title: Contrast-enhanced intraoperative ultrasound for hepatocellular carcinoma: high sensitivity of diagnosis and therapeutic impact.
abstract: BACKGROUND
  Postoperative early recurrence is a crucial issue in the treatment of hepatocellular carcinoma (HCC) patients. Some early recurrences seem to occur from minute tumors which were overlooked during both preoperative and intraoperative investigations. Therefore, it is urgently necessary to increase detectability of minute HCCs during operation. If they could be detected and resected during surgery, the prognosis should be improved. The purpose of this study is to investigate the usefulness of contrast-enhanced intraoperative ultrasound (CEIOUS) for the diagnosis and treatment of HCC.
  
  
  METHODS
  Institutional ethics committee approval and informed consent were obtained. Fifty-two patients (mean age 65 years; 38 males and 14 females) who underwent liver resection with either preoperative computed tomography during angiography (CTA) or CEIOUS with Sonazoid (perflubutane microbubble contrast agent) were studied. We determined the presence of HCC on the basis of the histopathological findings of resected specimens.
  
  
  RESULTS
  The sensitivity of CEIOUS [97.6% (95% CI 91.8-99.4)] was higher than that of CTA [89.4% (95% CI 81.1-94.3)]. The positive predictive values of CEIOUS [91.2% (95% CI 83.6-95.5) and CTA [91.6% (95% CI 83.6-95.9)] were similar. Eight new HCCs from 7 patients, which accounted for 9.4% (8/85) of the total HCCs, were correctly detected and diagnosed by CEIOUS, and we performed an additional partial hepatectomy in 3 of these 7 patients.
  
  
  CONCLUSIONS
  CEIOUS with Sonazoid provided increased sensitivity of detection of small HCCs compared with preoperative CTA, thereby leading to a more appropriate surgical procedure and contributing to complete tumor removal.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Mitsunori
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Noriaki
authors.initials: N
authors.lastname: Nakamura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ban
authors.forename: Takumi
authors.initials: T
authors.lastname: Irie
authors.forename: Norio
authors.initials: N
authors.lastname: Noguchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kudo
authors.forename: Hiroko
authors.initials: H
authors.lastname: Iijima
authors.forename: Shigeki
authors.initials: S
authors.lastname: Arii
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000601:surgery; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005290:Ferric Compounds; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007432:Intraoperative Period; D007501:Iron; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010087:Oxides; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron