Andrew James Swift BMedSc, FRCR, Presenter: Nothing to Disclose

Pamela Parker, Abstract Co-Author: Nothing to Disclose

Andrew Hunter, Abstract Co-Author: Nothing to Disclose

John Hartley, Abstract Co-Author: Nothing to Disclose

Edward Leen MD, Abstract Co-Author: Research grant, Bracco Group Research grant, AngioDynamics, Inc Equipment support, Koninklijke Philips Electronics NV Equipment support, General Electric Company Equipment support, SuperSonic Imagine

Oliver Richard Byass MBChB, Abstract Co-Author: Nothing to Disclose

The potential to predict, and therefore avoid anastomotic failure has eluded generations of colon and rectal surgeons to date. A reliable, reproducible method of assessing bowel perfusion therefore would be of enormous potential clinical relevance. To our knowledge, intra-operative CEUS of bowel has not been performed previously. The aim of our study was to assess the feasibility of using CEUS to study bowel perfusion intra-operatively.

We studied 8 patients who underwent colorectal surgery (right hemi colectomies n=3, Hartmans procedure n=1, anterior resection n=2, bowel resections with ileocolic anastomoses n=2). 4.8ml of SonoVue were injected pre and post vascular ligation with simultaneous non-compression scanning, directly over the large bowel using an Esaote Technos MPX ultrasound machine with a 5-2 MHz curvilinear probe. The patients were followed up clinically to assess for leaks. Contrast ultrasound signal time curves were generated from each acquisitions, and time to peak (TTP), max amplitude (MA) and rate of signal rise (RSR) were assessed. Intra and inter-observer reproducibility study was also carried out in all patients with 2 blinded readers.

No significant difference was demonstrated between the pre and post vascular ligation scans TTP (p = 0.28), MA (p = 0.49) and RSR (p=0.52). MA showed good interobserver and intraobserver variability, r = 0.65 and r = 0.68 respectively (p <0.05). TTP demonstrated good interobserver and intraobserver variability r = 0.62 and r = 0.82 respectively (p <0.05), and RSR showed good interobserver and intraobserver variability r = 0.62 and r = 0.67 respectively (p <0.05). No patients in the study group developed leak related complications.  

To our knowledge, intra-operative CEUS of bowel has not been performed previously. We have shown the technique to be feasible with good interobserver agreement. Further work is ongoing in order to optimize the technique and assess it’s use in predicting anastomotic breakdown.

These early findings suggest that CEUS is a potentially useful tool for assessing bowel perfusion, further studies will look at predicting anastomotic breakdown.

Swift, A, Parker, P, Hunter, A, Hartley, J, Leen, E, Byass, O, Intraoperative Contrast-enhanced Ultrasound (CEUS) of Bowel Perfusion: Preliminary Experience.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9000801.html