Fioole Bram, de Haas Robbert J, Wicherts Dennis A, Elias Sjoerd G, Scheffers Jolanda M, van Hillegersberg Richard, van Leeuwen Maarten S, Borel Rinkes Inne H M
Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Eur J Radiol. 2008 Jul;67(1):169-76. doi: 10.1016/j.ejrad.2007.03.017. Epub 2007 Apr 30.
Substantial recurrence rates following partial liver resection for colorectal liver metastases (CRM) imply that small metastases remain undetected using intraoperative ultrasound (IOUS). The aim of this study was to evaluate the additional value of contrast enhanced IOUS (CE-IOUS) when compared to preoperative contrast enhanced computed tomography (CE-CT) and IOUS in liver surgery for CRM.
After obtaining informed consent, 39 consecutive patients with CRM were included prospectively for evaluation. The study population consisted of 26 male and 13 female patients with a median (range) age of 62 (49-83) years. A lesion-per-lesion analysis was performed with histopathological examination as the reference standard after resection and follow-up for unresected lesions. The added value of CE-IOUS in correctly diagnosing malignant lesions was statistically evaluated, using receiver operating characteristic curves.
A total of 234 lesions were identified, 137 of which were malignant, according to the reference standard. The addition of CE-IOUS did not improve the diagnostic accuracy when compared to the combination of CE-CT and IOUS (P=0.617). In one of two patients with newly detected lesions on CE-IOUS the extent of resection changed.
The addition of CE-IOUS to preoperative CE-CT and IOUS does not improve the ability to characterize already detected lesions. In a small number of patients it appears to facilitate the detection of new metastatic lesions with implications on surgical strategy.
结直肠癌肝转移（CRM）行部分肝切除术后复发率较高，这意味着术中超声（IOUS）无法检测到小的转移灶。本研究的目的是评估在CRM肝手术中，与术前对比增强计算机断层扫描（CE-CT）和IOUS相比，对比增强IOUS（CE-IOUS）的附加价值。
在获得知情同意后，前瞻性纳入39例连续的CRM患者进行评估。研究人群包括26例男性和13例女性患者，中位（范围）年龄为62（49 - 83）岁。以切除后的组织病理学检查为参考标准，对未切除病灶进行随访，并对每个病灶进行分析。使用受试者工作特征曲线，对CE-IOUS在正确诊断恶性病灶方面的附加价值进行统计学评估。
根据参考标准，共识别出234个病灶，其中137个为恶性。与CE-CT和IOUS联合使用相比，添加CE-IOUS并未提高诊断准确性（P = 0.617）。在CE-IOUS上新发现病灶的两名患者中，有一名患者的切除范围发生了变化。
在术前CE-CT和IOUS的基础上添加CE-IOUS并不能提高对已检测到病灶的特征描述能力。在少数患者中，它似乎有助于检测新的转移病灶，从而影响手术策略。
