title: Routine Preoperative Liver-specific Magnetic Resonance Imaging Does Not Exclude the Necessity of Contrast-enhanced Intraoperative Ultrasound in Hepatic Resection for Colorectal Liver Metastasis.
abstract: OBJECTIVE
  To assess the usefulness of contrast-enhanced intraoperative ultrasound (CE-IOUS) during surgery for colorectal liver metastases (CRLM) when gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) is performed as a part of preoperative imaging work-up.
  
  
  BACKGROUND
  EOB-MRI is expected to supersede CE-IOUS, which is reportedly indispensable in surgery for CRLM.
  
  
  METHODS
  One hundred consecutive patients underwent EOB-MRI, contrast-enhanced computed tomography (CE-CT), and contrast-enhanced ultrasound within 1 month before surgery for CRLM. Conventional IOUS and subsequent CE-IOUS using perflubutane were performed after the laparotomy. All the nodules identified in any of the preoperative or intraoperative examinations were resected and were submitted for histological examination, in principle.
  
  
  RESULTS
  Preoperative imaging examinations identified 242 nodules; 25 additional nodules were newly identified using IOUS, 22 additional nodules were newly identified during CE-IOUS, and a histological examination further identified 4 nodules. Among the 25 nodules newly identified using IOUS, all 21 histologically proven CRLMs and 3 of the 4 benign nodules were correctly diagnosed using CE-IOUS. Among the 22 nodules newly identified using CE-IOUS, 17 nodules in 16 patients were histologically diagnosed as CRLMs. The planned surgical procedure was modified on the basis of IOUS and CE-IOUS findings in 12 and 14 patients, respectively. The sensitivity, positive-predictive value, and accuracy of CE-IOUS were 99%, 98%, and 97%, respectively. Those values of EOB-MRI (82%, 99%, 83%, respectively) were similar to CE-CT (81%, 99%, 81%, respectively).
  
  
  CONCLUSIONS
  CE-IOUS is useful in hepatic resection for CRLM, even if EOB-MRI and CE-CT are performed.
authors.affiliation: Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Arita
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ono
authors.forename: Michiro
authors.initials: M
authors.lastname: Takahashi
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Inoue
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Matsueda
authors.forename: Akio
authors.initials: A
authors.lastname: Saiura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005466:Fluorocarbons; D019786:Gadolinium DTPA; D006498:Hepatectomy; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging* / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA; C108042:perfluorobutane