Intracaval endovascular ultrasonography for preoperative assessment of retrohepatic inferior vena cava infiltration by malignant hepatic tumors

✍ Scribed by T Kaneko; A Nakao; S Nomoto; T Endo; S Itoh; H Takagi

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 1017 KB
• Volume: 24
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510240524

✦ Synopsis

the procedure itself remain debatable, and the best way to The accurate diagnosis of inferior vena cava infiltradiagnose IVC infiltration preoperatively has not been estabtion is important not only for preoperative staging but lished. also for performing surgery for hepatic tumor involving

It is important to accurately diagnose the IVC infiltration the inferior vena cava (IVC). We investigated the diagby tumor thrombus and the level of its extension and adhernostic value of intracaval endovascular ultrasonograence to the vessel wall. Despite recent progress in imaging phy (ICEUS) in the diagnosis of invasion of the IVC by technology, questions remain about the degree of adherence a prospective study of 30 consecutive patients with heand the presence or extent of vena cava thrombus in some patic tumors with possible invasion of the IVC. The procases. In clinical practice, we sometimes encountered cases cedure was performed using an 8F, 20-MHz intravascuin which hepatic tumor was in contact with the IVC and lar ultrasonography (US) from the right femoral vein.

pressing on it. In such cases, it is extremely difficult to clearly Twenty-nine of the 30 patients underwent surgery, and differentiate between external compression and direct parithe tumor was resected in 25 cases, including 3 cases of etal infiltration by conventional imaging techniques. 6 But combined resection of the IVC. The diagnostic criterion this information is very important in selecting the approfor IVC infiltration with ICEUS was obliteration of a priate therapeutic procedure. single echogenic layer of the IVC wall or intracaval tu-With the recent progress of ultrasound (US) technology, an mor mass. The results of ICEUS were compared with intravascular US catheter has been developed. Intravascular those of computed tomography (CT), cavography, con-US imaging is a new, evolving modality in which a highventional US, and intraoperative US. Vascular invasion frequency transducer is placed on the tip of a catheter, thus was identified in 7 of 30 cases and was subsequently providing high-resolution, cross-sectional, real-time images confirmed by pathological examination of four resected of the vessel wall. 7,8 We have applied this technology to the specimens, including one autopsy and two operative diagnosis of vena caval involvement by hepatic tumor and findings. The sensitivity, specificity, and overall accuherein report the results. racy of ICEUS for the diagnosis of the IVC invasion was 100%, 95.8%, and 96.7%, respectively, against 85.7%, PATIENTS AND METHODS 60.8%, and 66.7% for CT, and 71.4%, 73.9%, and 73.3%, respectively, for cavography. The sensitivity, specificity, From February 1992 to December 1995, 30 consecutive patients with hepatic tumor with possible tumor infiltration of the IVC, based and overall accuracy of conventional US was 87.5%, 59%, on the results of computed tomography (CT) or extracorporeal US, and 66.7%, respectively; those of intraoperative US were were prospectively studied with intracaval endovascular ultrasonog-100%, 81.8%, and 86.2%, respectively. ICEUS is a useful raphy (ICEUS). The study group consisted of 26 men and 4 women, is projected from the transducer to create a 360Њ real-time image perpendicular to the catheter. Axial resolution was set at 230 mm, lateral resolution at 120 mm, and the radius of tissue penetration at Abbreviations: IVC, inferior vena cava; US, ultrasonography; CT, computed tomography; 20 mm. In terms of quality, the rotating-tip type produced more ICEUS, intracaval endovascular ultrasonography.