title: Intraoperative ultrasound with contrast medium in resective pancreatic surgery: a pilot study.
abstract: BACKGROUND
  The introduction of contrast-enhanced ultrasound has been a major innovation in liver and pancreatic imaging. Previous studies have validated its intraoperative use during liver surgery, while there is a lack of data regarding its use during pancreatic surgery. The purpose of the present study was to prospectively evaluate the possible role of contrast-enhanced intraoperative ultrasound (CEIOUS) during resective pancreatic surgery for primary lesion characterization and intraoperative staging.
  
  
  METHODS
  Thirty-four patients (70% males, mean age 67.9 years) were selected for pancreatic surgery between October 2006 and July 2009. All patients underwent intraoperative ultrasound with intravenous injection of 4.8 mL sulfur-hexafluoride microbubbles. Location of the primary tumor, relation to the main vessels, contrast medium uptake modalities, presence of liver metastases, and multifocal pancreatic involvement were evaluated. The majority of operations were pancreatoduodenectomies (70.6%) performed for pancreatic ductal adenocarcinoma (64.7%).
  
  
  RESULTS
  Additional lesions were detected by ultrasound in six patients (17.6%: liver metastases in four patients, a hemangioma in one patient, and a further pancreatic lesion in one patient). In five of these patients (5/34, 14.7%) surgical management was modified by these findings. All these new findings were diagnosed before injection of contrast medium, except for a metastasis from a neuroendocrine tumor; the characterization of the hemangioma was possible only after contrast injection. Intraoperative findings regarding location of primary tumor, relation to the main vessels, and lesion characterization did not differ from those obtained with preoperative imaging.
  
  
  CONCLUSIONS
  In our experience intraoperative ultrasound is a valid technique for intraoperative staging prior to pancreatic resection; it is unclear whether, in pancreatic surgery, the addition of contrast enhancement adds any benefit to traditional intraoperative ultrasound.
authors: Unità Operativa e Cattedra di Chirurgia Generale, Università degli Studi di Milano, Istituto Clinico Humanitas-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. antonino.spinelli@humanitas.it
authors: Antonino
authors: A
authors: Spinelli
authors: Daniele
authors: D
authors: Del Fabbro
authors: Matteo
authors: M
authors: Sacchi
authors: Alessandro
authors: A
authors: Zerbi
authors: Guido
authors: G
authors: Torzilli
authors: Fabio R
authors: FR
authors: Lutman
authors: Luigi
authors: L
authors: Laghi
authors: Alberto
authors: A
authors: Malesci
authors: Marco
authors: M
authors: Montorsi
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D009367:Neoplasm Staging; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D013459:Sulfur Hexafluoride