title: Is intra-operative ultrasound still useful for the detection of a hepatic tumour in the era of modern pre-operative imaging?
abstract: BACKGROUND
  The current role of intra-operative ultrasound (IOUS) is questioned because of recent progress in medical imaging. The aim of the present study was to determine the accuracy of IOUS in the detection of a hepatic tumour (HT) compared with a pre-operative multi-detector computed tomography (MDCT) scan and magnetic resonance imaging (MRI).
  
  
  METHODS
  This retrospective study included 418 patients evaluated using an 8-slice MDCT scan (SCAN8), 64-slice MDCT scan (SCAN64) and MRI alone or combined with a computed tomography (CT) scan. The pathological result was used as a gold standard.
  
  
  RESULTS
  Correlation rates for the number of detected lesions compared with pathology results were 0.627 for SCAN8, 0.785 for SCAN64, 0.657 for MRI and 0.913 for IOUS. Compared with pathology, the rate of concordance was significantly higher with IOUS (0.871) than with SCAN8 (0.736; P=0.011), SCAN64 (0.792; P<0.001) and MRI (0.742; P<0.001). IOUS was responsible for a change in operative strategy in 16.5% of patients. Surgery was extended in 12.4%, limited in 1.7% and abandoned in 2.4%.
  
  
  CONCLUSIONS
  Compared with cross-sectional pre-operative imaging, IOUS is still superior for the detection of HT and the planning of surgery. IOUS remains recommended as a routine procedure in patients having a hepatic resection in the era of modern pre-operative imaging.
authors.affiliation: HPB and Liver Transplantation Unit, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: D'Hondt
authors.forename: Franck
authors.initials: F
authors.lastname: Vandenbroucke-Menu
authors.forename: Sébastien
authors.initials: S
authors.lastname: Préville-Ratelle
authors.forename: Simon
authors.initials: S
authors.lastname: Turcotte
authors.forename: Miguel
authors.initials: M
authors.lastname: Chagnon
authors.forename: Marylène
authors.initials: M
authors.lastname: Plasse
authors.forename: Richard
authors.initials: R
authors.lastname: Létourneau
authors.forename: Michel
authors.initials: M
authors.lastname: Dagenais
authors.forename: André
authors.initials: A
authors.lastname: Roy
authors.forename: Réal
authors.initials: R
authors.lastname: Lapointe
mesh_terms: D000368:Aged; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011792:Quebec; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography