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Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 28, 2008; 14(20): 3207-3211
Published online May 28, 2008. doi: 10.3748/wjg.14.3207
Contrast-enhanced intraoperative ultrasonography equipped with late Kupffer-phase image obtained by sonazoid in patients with colorectal liver metastases
Hiroshi Nakano, Yasuo Ishida, Toshiyuki Hatakeyama, Kazuma Sakuraba, Masahiro Hayashi, Osamu Sakurai, Kiyoshi Hataya
Hiroshi Nakano, Yasuo Ishida, Toshiyuki Hatakeyama, Kazuma Sakuraba, Masahiro Hayashi, Osamu Sakurai, Kiyoshi Hataya, Department of Surgery, Yokohama Asahi-Chuo General Hospital, 4-20-1 Wakabadai, Asahi-ku, Yokohama 241-0801, Japan
Author contributions: Nakano H designed the study and performed hepatectomies; Ishida Y, Hatakeyama T, Hayashi M, and Sakuraba K helped surgeries; Nakano H, Ishida Y, Hatakeyama T, Sakuraba K, and Hayashi M performed contrast-enhanced intraoperative ultrasonography; Nakano H, Sakurai O, and Hataya K analyzed the data and wrote the paper.
Correspondence to: Dr. Hiroshi Nakano, Department of Surgery, Yokohama Asahi-Chuo General Hospital, 4-20-1 Wakabadai, Asahi-ku, Yokohama 241-0801, Japan. nakahiro@marianna-u.ac.jp
Telephone: +81-45-9216111
Fax: +81-45-9214931
Received: March 8, 2008
Revised: April 16, 2008
Accepted: April 23, 2008
Published online: May 28, 2008
Abstract

AIM: To find occult metastases during hepatectomy in patients with colorectal cancer liver metastases (CRCLM), contrast-enhanced intraoperative ultrasonography (CE-IOUS) was performed using a new microbubble agent, sonazoid, which provides a parenchyma-specific contrast image based on its accumulation in the Kupffer cells.

METHODS: Eight patients with CRCLM underwent CE-IOUS using sonazoid before hepatectomy. The liver was investigated during a late Kupffer-phase imaging, which is a valuable characteristic of sonazoid.

RESULTS: CE-IOUS using sonazoid provided the early vascular- and sinusoidal-phase images for

10 min followed by the late Kupffer-phase image up to 30 min after the injection of sonazoid. IOUS did not provide new findings of metastatic lesion in the 8 patients. However, during the late Kupffer-phase image of sonazoid, a metastatic lesion was newly found in two of the 8 patients. These newly detected lesions were removed by an additional hepatectomy and histopathologically diagnosed as a metastasis.

CONCLUSION: CE-IOUS using sonazoid can allow surgeons to investigate the whole liver with enough time and to find new metastases intraoperatively.

Keywords: Contrast-enhanced intraoperative ultrasonography; Late Kupffer-phase image; Sonazoid; Colorectal cancer liver metastases; Occult hepatic lesions