CLINICAL-SIGNIFICANCE OF THE COLOR DOPPLER IMAGING IN PREOPERATIVE INVESTIGATION FOR SURGERY OF THE LIVER

Aim: Resection of liver tumours is not always successful despite detai led diagnostic work-up preoperatively. In our study we compared the pr edictive value of colour Doppler imaging of the liver with other radio logical examinations for tumour staging, surgical decision making and postoperative complications. Methods: From 1/95 to 6/1997 we investiga ted 76 patients with liver tumours; 60 patients with liver metastases, 13 with primary liver carcinomas and 3 with benign lesions. Resectabi lity was defined in colour Doppler imaging by tumour localisation, dis tance of the tumour to the central vessels and blood flow in the porta l vein. CT-scan in all patients and angiography in patients with centr al tumour localisation was performed. The preoperative results were co mpared to intraoperative ultrasound and surgical examination. Results: 108 out of 118 intrahepatic lesions were found preoperatively using h igh-resolution ultrasound. Ultrasound and CT-scan achieve comparable r esults in delineating pathologic changes in the liver. Considering onl y the liver findings and local resectability in 76 patients, the sensi tivity achieved for B-mode-ultrasound was 77,6% (59/76); for CT-scan 7 8,9% (61/76) and for colour Doppler imaging 86,4% (66/76). 31 out of 7 6 laparotomies were terminated after exploration. Resectability was co rrectly predicted by ultrasound in 55 (72,4%) and by CT-scan in 57 (73 ,7%) patients. Colour Doppler imaging improved the ultrasound results in up to 62 (81,6%) patients. Unsuspected not resectable tumour growth was found in 9 patients with local/regional recurrences, in 4 patient s with peritoneal spread and in one patient with multiple bilateral li ver metastases. Conclusions: Using high-resolution ultrasound systems the preoperative detection of lesions in the liver achieves the result s of CT-scan. Little isoechogenic lesions, peritoneal spread and locor egional recurrences can be missed by ultrasound examination. Colour Do ppler imaging shows compared with B-mode and CT-scan a higher sensitiv ity for the detection of the infiltration of hilar structures and can take place of more invasive methods in preoperative liver investigatio ns. Considering functional and morphological aspects colour Doppler im aging makes an essential contribution to the planning of liver surgery . Using lung passing contrast media the determination of tumour vascul arisation and perioperative quantification of liver perfusion is possi ble. The use of the intraoperative ultrasound is justified to determin e resection limits, detection of smallest non-palpable lesions and to control perfusion after vascular reconstruction. In experienced hands colour Doppler imaging gives valuable preoperative information with ex cellent cost-benefit ratio.