Abstract
PurposeIntraoperative detection of intrahepatic lesions can be demanding. The use of preoperative contrast-enhanced magnetic resonance imaging (MRI) or computer tomography (CT) combined with intraoperative ultrasound of the liver is state of the art. Near totally regressed colorectal liver metastases (CRLM) after neoadjuvant chemotherapy or nodules in severely altered liver tissue as steatosis or cirrhosis are often hard to detect during the operative procedure. Especially differentiation between benign atypical nodules and malignant tumors can be very difficult. The intraoperative use of contrast-enhanced ultrasound or intraoperative navigation are helpful tools. However, both methods show relevant limitations.The use of intraoperative MRI (ioMRI) can overcome this problem. Relevant structures can be marked within the operative site or immediate control of complete tumor resection can be achieved. This might allow immediate surgical optimization in case of failure.MethodsWe report the intraoperative application of ioMRI in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar CRLM who was treated stepwise by multimodal treatment and staged hepatectomy. Intraoperative contrast-enhanced MRI of the liver was used during completion procedure of an extended right hemihepatectomy performed as “Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS)”.ResultsioMRI provided excellent images and showed absence of liver metastases in the liver remnant. Procedure of ioMRI was safe, fast and feasible.ConclusionTo the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced MRI during open liver surgery at the University Hospital of Dresden.
Highlights
Inspection, palpation, and the use of intraoperative ultrasound (IOUS) are important intraoperative tools to detect and localize liver metastases in open liver surgery that are regularly used.intraoperative localization and detection of liver tumors can be difficult—especially in patients with severe alteration of the liver tissue such as steatosis, steatohepatitis, or liver cirrhosis
We report the intraoperative application of intraoperative magnetic resonance imaging (ioMRI) in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar colorectal liver metastases (CRLM) who was treated stepwise by multimodal treatment and staged hepatectomy
To the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced magnetic resonance imaging (MRI) during open liver surgery at the University Hospital of Dresden
Summary
Intraoperative localization and detection of liver tumors can be difficult—especially in patients with severe alteration of the liver tissue such as steatosis, steatohepatitis, or liver cirrhosis. Another challenge for intraoperative localization are small nodules as near totally regressed liver metastases after chemotherapy as well as the differentiation between tumor nodules and scar tissue after resection in patients with repeated liver resections or two-staged hepatectomy. Contrast-enhanced ultrasound, intraoperative use of indocyanine green (ICG) fluorescence imaging, and 3D navigation. Intraoperative use of ICG fluorescence imaging in liver surgery can be helpful to detect tumor nodules as well as segment borders within the liver. ICG has to be applied a few days before surgery for the detection of tumor nodules [1]
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