Application of contrast-enhanced intraoperative ultrasonography in the decision-making about hepatocellular carcinoma operation

Abstract

Aim: To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography (CE-IOUS) in hepatocellular carcinoma (HCC) operations.

Methods: Clinical data of 50 HCC patients were retrospective analyzed. The sensitivity, specificity, false negative and false positive rates of contrast enhanced magnetic resonance imaging (CE-MRI), IOUS and CE-IOUS were calculated and compared. Surgical strategy changes due to CE-IOUS were analyzed.

Results: Lesions detected by CE-MRI, IOUS and CE-IOUS were 60, 97 and 85 respectively. The sensitivity, specificity, false negative rate, false positive rate of CE-MRI were 98.2%, 98.6%, 98.6%, 60.0%, respectively; for IOUS were 50.0%, 90.9%, 1.8%, 1.4%, respectively; and for CE-IOUS were 1.4%, 40.0%, 50.0%, 9.1%, respectively. The operation strategy of 9 (9/50, 18.0%) cases was changed according to the results of CE-IOUS.

Conclusion: Compared with CE-MRI, CE-IOUS performs better in detection and differentiation of small metastasis and regenerative nodules. It plays an important role in the decision-making of HCC operation.

Figures

Figure 1

IOUS showing typical sonographic appearance of HCC nodules with mosaic pattern (A, arrow) and hyperechoic regenerative nodules (B, arrow); It is hard for IOUS to accurately diagnose a hypoechoic nodule (C, arrow) which could be a regenerative nodule or a small HCC nodule or focal fatty sparing nodule.

Figure 2

CE-IOUS showing an HCC nodule with hyperenhancement in arterial phase (A, arrow) while a regenerative hyperechoic nodule shows isoenhancement on CE-IOUS (B, arrow); Hypoechoic intrahepatic metastatic nodule showing wash out of contrast agent on late phase (C, arrow); Isoechoic nodule missed on IOUS showing a clear margin on CE-IOUS (D, arrow).