IOUS and CE-IOUS during hepatic resection for patients with hepatocellular carcinoma in liver cirrhosis¹

Article type: Research Article

Authors: Gong, Nian-Mei^{a; #; *} | Yin, Hao-Hao^{b; #} | Cai, Wei-Hua^c | Li, Qiu-Wei^a | Wang, Jian-Xin^c | Gu, Chun-Yan^d | Wang, Yan-Fei^a | Wu, Jing^a | Zhang, Yi-Feng^{b; **}

Affiliations: [a] Department of Medical Ultrasound, Third People’s Hospital of Nantong University & Nantong Third People’s Hospital, Nantong, China | [b] Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China | [c] Department of Hepatobiliary Surgery, Third People’s Hospital of Nantong University & Nantong Third People’s Hospital, Nantong, China | [d] Department of Pathology, Third People’s Hospital of Nantong University & Nantong Third People’s Hospital, Nantong, China

Correspondence: [*] Corresponding author: Nian-Mei Gong, Department of Medical Ultrasound, Nantong Third People’s Hospital Third People’s Hospital of Nantong Nantong, Jiangsu, China. E-mail: sunnygnm@163.com.

Correspondence: [**] Corresponding author: Yi-Feng Zhang, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China. E-mail: zhangyifeng0108@sina.com.

Note: [1] This work was partly supported by grants from Nantong Municipal Bureau of Science and Technology, Jiangsu Province, China (No. MS 22015060).

Note: [#] These authors are contributed equally to this work.

Abstract: PURPOSE:To retrospectively evaluate the role of intraoperative ultrasonography (IOUS) and contrast-enhanced IOUS (CE-IOUS) for the patients with hepatocellular carcinoma (HCC) undergoing hepatic resection (HR). METHODS:Twenty-one consecutive patients who had undergone HR for HCC were included in this study. The patients were subject to preoperative imaging modalities including preoperative ultrasonography (Pre-US) and preoperative contrast-enhanced ultrasonography (Pre-CEUS). All the patients then underwent intraoperative ultrasonography (IOUS) and contrast-enhanced intraoperative ultrasonography (CE-IOUS) during surgery. The visualization of primary HCC and additional lesions of all patients were analyzed. RESULTS:Twenty-one HCCs were detected during Pre-US and the remaining six lesions (28.6%) were detected during IOUS and CE-IOUS. Thus the treatment plan was changed in 28.6% of patients. Twenty-one HCCs (diameter, 0.6–3.0 cm; mean±SD, 1.98±0.85 cm) were measured on Pre-US and remeasured on IOUS (diameter, 0.9–3.3 cm; mean±SD, 2.19±0.84 cm) (p < 0.001). The 6 additional lesions consisted of three moderately differentiated HCCs, one cholangiocarcinoma (ICC), and two high-grade dysplastic nodules (DNs). The mean maximal diameter of the 6 additional lesions was 0.83 cm (range: 0.6–1.1 cm). The malignancy associated features such as capsule interruption, echo heterogeneity, hypo-echoic rim, and a nodule in nodule pattern were more often depicted on IOUS than on Pre-US (all p < 0.01). On CEUS, 19 (90.5%) of 21 HCCs were hyper-enhanced in the arterial phase and washed out from the portal phase to the late phase; the remaining two (9.5%) were hypoenhanced. On CE-IOUS, tumor vasculatures were classified as four patterns: 11 (52.4%) exhibited netlike pattern, 7 (33.3%) annular pattern, 2 (9.5%) mixed pattern, and 1 (4.8%) radial pattern. 3 mHCCs and 2 DNs of six additional nodules had similar greyscale imagining features on IOUS, but they showed different enhancement patterns on CE-IOUS. The ICC showed slightly heterogeneous enhancement during the arterial phase and hypo-enhancement during the portal phase. CONCLUSIONS:IOUS detects more lesions and the treatment plan is changed in 28.6% of patients. HCCs were larger on IOUS than on Pre-US. The typical imaging features of HCCs were better depicted on IOUS in comparison with Pre-US. CE-IOUS can catch the details of microcirculation perfusion of HCCs more sensitively than CEUS. Both IOUS and CE-IOUS were able to provide more decision information during surgery.

Keywords: Hepatocellular carcinoma, intraoperative ultrasonography, contrast-enhanced intraoperative ultrasound, hepatic resection

DOI: 10.3233/CH-180431

Journal: Clinical Hemorheology and Microcirculation, vol. 71, no. 4, pp. 483-498, 2019