Contrast-enhanced intraoperative ultrasonography using perfluorobutane microbubbles for the enumeration of colorectal liver metastases

Background: Intraoperative ultrasonography (IOUS) is considered the standard for the identification of liver metastases. Use of lipid-stabilized perfluorobutane microbubbles as an ultrasound contrast agent may improve this. The value of contrast-enhanced IOUS (CE-IOUS) in enumerating colorectal liver metastases was studied here. Methods: CE-IOUS was performed in consecutive resections for colorectal liver metastases in 20072010. All patients underwent preoperative computed tomography. Magnetic resonance imaging was not carried out routinely. Conventional intraoperative examination including IOUS, and CE-IOUS with peripherally injected contrast were performed. The histopathological findings and 6-month follow-up images were used as the reference standard. Results: The study group of 102 patients had a total of 315 lesions identified on preoperative imaging (2.4 lesions per operation; 129 operations). Conventional intraoperative examination including IOUS identified 350 lesions (2.7 per operation). CE-IOUS identified 370 lesions (2.9 per operation). The sensitivity, specificity and accuracy of CE-IOUS were 97.1, 59.1 and 93.2 per cent respectively. The CE-IOUS findings altered the surgical plan in 19 operations (14.7 per cent). Conclusion: CE-IOUS provided additional information to that obtained using contemporary preoperative imaging and conventional intraoperative examinations. Copyright (c) 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.