Philipp Wiggermann, Abstract Co-Author: Nothing to Disclose

Martin Loss, Abstract Co-Author: Nothing to Disclose

Christian Roland Stroszczynski MD, Abstract Co-Author: Nothing to Disclose

Ernst Michael Jung MD, Presenter: Nothing to Disclose

The aim of this study was to evaluate the value of linear contrast enhanced intraoperative ultrasound (CE-IOUS) to improve detection of malign liver tumors lesions before surgery or radiofrequency ablation (RFA).

70 patients were included for surgery of malignant liver tumors (mean age 60 years (19-81); male n=45, female n=25), suffering from HCC (n=25), colorectal liver-metastasis (n=33), CCC (n=7) or other malign liver lesions (n=5). Preoperative CE-CT (n=48), CE-MRI (n=33) or PET-CT (n=10) confirmed hepatic tumor manifestation. Before undergoing surgery, intraoperative conventional (IOUS) as well as CE-IOUS were performed by one experienced examiner in all cases using multifrequency linear probes (6-9 MHz, 6-15 MHz; LOGIQ E9; GE). CE-IOUS was performed after bolus injection of 5 ml up to 15 ml SonoVue® (Bracco, Italy). Digitally stored images of CE-IOUS were compared with fundamental B-Scan and preoperative imaging (CE-CT, CE-MRI and PET-CET).

In 38 of 70 patients (54%), additional lesions were found using CE-IOUS (mean tumor size 8 mm, range 4-11 mm). This resulted in a change of surgical strategy or the intraoperative application of RFA in 37 patients (52%). Modification of therapy due to additionally found liver lesions was statistically significant (p<0.05). Comparing conventional IOUS and CE-IOUS, 14 additional lesions in 10 patients were seen by CE-IOUS. All lesions seen in B-scan could also be detected with CE-IOUS.

This is the first study using contrast-enhanced ultrasound with high resolution linear probes for intraoperative detection of malignant liver lesions. Compared to preoperative imaging and also conventional IOUS more additional lesions were found leading to therapeutic consequences of patients. A recently started prospective study has to show whether these changes in the surgical or interventional therapy will influence the recurrence rate.

IOUS has a significant impact on intraoperative detection of small malignant liver lesions.

Wiggermann, P, Loss, M, Stroszczynski, C, Jung, E, Intraoperative High Resolution Linear Contrast-enhanced Ultrasound (IOUS) for Detection of Microvascularization of Malignant Liver Lesions before Surgery or Radiofrequency Ablation.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043491.html