Characterization of microvascularization of liver tumor lesions with high resolution linear ultrasound and contrast enhanced ultrasound (CEUS) during surgery: First results

Abstract

Aim: Evaluation of high resolution linear ultrasound and intra-operative linear contrast enhanced ultrasound (CEUS) and its benefit for the detection and characterization of tumor lesions.Material and methods: Twenty patients were investigated preoperatively regarding tumor detection using CT (n = 8) or MRI (n = 12) and image fusion (VNav) (n = 3). All patients had surgery for their hepatic tumor (hepatocellular carcinoma (HCC), cholangiocellular carcinoma (CCC), metastasis, and adenoma).Ultrasound was performed intra-operatively first with B-scan using a convex probe. Than multifrequency linear transmitters (6-9 MHz, 6-15 MHz, LOGIQ E9, GE) were applied for B-scan, coulor coded Doppler sonography (CCDS) and Power Doppler followed by dynamic CEUS with Contrast Harmonic Imaging (CHI) after bolus injection of a maximum of 15 mL SonoVue ® .Results: In 9 cases with the use of intra-operative CEUS additional tumor lesions (diameter 4-15 mm) could be detected and were histologically confirmed after surgical resection (7 cases) or intra-operative biopsy (2 cases). Using intraoperative CEUS 64 tumor lesions could be detected compared to 51 tumor lesions detected by preoperative CT or MRI (p < 0.05). Using the 6-15 MHz multifrequency linear transducer with CHI, arterial perfusion of adenomas, neuroendocrine metastases and HCC lesions was detectable. In 3 cases a resection was not achievable. Two of these cases were treated with radio frequency ablation (RFA). The other case had no curable option due to multifocal tumor manifestation.Conclusion: The intra-operative use of high-resolution linear transducer techniques with CEUS offers new diagnostic perspectives for an effective liver surgery.

Small Liver Nodule Detection With a High-Frequency Transducer in Patients With Chronic Liver Disease

“…The use of high‐frequency transducers plays an important role in delineating focal liver lesions. Jung at al 7 described 9 cases in which small liver lesions (4–15 mm), including tumors, were detected during intraoperative sonography with high‐frequency transducers and contrast‐enhanced sonography. Some of these liver lesions had not been detected on computed tomography (CT) or magnetic resonance imaging (MRI).…”

Contrast‐enhanced ultrasound in the preoperative, intraoperative and postoperative assessment of liver lesions

“…50,58,64 CEUS was also able to correctly diagnose a part of small lesions (<1 cm) that were detected but undetermined at CT. 68 In 35%, the addition of CA to US changed the surgical strategy. 59 Compared to MRI, CEUS detected more lesions 75,76 and achieved similar results for the prediction of the histological grading (superparamagnetic iron oxide MRI). 61…”

“…CEUS also outlined specific characteristics for peculiar tumors such as cholangiocarcinoma . Compared to CT, the CEUS preoperative detection of hepatic lesions was similar or better, the correct diagnosis rate was similar or better, and the postoperative detection of residual disease after RFA or TACE was generally improved (Table ) . CEUS was also able to correctly diagnose a part of small lesions (<1 cm) that were detected but undetermined at CT .…”

Quantitative Assessment of Bone Microvascularization After Osteocutaneous Flap Transplantation Using Contrast-Enhanced Ultrasound (CEUS)

“…Furthermore, an objective quantitative analysis of the microcirculation can be performed using the special perfusion software QONTRAST ® (Bracco, Italy). As tissue penetration of ultrasound is only limited [20,25,29,33] to a slight extent, buried flaps can be estimated unrestrained. In previous studies principles of imaging and quantitative analysis of microcirculatory disorders with CEUS could be performed [13,14,22,[34][35][36][37].…”