title: Intraoperative Contrast-Enhanced Ultrasound in Colorectal Liver   Metastasis Surgery Improves the Identification   and Characterization of Nodules.
abstract: BACKGROUND
  The sensitivity of preoperative assessment of colorectal liver metastases (CRLM) ranges from 74 to 80%. Intraoperative ultrasound (IOUS) associated with contrast-enhanced intraoperative ultrasound (CE-IOUS) may be able to improve this. Thus, the aims of this study were to assess the value of IOUS and CE-IOUS for the surgical approach and to determine risk factors both for the detection of new nodules and for the modification of the surgical strategy.
  
  
  METHODS
  Forty-three patients who underwent CRLM surgery were included. These patients had an MRI in the 8 weeks preceding surgery and benefited from intraoperative IOUS and CE-IOUS.
  
  
  CONCLUSIONS
  The use of IOUS/CE-IOUS permitted the identification of 43 additional lesions and an improved characterization of nodules in 23 patients with a resulting modification of surgical strategy. Lesions were down-staged in six patients and up-staged in six patients. Chemotherapy (p = 0.02) and the presence of nodules in the left lobe (p = 0.04) were predictive factors for finding new nodules at IOUS/CE-IOUS. The discovery of a new nodule systematically modified surgical management. IOUS/CE-IOUS improved intraoperative management of liver metastases. The techniques enable pertinent modification of surgical resections and a reduction of residual lesions.
authors.forename: Julien
authors.initials: J
authors.lastname: Hoareau
authors.forename: Aurélien
authors.initials: A
authors.lastname: Venara
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lebigot
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Hamel
authors.forename: Emilie
authors.initials: E
authors.lastname: Lermite
authors.forename: Francois Xavier
authors.initials: FX
authors.lastname: Caroli-Bosc
authors.forename: Christophe
authors.initials: C
authors.lastname: Aube
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery* / Q000648:ultrastructure; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D003287:Contrast Media