to (a) additional metastases in 9 cases (18%), (b) fewer lesions in 2 cases (4%), (c) confirmed benign lesions previously diagnosed as solitary metastasis in 3 cases (6%) and (d) vascular proximity in 1 (2%) case. The mean number of lesions per patient was 1.5, 1.6 and 1.9 for CT/MRI, IOUS and CE-IOUS respectively: differences were not statistically significant. CE-IOUS altered hepatic staging in 18 of 50 patients (36%). In 6 of the 9 patients with additional lesions, as an adjunct to resection RF ablation could only be performed with CE-IOUS guidance for targeting

These preliminary results suggest CE-IOUS is an essential tool prior to liver resection of metastases with implications on surgical options and in guiding adjunctive RA ablation.

Leen, E, Ceccotti, P, Glen, P, Moug, S, Albrecht, T, Horgan, P, The Clinical Value of Contrast-enhanced Intraoperative Ultrasonography (CE-IOUS): An Essential Tool for Staging Prior to Resection and Also in Guiding Adjunctive RF Ablation.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4405598.html