Is intraoperative ultrasonography during partial hepatectomy still necessary in the age of magnetic resonance imaging?
OBJECTIVE
The aim of our study was to determine if intraoperative ultrasonography is still necessary in the time of magnetic resonance imaging.


METHODS
Our prospective study comprised 122 patients (82% with malignant tumors) undergoing partial hepatectomy with preoperative magnetic resonance imaging, done at the same institution using a standardized liver protocol as well as intraoperative ultrasonography performed in a systematic fashion.


RESULTS
Seventeen additional malignant lesions in 16/122 patients (13.1%) were found intraoperatively [7 visible, 2 palpable, 8 (6.6%) diagnosed by intraoperative ultrasonography only; mean size: 1.5 cm; left:right lobe = 11:6]. This caused a change in surgical strategy in 14 patients (11.5%), including 6 patients (4.9%) with lesions seen on intraoperative ultrasonography only. The average total number of lesions in those patients was 3.4. Ten lesions (7 benign, 3 malignant) described on magnetic resonance imaging were not found on intraoperative ultrasonography, but no unnecessary operations resulted from this. In one patient additional micrometastases seen neither on magnetic resonance imaging nor on intraoperative ultrasonography were found histologically.


CONCLUSIONS
Intraoperative ultrasonography is still worthwhile as it remains unsurpassed in the ultimate determination of the number of lesions, tumor extension and anatomical resolution. However, in the course of time its benefits may decrease further due to ongoing improvement of preoperative imaging.
Cerwenka
Herwig
H
Department of Visceral Surgery, Department of Radiology, Karl-Franzens University, Auenbruggerplatz 29, A-8036 Graz, Austria. cerwenka@kfunigraz.ac.at
Raith
Johann
J
Bacher
Heinz
H
Werkgartner
Georg
G
el-Shabrawi
Azab
A
Kornprat
Peter
P
Mischinger
Hans-Jörg
HJ
D006498:Hepatectomy; D006801:Humans; D007432:Intraoperative Period; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014463:Ultrasonography