Characterization of microvascularization of liver tumor lesions with high resolution linear ultrasound and contrast enhanced ultrasound (CEUS) during surgery: First results.
OBJECTIVE
Evaluation of high resolution linear ultrasound and intra-operative linear contrast enhanced ultrasound (CEUS) and its benefit for the detection and characterization of tumor lesions.


METHODS
Twenty patients were investigated preoperatively regarding tumor detection using CT (n = 8) or MRI (n = 12) and image fusion (VNav) (n = 3). All patients had surgery for their hepatic tumor (hepatocellular carcinoma (HCC), cholangiocellular carcinoma (CCC), metastasis, and adenoma). Ultrasound was performed intra-operatively first with B-scan using a convex probe. Than multifrequency linear transmitters (6-9 MHz, 6-15 MHz, LOGIQ E9, GE) were applied for B-scan, coulor coded Doppler sonography (CCDS) and Power Doppler followed by dynamic CEUS with Contrast Harmonic Imaging (CHI) after bolus injection of a maximum of 15 mL SonoVue®.


RESULTS
In 9 cases with the use of intra-operative CEUS additional tumor lesions (diameter 4-15 mm) could be detected and were histologically confirmed after surgical resection (7 cases) or intra-operative biopsy (2 cases). Using intraoperative CEUS 64 tumor lesions could be detected compared to 51 tumor lesions detected by preoperative CT or MRI (p < 0.05). Using the 6-15 MHz multifrequency linear transducer with CHI, arterial perfusion of adenomas, neuroendocrine metastases and HCC lesions was detectable. In 3 cases a resection was not achievable. Two of these cases were treated with radio frequency ablation (RFA). The other case had no curable option due to multifocal tumor manifestation.


CONCLUSIONS
The intra-operative use of high-resolution linear transducer techniques with CEUS offers new diagnostic perspectives for an effective liver surgery.
Department of Radiology, University Medical Center Regensburg, Regensburg, Germany. emjung@gmx.de
E M
EM
Jung
C J
CJ
Ross
J
J
Rennert
M N
MN
Scherer
S
S
Farkas
P
P
von Breitenbuch
A A
AA
Schnitzbauer
P
P
Piso
P
P
Lamby
C
C
Menzel
A G
AG
Schreyer
S
S
Feuerbach
H J
HJ
Schlitt
M
M
Loss
D000236:Adenoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D018281:Cholangiocarcinoma / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D003287:Contrast Media; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery; D008113:Liver Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D013459:Sulfur Hexafluoride; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride