IS CT PORTOGRAPHY (CTAP) REALLY USEFUL IN PATIENTS WITH LIVER-TUMORS WHO UNDERGO INTRAOPERATIVE ULTRASONOGRAPHY (IOUS)

The objectives were to compare the role of CT during arterial portogra phy (CTAP) and intraoperative ultrasound (IOUS) in the management of p atients with primary or metastatic liver tumors; to study the ability of CTAP to define resectability before laparotomy in these patients; a nd to study whether the omission of CTAP in the imaging algorithm resu lted in a diminished resectability rate. Eighty-eight consecutive pati ents with primary or metastatic liver cancer who underwent CTAP and/or IOUS between January 1990 and December 1993 were reviewed. Thirty pat ients had both CTAP and IOUS and underwent 31 laparotomies (Group I). The sensitivity of these two tests to detect liver tumors was compared . Twenty-eight explorations were performed for hepatic metastases and three for hepatocellular carcinoma. Fifty-three patients, including th ose in group I, underwent CTAP before laparotomy and were studied to a ssess the sensitivity of CTAP in determining unresectability (Group II ). Thirty-five patients (Group III) had IOUS only and were studied to determine whether the omission of CTAP decreased the resectability rat e. In Group I, 52 hepatic lesions were found by a combination of imagi ng studies, operative exploration, and pathologic examination, The sen sitivity of CT, CTAP, IOUS, and exploration were 67 per cent, 65 per c ent, 100 per cent, and 75 per cent, respectively. IOUS was more sensit ive than any other modality in detecting liver tumors (P < 0.001). It added new information in 7/31 cases (23%). The false positive rate of CTAP was 4/31 (13%). In one case (3%), a false positive result would h ave precluded a curative resection. CTAP changed management of 4/53 pa tients (7.5%) by showing unresectable disease. The percentage of curat ive resections was similar in all groups (I = 64%, vs II = 66%, and II I = 65%, P = NS). IOUS is the most sensitive test to detect liver tumo rs and often alters operative management. Contrary to previous reports , CTAP may not be a powerful discriminator of unresectable disease. It s routine use needs to be clarified.