Evaluation of Contrast-Enhanced Intraoperative Ultrasound in the Detection and Management of Liver Lesions in Patients with Hepatocellular Carcinoma

Abstract

Aim. To evaluate the role of contrast-enhanced intraoperative ultrasound (CE-IOUS) during liver surgery in the detection and management of liver lesions in patients with hepatocellular carcinoma (HCC). Materials and Methods. From December 2016 to December 2017, 50 patients with HCC, who were candidates for liver resection, were evaluated with intraoperative ultrasound (IOUS). For all patients, MRI and/or CT were performed before surgery. During surgery, IOUS was performed after liver mobilization, and when nodules that had not been detected in the preoperative MRI and/or CT were observed, CE-IOUS scans were carried out with the dual purpose of better characterizing the unknown lesion and discovering new lesions. Results. In 12 patients, IOUS showed 14 nodules not detected by preoperative MRI and/or CT, before surgery. Out of the 12 lesions, five presented vascular features compatible with those of malignant HCC to the evaluation with CE-IOUS and four of these were simultaneously treated with intraoperative radiofrequency ablation (RFA). The fifth lesion was resected by the surgeon. The remaining nine lesions recognized by IOUS were evaluated as benign at CE-IOUS and considered regenerative nodules. The last diagnosis was confirmed during follow-up obtained by means of CT and/or MRI after 1, 3, 6, or 12 months. Conclusion. In our experience, CE-IOUS is a useful diagnostic tool in both benign pathologies, such as regenerative nodules, and malignant liver lesions. The advantage of this approach is the possibility of intraoperatively characterizing, based on vascularization patterns, lesions that could not be diagnosed by preoperative imaging, resulting in modification of the surgical therapy decision and expansion of the resection or intraoperative ablation.

Intraoperative contrast-enhanced ultrasound has an outcome-relevant impact on surgery of primary and metastatic liver lesions

“…Although several studies have shown the ability of CE-IOUS to detect lesions unknown preoperatively [13,14], the resulting implications for the surgical approach during liver surgery have usually only been a secondary endpoint. For example, Torzilli et al [9] and Arita et al [15] described a CE-IOUS-related change in strategy for CRLM patients in 18 % and 10 % of cases, respectively.…”

Downstaging and laparoscopic hepatectomy plus intraoperative radiofrequency ablation for the treatment of initially unresectable multifocal hepatocellular carcinomas

“…Intraoperative ultrasound is helpful for localization of the intrahepatic duct structure and timely correction of the surgical section. It is also helpful for the detection of residual lesions in the residual liver, and RFA can be performed at the same time (39). Current research suggests that for tumours with a diameter of ≤3 cm, the radical effect of RFA is comparable to surgical resection on tumours, and RFA is especially suitable for tumours with deep lesions that are difficult to reveal (12).…”

Intraoperative ultrasound in liver and pancreatic surgery

“…The typical vasculature features of CE-IOUS for HCC on a cirrhotic liver are represented by early contrast enhancement in the arterial phase with fast washout in the venous phase [30,31]. The most frequent used contrast agent is SonoVue (Bracco, Italy).…”