title: Impact of intraoperative sonography on resection and cryoablation of liver tumors.
abstract: OBJECTIVE
  We retrospectively analyzed the impact of intraoperative sonography (IOUS) on the management of patients referred for resection of liver tumors.
  
  
  METHODS
  Forty patients underwent IOUS with a 7-MHz curved-array sector transducer; in selected cases, a 5-MHz linear-array transducer attached to a color Doppler unit was also used. The number, size, and location of tumors on IOUS, including tumor proximity to or invasion of major vessels or invasion of the diaphragm, were compared to findings on preoperative imaging studies. The effect of these findings on surgical management was assessed. Unresectable lesions were treated by cryoablation under ultrasound guidance.
  
  
  RESULTS
  IOUS detected preoperatively unsuspected lesions in 7 patients (18%). Metastases suspected on CT arterial portography were ruled out in 2 patients (5%), and indeterminate lesions were diagnosed as cysts by IOUS in 2 other patients (5%). Vascular proximity or vascular or diaphragmatic invasion detected by IOUS rendered lesions unresectable in 4 patients (10%). Cryoablation under IOUS guidance and monitoring was attempted in 11 patients (28%) and performed successfully in 10.
  
  
  CONCLUSIONS
  IOUS changed the management in 38% of patients and guided cryoablation in 28% of patients. IOUS performed by an experienced sonologist is invaluable for the accurate assessment of liver tumor resectability; the detection of additional, preoperatively unknown lesions; and the guidance of cryoablation of unresectable tumors.
authors.affiliation: Ultrasound Unit, Department of Diagnostic Radiology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Ha'aliya Hashniya 8, Bat Galim, POB 9602, Haifa 31096, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Gaitini
authors.forename: D
authors.initials: D
authors.lastname: Kopelman
authors.forename: M
authors.initials: M
authors.lastname: Soudak
authors.forename: M
authors.initials: M
authors.lastname: Epelman
authors.forename: A
authors.initials: A
authors.lastname: Assalia
authors.forename: M
authors.initials: M
authors.lastname: Hashmonai
authors.forename: A
authors.initials: A
authors.lastname: Engel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009362:Neoplasm Metastasis; D010347:Patient Care Planning; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional / Q000379:methods*