Intraoperative US in patients undergoing surgery for liver neoplasms: comparison with MR imaging

Radiology. 2004 Sep;232(3):810-4. doi: 10.1148/radiol.2323030896. Epub 2004 Jul 23.


Purpose: To retrospectively compare intraoperative ultrasonography (US) and preoperative magnetic resonance (MR) imaging with contrast material enhancement for the depiction of liver lesions in patients undergoing hepatic resection.

Materials and methods: A radiologist (D.V.S.) and a surgeon (K.K.T.) retrospectively identified 79 patients (36 female and 43 male patients; age range, 10-78 years; mean age, 57 years) who had undergone surgical resection for primary liver tumor or metastasis and had also undergone preoperative contrast-enhanced MR imaging within 6 weeks before surgery. MR imaging was performed with a 1.5-T system. Dedicated intraoperative US of the liver was performed or supervised by a gastrointestinal radiologist using a 7.5-MHz linear-array transducer, after adequate hepatic mobilization by the surgeon. Histopathologic evaluation of the 159 resected hepatic lesions served as the reference standard. The lesion distribution included colon cancer metastasis (n = 122), hepatocellular carcinoma (n = 23), cholangiocarcinoma (n = 6), cavernous hemangioma (n = 4), focal nodular hyperplasia (n = 2), hamartoma (n = 1), and metastatic embryonal sarcoma (n = 1).

Results: Of 159 lesions, 138 (86.7%) were identified at both MR imaging and intraoperative US. Twelve additional lesions (7.5%) in 10 patients were detected only at intraoperative US (eight metastases, one hepatocellular carcinoma, one cholangiocarcinoma, one hemangioma, and one biliary hamartoma). Both modalities failed to depict nine lesions (5.6%) (four metastases, four hepatocellular carcinomas, and one cholangiocarcinoma). The sensitivities of MR imaging and intraoperative US for liver lesion depiction were 86.7% and 94.3%, respectively. Surgical management was altered on the basis of the intraoperative US findings in only three of 10 patients (4%).

Conclusion: Contrast-enhanced MR imaging is as sensitive as intraoperative US in depicting liver lesions before hepatic resection.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Female
  • Humans
  • Intraoperative Care
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / pathology*
  • Liver Neoplasms / surgery
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Preoperative Care
  • Retrospective Studies
  • Ultrasonography