title: Value of contrast-enhanced intraoperative ultrasound for cirrhotic patients with hepatocellular carcinoma: a report of 20 cases.
abstract: OBJECTIVE
  To assess the clinical value of contrast-enhanced intraoperative ultrasound (CE-IOUS) as a novel tool in partial hepatectomy for cirrhotic patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  From January 2007 to September 2007, a total of 20 consecutive cirrhotic patients with HCC scheduled to undergo partial hepatectomy were studied. Preoperative contrast enhanced computer tomography (CT) and/or magnetic resonance (MR) scans were performed within 1-2 wk before operation. Intraoperative ultrasound (IOUS) and CE-IOUS were carried out after mobilization of the liver. Lesions on precontrast and postcontrast scans were counted and mapped. CE-IOUS was performed with intravenous injection of ultrasound contrast agents SonoVue (Bracco Imaging, Milan, Italy). Arterial, portal and late phases of contrast enhancement were recorded and analyzed. Nodules showing arterial phase hyper-enhancing and/or hypo-enhancing in late parenchymal phase were considered malignant and removed surgically. Ultrasound-guided biopsy and ethanol ablation would be an option if the nodule could not be removed surgically. Newly detected nodules on IOUS showing iso-enhancement in both arterial and late phases were considered benign. These nodules were either removed surgically if they were close to the main lesion or followed by examinations of alpha-fetoprotein (AFP) level and ultrasound and/or CT/MR every 3 mo.
  
  
  RESULTS
  IOUS found 41 nodules in total, among which 17 (41.46%) were newly detected compared to preoperative imaging. Thirty-three nodules were diagnosed malignant by CE-IOUS, including one missed by IOUS. The sensitivity and specificity of CE-IOUS on detecting HCC nodules are 100% (33/33 and 100% (9/9), respectively. Nine nodules were considered benign by CE-IOUS, four was confirmed at histology and five by follow-up. CE-IOUS changed the surgical strategy in 35% (7/20) of patients and avoid unnecessary intervention in 30% (6/20) of patients.
  
  
  CONCLUSIONS
  CE-IOUS is a useful means to characterize the nodules detected by IOUS in cirrhotic liver, to find isoechoic HCC nodules which can not be shown on IOUS and to improve the accuracy of conventional IOUS, thus it can be used as an essential tool in the surgical treatment of cirrhotic patients with HCC.
authors.affiliation: Department of Sonography, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Lu
authors.forename: Yan
authors.initials: Y
authors.lastname: Luo
authors.forename: Chao-Xin
authors.initials: CX
authors.lastname: Yuan
authors.forename: Yong
authors.initials: Y
authors.lastname: Zeng
authors.forename: Hong
authors.initials: H
authors.lastname: Wu
authors.forename: Zheng
authors.initials: Z
authors.lastname: Lei
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhong
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Fan
authors.forename: Hong-Hao
authors.initials: HH
authors.lastname: Wang
authors.forename: Yang
authors.initials: Y
authors.lastname: Luo
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007275:Injections, Intravenous; D007430:Intraoperative Care; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000008:administration & dosage; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride