Abstract
Background
The accuracy of preoperative computed tomography (CT) scans in the era of modern imaging techniques with helical, high-resolution CT has not been adequately assessed. We reviewed the data from our departmental prospective database with the hypothesis that intraoperative ultrasonography (IOUS) still detects more hepatic tumors than are evident on preoperative helical CT scans.
Methods
All patients who underwent surgical resection and/or radiofrequency ablation of primary or metastatic hepatic tumors between January 2001 and July 2002 were included in the review. All patients had preoperative helical CT imaging followed by hepatic IOUS. The number of malignant lesions and evidence of local disease identified by the preoperative CT scan versus IOUS and surgical exploration were compared.
Results
In this time period, 250 patients underwent surgical resection and/or radiofrequency ablation of hepatic tumors. In 67 (27%) of these patients, IOUS identified more hepatic tumors than were seen on preoperative helical CT scan. In eight patients (3%), CT underestimated local extension of the disease into the diaphragm. The incidence of inaccurate preoperative prediction of the extent of disease increased significantly with a greater number of hepatic tumors.
Conclusions
IOUS identified additional hepatic tumors in 27% of patients who underwent hepatic resection after state-of-the-art preoperative CT imaging. This study provides evidence that IOUS remains an essential part of the complete assessment of hepatic malignancies in patients who receive surgical treatment.
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References
Clarke MP, Steele G, Hamilton ES, Ravikumar TS, Onik G, Clouse ME. Prospective comparison of preoperative imaging in the detection of liver tumors. Surgery 1989;106:849–55
Soyer P, Levesque M, Elias D, Zeitoun G, Roche A. Preoperative assessment of respectability of hepatic metastases from colonic carcinoma: CT portography vs sonography and dynamic CT. AJR Am J Roentgenol 1992;159:741–4
Knol JA, Marn CS, Francis IR, Rubin JM, Bromberg J, Chang AE. Comparisons of dynamic infusion and delayed computed tomography, intraoperative ultrasound, and palpation in the diagnosis of liver metastases. Am J Surg 1993;165:81–8
Kane RA, Hughes LA, Cua EJ, Steele GD, Jenkins RL, Cady B. The impact of intraoperative ultrasonography on surgery for liver neoplasms. J Ultrasound Med 1994;13;1–6
Fortunato L, Clair M, Hoffman J, et al. Is CT portography (CTAP) really useful in patients with liver tumors who undergo intraoperative ultrasonography (IOUS)? Am Surg 1995;61:560–5
Matsuo M, Kanematusu M, Inaba Y, et al. Pre-operative detection of malignant hepatic tumors: value of combined helical CT during arterial portography and biphasic CT during hepatic arteriography. Clin Radiol 2001;56:138–45
Kehagias D, Metafa A, Hatziioannou A, et al. Comparison of CT, MRI, and CT during arterial portography in the detection of malignant hepatic lesions. Hepatogastroenterology 2000;47:1399–403
Schmidt J, Strotzer M, Fraunhofer S, Boedeker H, Zirngibl H. Intraoperative ultrasonography versus helical computed tomography and computed tomography with arterioportography in diagnosing colorectal liver metastases: lesions-by-lesion analysis. World J Surg 2000;24:43–8
Conlon R, Jacobs M, Dasgupta D, Lodge JPA. The value of intraoperative ultrasound during hepatic resection compared with improved preoperative magnetic resonance imaging. Eur J Ultrasound 2003;16:211–6
Hagspeil KD, Neidl KF, Eichenberger AC, Weder W, Marincek B. Detection of liver metastases: comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5 T with dynamic CT, intraoperative US, and percutaneous US. Radiology 1995;1969:471–8
Foroutani A, Garland A, Berber E, et al. Laparoscopic ultrasound vs triphasic computed tomography for detecting liver tumors. Arch Surg 2000;135:933–8
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Scaife, C.L., Ng, C.S., Ellis, L.M. et al. Accuracy of Preoperative Imaging of Hepatic Tumors With Helical Computed Tomography. Ann Surg Oncol 13, 542–546 (2006). https://doi.org/10.1245/ASO.2006.07.009
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DOI: https://doi.org/10.1245/ASO.2006.07.009