Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
World J Surg. 2010 Dec;34(12):2953-9. doi: 10.1007/s00268-010-0764-1.
The purpose of this study was to assess the concomitant use of contrast-enhanced intraoperative ultrasound (CE-IOUS) using the new microbubble agent Sonazoid, and to assess the fluorescence navigation system (Photo Dynamic Eye, or PDE) using indocyanine green (ICG) as a novel tool for identifying colorectal metastatic lesions compared with preoperative contrast-enhanced multiple row-detected computed tomography (MDCT) and gadoxetic acid-enhanced MRI.
Thirty-two patients who underwent a liver resection for colorectal metastatic carcinoma from 2008 to 2009 were included in the present study. ICG was intravenously injected within 2 weeks of the operation. The liver was inspected with CE-IOUS using Sonazoid and PDE for visualizing small metastatic lesions. A lesion analysis was performed with the postoperative histopathological examination of the resected tissues. The clinical values of CE-IOUS and PDE to confirm the malignant lesion diagnoses were statistically evaluated.
A total of 56 lesions were identified based on the histopathological findings of the biopsies and resected tissues; of these, 52 were confirmed to be metastases, whereas 4 were benign tumors. The numbers of identified metastases by MDCT/MRI and CE-IOUS/PDE were 46 and 51, respectively. The use of CE-IOUS and PDE improved the diagnostic sensitivity compared with the use of MDCT and EOB-MRI (98.1 vs. 88.5%, respectively; P = 0.050).
The present results suggested that the concomitant use of CE-IOUS with the Sonazoid and PDE system may be a useful and safe method, in addition to CT or MRI.
本研究旨在评估使用新型微泡造影剂声诺维（Sonazoid）的术中增强超声（CE-IOUS），以及使用吲哚菁绿（ICG）的荧光导航系统（Photo Dynamic Eye，PDE），作为识别结直肠癌肝转移病灶的新工具，与术前对比增强多排 CT（MDCT）和钆塞酸增强 MRI 相比。
本研究纳入了 2008 年至 2009 年间因结直肠癌肝转移而接受肝切除术的 32 名患者。ICG 在手术前 2 周内静脉注射。使用声诺维和 PDE 进行 CE-IOUS 检查，以观察小转移病灶。对切除组织的术后组织学检查进行病变分析。使用术后组织学检查评估 CE-IOUS 和 PDE 对确认恶性病变诊断的临床价值。
根据活检和切除组织的组织学发现，共发现 56 个病灶，其中 52 个被证实为转移灶，4 个为良性肿瘤。MDCT/MRI 和 CE-IOUS/PDE 分别识别出 46 个和 51 个转移灶。CE-IOUS 和 PDE 的使用提高了诊断敏感性，与 MDCT 和 EOB-MRI 相比（分别为 98.1%和 88.5%；P=0.050）。
本研究结果表明，除 CT 或 MRI 外，联合使用声诺维的 CE-IOUS 和 PDE 系统可能是一种有用且安全的方法。
