Ute Wagnetz, Mostafa Atri, Christine Massey, Alice C.Wei, Ur Metser
OBJECTIVE. The purpose of this study is to compare intraoperative ultrasound and pre-operative contrast-enhanced MRI or 64-MDCT for the depiction of malignant lesions and for prediction of hepatic segments positive and negative for malignancy in patients undergoing partial hepatic resection.
MATERIALS AND METHODS. In this retrospective study, 292 patients undergoing hepatic resection for metastatic colorectal cancer (n = 168), hepatocellular carcinoma (n = 70), or other hepatic malignancies (n = 54) were included. The sensitivity and negative predictive value of intraoperative ultrasound and preoperative cross-sectional imaging were cal-culated. The mean (� SD) time intervals to surgery were 37.6 � 26 days for 64-MDCT and 48.1 � 34 days for MRI. Surgical histopathologic examination was the reference standard. Changes in surgical management were recorded. Logistic regression models were used to es-timate and compare proportions.
RESULTS. For all 561 malignant lesions, the sensitivity of intraoperative ultrasound was 95.1%, compared with 96.8% for 64-MDCT (p = 0.025) and 94.4% for MRI (p = 0.960); 64-MDCT was also more sensitive than intraoperative ultrasound in identifying positive liver segments (p = 0.013). After controlling for patient group and time interval between imaging and surgery, the negative predictive value of 64-MDCT and MRI was higher than that of in-traoperative ultrasound (p < 0.001 and p = 0.040, respectively). In only eight cases (2.7%) was surgical management changed after intraoperative ultrasound.