Combined use of contrast-enhanced intraoperative ultrasonography and a fluorescence navigation system for identifying hepatic metastases.
BACKGROUND
The purpose of this study was to assess the concomitant use of contrast-enhanced intraoperative ultrasound (CE-IOUS) using the new microbubble agent Sonazoid, and to assess the fluorescence navigation system (Photo Dynamic Eye, or PDE) using indocyanine green (ICG) as a novel tool for identifying colorectal metastatic lesions compared with preoperative contrast-enhanced multiple row-detected computed tomography (MDCT) and gadoxetic acid-enhanced MRI.


METHODS
Thirty-two patients who underwent a liver resection for colorectal metastatic carcinoma from 2008 to 2009 were included in the present study. ICG was intravenously injected within 2 weeks of the operation. The liver was inspected with CE-IOUS using Sonazoid and PDE for visualizing small metastatic lesions. A lesion analysis was performed with the postoperative histopathological examination of the resected tissues. The clinical values of CE-IOUS and PDE to confirm the malignant lesion diagnoses were statistically evaluated.


RESULTS
A total of 56 lesions were identified based on the histopathological findings of the biopsies and resected tissues; of these, 52 were confirmed to be metastases, whereas 4 were benign tumors. The numbers of identified metastases by MDCT/MRI and CE-IOUS/PDE were 46 and 51, respectively. The use of CE-IOUS and PDE improved the diagnostic sensitivity compared with the use of MDCT and EOB-MRI (98.1 vs. 88.5%, respectively; P = 0.050).


CONCLUSIONS
The present results suggested that the concomitant use of CE-IOUS with the Sonazoid and PDE system may be a useful and safe method, in addition to CT or MRI.
Uchiyama
Kazuhisa
K
Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Ueno
Masaki
M
Ozawa
Satoru
S
Kiriyama
Sigehisa
S
Shigekawa
Yoshinobu
Y
Yamaue
Hiroki
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005290:Ferric Compounds; D005456:Fluorescent Dyes; D019786:Gadolinium DTPA; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D007501:Iron; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010087:Oxides; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D003287:Contrast Media; D005290:Ferric Compounds; D005456:Fluorescent Dyes; D010087:Oxides; C069727:Sonazoid; C073590:gadolinium ethoxybenzyl DTPA; D007501:Iron; D007208:Indocyanine Green; D019786:Gadolinium DTPA