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CT Laparoscopy for Detecting Small Superficial Metastatic Lesions of the Liver Surface: Initial Experience

Yoji S. Maetani1, Hiroyoshi Isoda1, Akinori Nomura2, Shigeki Arizono1, Yuusuke Hirokawa1, Toshiya Shibata1 and Togashi Kaori1

1 Department of Radiology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyoku, Kyoto 606-8507, Japan.
2 Division of Gastrointestinal Surgery, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.


Figure 1
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  		Fig. 1A —71-year-old woman with rectal cancer. Pathologic finding after partial liver resection was metastatic adenocarcinoma from rectal cancer. Intraoperative laparoscopic image shows white superficial hepatic metastatic lesions (arrow) at right lower segment.

 

Figure 2
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  		Fig. 1B —71-year-old woman with rectal cancer. Pathologic finding after partial liver resection was metastatic adenocarcinoma from rectal cancer. CT laparoscopic image shows same finding (arrow) as A.

 

Figure 3
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  		Fig. 1C —71-year-old woman with rectal cancer. Pathologic finding after partial liver resection was metastatic adenocarcinoma from rectal cancer. Frontal view CT laparoscopic image magnified three times nicely delineates lesion (arrow).

 

Figure 4
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  		Fig. 1D —71-year-old woman with rectal cancer. Pathologic finding after partial liver resection was metastatic adenocarcinoma from rectal cancer. Axial contrast-enhanced portal phase CT scan does not depict lesion (arrows).

 

Figure 5
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  		Fig. 2A —72-year-old man with pancreatic cancer. Small white nodule was present at anterior segment of liver. Intraoperative biopsy revealed metastatic poorly differentiated adenocarcinoma from pancreatic cancer. Photograph obtained at exploratory surgery shows tiny metastatic lesion (arrow) of liver surface.

 

Figure 6
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  		Fig. 2B —72-year-old man with pancreatic cancer. Small white nodule was present at anterior segment of liver. Intraoperative biopsy revealed metastatic poorly differentiated adenocarcinoma from pancreatic cancer. CT laparoscopic image at portal phase of dynamic CT shows lesion as small depression. Lesion (arrow) is not enhanced in comparison with liver.

 

Figure 7
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  		Fig. 2C —72-year-old man with pancreatic cancer. Small white nodule was present at anterior segment of liver. Intraoperative biopsy revealed metastatic poorly differentiated adenocarcinoma from pancreatic cancer. Preoperative superparamagnetic iron oxide–enhanced T2-weighted fast spin-echo MR image (TR/TE, 5,000/109) does not depict small superficial metastatic lesion (arrow).

 

Figure 8
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  		Fig. 2D —72-year-old man with pancreatic cancer. Small white nodule was present at anterior segment of liver. Intraoperative biopsy revealed metastatic poorly differentiated adenocarcinoma from pancreatic cancer. Axial contrast-enhanced portal phase CT scan does not depict lesion (arrow).

 

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