Report on 71 successful intraoperative sonographies. The advantages of the technique were particularly evident when searching for tumours which were not visible from the brain surface. In these conditions intraoperative sonography greatly facilitates the planning of the operative approach. The ultrasound examination allows to distinguish tumour from peritumoral edema and healthy tissues. In one case it proved superior to nuclear magnetic and computer tomography in determining extent and infiltration. The technique proved nearly indispensable for intraoperative puncture.
In this prospective study, 108 patients presenting with gastrointestinal cancer were examined for liver metastasis before and during surgery. The investigations emphasized a comparison of pre- and intraoperative ultrasound (US) examinations. The results of intraoperative liver inspection and palpation served as control parameters. In addition, an exact description and characterization of the liver metastases was attempted. Liver metastases were found in 30 of the 108 patients (28%). They could be identified in 17 subjects by preoperative US (57% sensitivity), in 21 patients by intraoperative palpation and inspection (70% sensitivity), and in 27 cases by intraoperative US (90% sensitivity). We concluded that 7%-34% of patients with liver metastases can be identified with 95% reliability using intraoperative US alone or in combination with palpation and inspection.
The present animal experimental study showed that intraoperative hepatic ultrasonography using an echo contrast medium can visualize small hepatomas (with a diameter of between 3 and 15 mm) induced in the rat liver, although they were not recognizable with plain ultrasonography. A homogeneous increase in the echogenicity of the liver tissue was achieved by using an echo contrast medium (Echovist) based on galactose microparticles. Self-made bubble preparations such as those used in echocardiography were far less effective. When the dosage was optimal (0.01-0.003 ml/g liver weight with concentrations of 200 and 300 mg/ml Echovist), homogeneous contrast enhancement of the liver was achieved for at least 10 min after a single bolus injection via all routes of contrast administration (hepatic artery, portal vein, bile duct). As a result, hepatomas appeared as hypodense formations (portal vein and bile duct) or as hyperdense zones (hepatic artery).
The value of intraoperative echo-contrast ultrasound (US) as compared with plain US was studied in 19 patients presenting with malignant liver tumors. The contrast medium SHU 454 was intraoperatively injected via the portal venous system or the biliary tract. Using intraoperative echo-contrast US, extremely small liver tumors could be sought in a limited area of the liver. In comparison with plain US, the former technique resulted in better demarcation of especially small tumors, which were seen as echo-poor areas in relation to the surrounding liver tissue.
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