Objective: Colorectal liver metastases (CRLM) has a relatively high affinity, and sometimes is accompanied by biliary invasion. Generally, small nodular CRLM is indicated for RFA. On the other hand, it was reported that CRLM with biliary invasion requires hepatectomy with enough surgical margin. Therefore, accurate diagnostic imaging on the presence or absence of biliary invasion is important for the appropriate therapeutic choice for CRLM. Methods: A 30-years-old man who underwent a sigmoidectomy and systemic chemotherapy for sigmoid colon cancer with simultaneous multiple liver metastases. Then, we planned Surgery for remaining multiple CRLM. Preoperative CT and MRI showed multiple CRLM with no biliary invasion. We performed contrast enhanced ultrasonography (CEUS) preoperatively for further evaluation. Results: CEUS revealed contrast defect in bile duct (B2 + 3) from portal to Kupffer phase and it was suspected to be a biliary invasion. Therefore, we performed left lobectomy of the liver and it was demonstrated that the lesion was accompanied by biliary invasion in histopathological examination. Conclusion: Although CT and EOB-MRI are goes up to the candidate in the modality to diagnose the CRLM with biliary invasion, they sometimes can't reveal presence of the lesion with biliary invasion, let alone the area of biliary invasion. Preoperative and intraoperative CEUS are very useful not only to diagnose the presense and the area of biliary invasion, but also to select appropriate therapeutics for CRLM.Image 3 Arteriogram after coil embolization. Splenic vein is not visualized.Image 4 CT venous phase on postprocedure day 1. Note thrombus in splenic vein and portal system (blue arrows). Image 5 CT venous phase obtained 4 months after anticoagulation therapy. No thrombus is seen in the splenic vein or portal system. Image 2 Initial arteriogram showing passage of contrast from splenic artery (red arrow) to vein (blue arrow).HPB 2017, 19 (S1), S120eS192 ePoster Abstracts S181
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