A PROSPECTIVE-STUDY OF 6 METHODS FOR DETECTION OF HEPATIC COLORECTAL METASTASES

Many techniques are available for the identification of patients with hepatic colorectal metastases. The accuracy and clinical relevance of transabdominal ultrasound (US), computed tomography (CT), static scint igraphy, dynamic scintigraphy (HPI), intraoperative ultrasound (IOUS) and manual palpation, in the detection of intrahepatic colorectal meta stases were assessed in 73 consecutive patients presenting with colore ctal carcinoma; 39 were male and 34 female with a mean age of 68 years (range 43-90 years). In 33 patients either intraoperative ultrasound or palpation were omitted owing to emergency presentation (n=14) or su bsequent non-operative management (n=19). All six investigations were completed in 40 patients. Computed tomography and hepatic perfusion sc intigraphy (HPI) were the most sensitive, detecting over 90% of lesion s, the others identifying approximately 80% of lesions, Specificity in all methods, apart from dynamic scintigraphy, was over 80%. Contrast- enhanced CT would appear to remain the most accurate method available. However, if the prognostic ability of HPI is confirmed on subsequent follow-up, the accuracy of HPI will rise with time, whereas that of CT will fall. Intraoperative ultrasonography took time to perform and di d not alter the management of any patient within the study. We suggest that its use is limited to those patients in whom resection is contem plated, where the vascular anatomical detail provided may be invaluabl e.