No abstract

Intraoperative ultrasonography (IOUS) is the most accurate diagnostic technique for staging hepatocellular carcinoma (HCC), but has low accuracy in differentiating the new nodules detected in the cirrhotic liver. The aim of this preliminary report is to evaluate whether contrast-enhanced intraoperative ultrasonography (CE-IOUS) could provide additional information to IOUS in patients with HCC. From August 2002 to July 2003, a prospective validation cohort study was conducted. For this purpose, 16 consecutive patients underwent liver resection for HCC using IOUS and CE-IOUS. Intraoperatively, in all patients 4.8 mL of SonoVue was injected intravenously through a peripheral vein. IOUS depicted 16 new focal liver lesions: 10 with no enhancement peculiar to HCC at CE-IOUS pattern and at histology (4) or imaging follow-up (6) proved to be benign; the remaining 6 had enhancement peculiar to HCC and histology confirmed this diagnosis. Two different patterns of enhancement were also recognized at CE-IOUS in those HCC nodules depicted preoperatively: one had no similarity to that observed at CT. CE-IOUS added findings to those of unenhanced IOUS in 50% of patients. These results show that IOUS accuracy and specificity is improved by CE-IOUS, with a great impact on surgical strategy and oncological radicality. I ntraoperative ultrasonography (IOUS) plays a fundamental role in liver surgery for liver tumors, and in particular for hepatocellular carcinoma (HCC). Complete tumor clearance and parenchyma-sparing anatomical resection are the goals in resective surgery for HCC, and in this sense IOUS is indispensable. New techniques for IOUS-guided resection have been recently proposed, confirming IUOS as a real surgical instrument in the hands of surgeons familiar with it. 1,2 IOUS is still the most accurate diagnostic technique for detecting focal liver lesions and has a great impact on the surgical approach to liver tumors. 3 However, in cirrhotic patients with HCC only the minority of nodules detected by IOUS are neoplastic. 4 Currently, IOUS provides better spatial resolution than computed tomography (CT) and magnetic resonance imaging (MRI), but does not provide information about tumor vascularity and tissue microcirculation. However, the application of an intravenous US contrast agent during transcutaneous US examination of the liver has shown to improve nodule characterization in comparison with unenhanced US. 5 Therefore, we applied contrast-enhanced (CE) IOUS to increase the accuracy in differentiating new nodules found during liver exploration in patients with HCC. PatientsFrom August 2002 to July 2003, 16 consecutive patients underwent liver resection for HCC using IOUS and CE-IOUS. Mean patient age was 69.4 years (range 58 -87) and there were 10 males and 6 females. The imaging diagnostic work-up for all the enrolled patients included abdominal US and CE spiral CT.Preoperatively, the total number of lesions detected was 21 (mean 1.3; median 1; range 1-2), with a mean tumor diameter of 4.5 cm (median 3.2; range 1.1-1...