Aim Defining sensitivity, specificity, diagnostic accuracy for detection of colorectal
liver metastases in imaging compared to intraoperative assessment. Defining a cutoff,
where accuracy of detection is impaired. Methods Prospective single-institution clinical
trial (clinicaltrials.gov: NCT01522209). Patients underwent CEUS, MDCT, and 3 Tesla
EOB-MRI within 2 weeks preoperatively. Intraoperative palpation. IOUS, and CEIOUS
were performed. A patient and lesion-based database was analyzed for accuracy of detection
of CEUS, CT, MRI, and Palp/IOUS/CEIOUS combined read. Histology was standard of reference.
Results Forty seven high tumor load (mean 5, 4 lesions) patients were analyzed. Histopathology
confirmed 264 lesions (245 malignant 19 benign). Accuracy for detection of all lesions:
CEUS 63%, CT 71%, MRI 92%, and PALP/IOUS/CEIOUS 98%. ROC analysis for lesion size
showed severe impairment of accuracy in lesion detection smaller than 5mm. Intraoperative
imaging was not impaired by lesion size. Patient-based analysis revealed a change
of resection plan after IOUS/CEIOUS in 35% of patients. Conclusion At 5-mm lesion
size, preoperative imaging shows a drop in accuracy of detection. In patients with
multiple lesions, addition of MRI to MDCT seems useful. Accuracy of intraoperative
ultrasound is not impacted by lesion size and should be mandatory. CEIOUS can improve
intraoperative decision-making.
