The role of intraoperative ultrasonography in the diagnosis and management of focal hepatic lesions

Ijin Joo, Ijin Joo

Abstract

Intraoperative ultrasonography (IOUS) has been widely utilized in hepatic surgery both as a diagnostic technique and in the course of treatment. Since IOUS involves direct-contact imaging of the target organ, it can provide high spatial resolution without interference from the surrounding structures. Therefore, IOUS may improve the detection, characterization, localization, and local staging of hepatic tumors. IOUS is also a real-time imaging modality capable of providing interactive information and valuable guidance in a range of procedures. Recently, contrast-enhanced IOUS, IOUS elastography, and IOUS-guided hepatic surgery have attracted increasing interest and are expected to lead to the broader implementation of IOUS. Herein, we review the various applications of IOUS in the diagnosis and management of focal hepatic lesions.

Keywords: Intraoperative care; Liver neoplasms; Ultrasonography.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.. A 48-year-old female with colon…
Fig. 1.. A 48-year-old female with colon cancer liver metastases after preoperative chemotherapy.
A, B. The hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance (MR) images show subcentimeter hypointense lesions (arrows) in segment IV (A) and segment II (B). C, D. Non-palpable liver metastases detected on the preoperative MR image are identified as hyperechoic nodules (C, segment IV; D, segment II; arrows) on gray-scale intraoperative ultrasonography using a 7.5-MHz linear probe. E. Follow-up computed tomography after tumorectomy shows that the liver metastases were successfully resected.
Fig. 2.. A 63-year-old female with Budd-Chiari…
Fig. 2.. A 63-year-old female with Budd-Chiari syndrome and hepatocellular carcinoma (HCC) previously treated with transarterial embolization.
A. The arterial (left) and portal (right) phases of contrast-enhanced dynamic magnetic resonance images show the local tumor progression of HCC (arrows) in segment IV of the liver. Surgical resection was planned to treat this tumor. B, C. Preoperative magnetic resonance images show another tiny lesion (arrows) highly suspicious for HCC in segment III of the liver as a hypervascular nodule on arterial-phase imaging (B), and as hypointensity on hepatobiliary-phase imaging (C). D. Intraoperative ultrasonography (IOUS) shows the lesion in segment III near the left hepatic vein (arrowhead) as an isoechoic nodule (arrow). E. Intraoperative radiofrequency ablation was performed for the hepatic nodule with IOUS guidance. F. Follow-up computed tomography shows complete tumor ablation (arrow).
Fig. 3.. A 70-year-old male with hepatocellular…
Fig. 3.. A 70-year-old male with hepatocellular carcinoma (HCC).
A, B. A preoperative magnetic resonance image shows a 0.8-cm nodule (arrows) in segment VI of the liver as a hyperenhancement on the hepatic arterial phase (A), and as hypointensity on the hepatobiliary phase (B). C, D. Gray-scale intraoperative ultrasonography (IOUS) (C) was not able to find the non-palpable hepatic nodule detected on preoperative magnetic resonance imaging. However, in the Kupffer-phase images of contrast-enhanced IOUS using Sonazoid (D, same scanning plane as C), the nodule (arrows) is clearly distinguished from the background parenchyma as an area of hypoechogenicity. This lesion was pathologically confirmed as HCC. E. Immediate follow-up computed tomography shows that the tumorectomy was successful.

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