title: Intraoperative high resolution linear contrast enhanced ultrasound (IOUS) for detection of microvascularization of malignant liver lesions before surgery or radiofrequeny ablation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the value of linear contrast enhanced intraoperative ultrasound (CE-IOUS) to improve detection of malign liver tumors lesions before surgery or radiofrequency ablation (RFA).
  
  
  METHODS
  50 patients were included for surgery of malignant liver tumors (mean age 61 years (19-80); male n = 35, female n = 15), suffering from HCC (n = 15), colorectal liver-metastasis (n = 28), CCC (n = 2) or other malign liver lesions (n = 5). Preoperative CE-CT (n = 38), CE-MRI (n = 23) or PET-CT (n = 8) confirmed hepatic tumor manifestation. Before undergoing surgery, intraoperative conventional (IOUS) as well as CE-IOUS were performed by one experienced examiner in all cases using multifrequency linear probes (6-9 MHz, 6-15 MHz; LOGIQ E9; GE Healthcare, Milwaukee, WI, USA). CE-IOUS was performed after bolus injection of 5 ml up to 15 ml SonoVue(®) (Bracco Imaging SpA, Milan, Italy). Digitally stored images of CE-IOUS were compared with fundamental B-Scan and preoperative imaging (CE-CT, CE-MRI and PET-CET).
  
  
  RESULTS
  In 28 of 50 patients (56%), additional lesions were found using CE-IOUS (mean tumor size 8 mm, range 4-12 mm). This resulted in a change of surgical strategy or the intraoperative application of RFA in 27 patients (54%). Modification of therapy due to additionally found liver lesions was statistically significant (p < 0.05). Comparing conventional IOUS and CE-IOUS, 14 additional lesions in 10 patients were seen by CE-IOUS. All lesions seen in B-scan could also be detected with CE-IOUS.
  
  
  CONCLUSIONS
  This is the first study using contrast-enhanced ultrasound with high resolution linear probes for intraoperative detection of malignant liver lesions. Compared to preoperative imaging and also conventional IOUS more than 50% additional lesions were found leading to therapeutic consequences of patients. A recently started prospective study has to show whether these changes in the surgical or interventional therapy will influence morbidity, mortality and especially the recurrence rate.
authors.affiliation: Department of Surgery, University Regensburg Medical Center, Germany. martin.loss@klinik.uni-regensburg.de
authors.forename: Martin
authors.initials: M
authors.lastname: Loss
authors.forename: Julia
authors.initials: J
authors.lastname: Schneider
authors.forename: Wibke
authors.initials: W
authors.lastname: Uller
authors.forename: P
authors.initials: P
authors.lastname: Wiggermann
authors.forename: Marcus N
authors.initials: MN
authors.lastname: Scherer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Jung
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
authors.forename: Christian
authors.initials: C
authors.lastname: Stroszczynski
authors.forename: Ernst M
authors.initials: EM
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000556:secondary; D017115:Catheter Ablation; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008113:Liver Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D013459:Sulfur Hexafluoride; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride