title: Intra-operative contrast-enhanced ultrasound improves image enhancement in the evaluation of liver tumors.
abstract: BACKGROUND
  Intra-operative hepatic tumor ultrasound assessment can be difficult in patients with abnormal hepatic parenchyma because of the inability to enhance echogenic differences.
  
  
  METHODS
  Prospective pilot study of intra-operative ultrasound contrast enhancement in the evaluation of liver tumors to establish safety, dosing, and increased image enhancement with ultrasound contrast evaluation. A single bolus of perfluten lipid microspheres was then injected and ultrasound images were then re-recorded and saved.
  
  
  RESULTS
  Twenty consecutive patients underwent contrast-enhanced ultrasound evaluation during the operative procedure. All patients received at least one bolus dose of microspheres (median 2 dose, range 1-3), without change in heart rate, blood pressure, end tidal CO(2), oxygen saturation, and sedation monitoring at the time of dosing and until 4 hr post-bolus doses. Two blinded independent readers found the contrasted images to have a statistically greater degree of enhancement (median improvement of 4, P = 0.01) and greater degree of size/border characteristics in the contrasted images (median improvement of 5, P = 0.01) for all histologies. In five patients, the extent of hepatic resection was altered from partial to complete lobectomy in order to obtain acceptable oncologic margin.
  
  
  CONCLUSIONS
  Contrast-enhanced ultrasound is safe and effective in pre-resection and pre-ablation treatment planning.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA.
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Reuter
authors.forename: Charles
authors.initials: C
authors.lastname: Woodall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: D003287:Contrast Media