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Usefulness of Intraoperative Sonography for Revealing Hepatic Metastases from Colorectal Cancer in Patients Selected for Surgery After Undergoing FDG PET

Bartosz Rydzewski1, Farrokh Dehdashti1,2, Brigid A. Gordon1, Sharlene A. Teefey1, Steven M. Strasberg2,3 and Barry A. Siegel1,2

1 Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110.
2 Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110.
3 Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110.



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  		Fig. 1. —Flow diagram shows composition of patient population in present study. Note that surgical resection was not performed in two of 47 patients who were deemed to be surgical candidates on the basis of preoperative imaging. In one, extensive intrahepatic disease was detected by intraoperative sonography, and in the other, extrahepatic disease was detected by surgeon at time of surgery. IOUS = intraoperative sonography.

 


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  		Fig. 2A. —65-year-old man who underwent sigmoidectomy for carcinoma of sigmoid colon and was found to have single hepatic metastasis on preoperative CT (not shown). Anterior reprojection FDG PET image shows single hepatic lesion (arrow) in left hepatic lobe. Note midline linear region of heterogeneously increased FDG uptake in anterior abdominal wall corresponding to recent surgical incision.

 


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  		Fig. 2B. —65-year-old man who underwent sigmoidectomy for carcinoma of sigmoid colon and was found to have single hepatic metastasis on preoperative CT (not shown). Intraoperative sonogram of left hepatic lobe shows solid mass (2.6 x 1.4 cm) (arrow) in left lobe of liver corresponding to lesion seen on FDG PET.

 


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  		Fig. 2C. —65-year-old man who underwent sigmoidectomy for carcinoma of sigmoid colon and was found to have single hepatic metastasis on preoperative CT (not shown). Intraoperative sonogram of right hepatic lobe shows small (4- to 5-mm) hypoechoic lesion (arrowhead) in anterior segment of right lobe of liver; this lesion was biopsied under sonographic guidance and proved to be benign.

 

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