Liver Cancer
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 7, 2008; 14(25): 4005-4010
Published online Jul 7, 2008. doi: 10.3748/wjg.14.4005
Value of contrast-enhanced intraoperative ultrasound for cirrhotic patients with hepatocellular carcinoma: A report of 20 cases
Qiang Lu, Yan Luo, Chao-Xin Yuan, Yong Zeng, Hong Wu, Zheng Lei, Yao Zhong, Yu-Ting Fan, Hong-Hao Wang, Yang Luo
Qiang Lu, Chao-Xin Yuan, Yan Luo, Zheng Lei, Yao Zhong, Yu-Ting Fan, Hong-Hao Wang, Yang Luo, Department of Sonography, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yong Zeng, Hong Wu, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Lu Q and Luo Y designed the research; Lu Q, Yuan CX and Wang HH did the ultrasound examination; Zeng Y and Wu H performed the surgeries; Lei Z, Zhong Y, Fan YT and Luo Y collected the data; Lu Q and Luo Y drafted and revised the manuscript and approved the final version.
Correspondence to: Yan Luo, Department of Sonography, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. luoyan77@vip.sina.com
Telephone: +86-28-85422304
Fax: +86-28-85423192
Received: March 12, 2008
Revised: May 19, 2008
Accepted: May 26, 2008
Published online: July 7, 2008
Abstract

AIM: To assess the clinical value of contrast-enhanced intraoperative ultrasound (CE-IOUS) as a novel tool in partial hepatectomy for cirrhotic patients with hepatocellular carcinoma (HCC).

METHODS: From January 2007 to September 2007, a total of 20 consecutive cirrhotic patients with HCC scheduled to undergo partial hepatectomy were studied. Preoperative contrast enhanced computer tomography (CT) and/or magnetic resonance (MR) scans were performed within 1-2 wk before operation. Intraoperative ultrasound (IOUS) and CE-IOUS were carried out after mobilization of the liver. Lesions on precontrast and postcontrast scans were counted and mapped. CE-IOUS was performed with intravenous injection of ultrasound contrast agents SonoVue (Bracco Imaging, Milan, Italy). Arterial, portal and late phases of contrast enhancement were recorded and analyzed. Nodules showing arterial phase hyper-enhancing and/or hypo-enhancing in late parenchymal phase were considered malignant and removed surgically. Ultrasound-guided biopsy and ethanol ablation would be an option if the nodule could not be removed surgically. Newly detected nodules on IOUS showing iso-enhancement in both arterial and late phases were considered benign. These nodules were either removed surgically if they were close to the main lesion or followed by examinations of alpha-fetoprotein (AFP) level and ultrasound and/or CT/MR every 3 mo.

RESULTS: IOUS found 41 nodules in total, among which 17 (41.46%) were newly detected compared to preoperative imaging. Thirty-three nodules were diagnosed malignant by CE-IOUS, including one missed by IOUS. The sensitivity and specificity of CE-IOUS on detecting HCC nodules are 100% (33/33 and 100% (9/9), respectively. Nine nodules were considered benign by CE-IOUS, four was confirmed at histology and five by follow-up. CE-IOUS changed the surgical strategy in 35% (7/20) of patients and avoid unnecessary intervention in 30% (6/20) of patients.

CONCLUSION: CE-IOUS is a useful means to charac-terize the nodules detected by IOUS in cirrhotic liver, to find isoechoic HCC nodules which can not be shown on IOUS and to improve the accuracy of conventional IOUS, thus it can be used as an essential tool in the surgical treatment of cirrhotic patients with HCC.

Keywords: Cirrhosis; Liver neoplasms; Intraoperative ultrasound; Microbubble contrast agent; Hepatectomy