背景:超声检查(US)广泛用于肝肿瘤的术前检测。然而,美国没有高分辨率和非常小的肿瘤,位于肝脏表面附近的肿瘤,或者肝硬化肝脏中的那些通常没有被检测到。
方法:一名曾接受乙状结肠癌(T3N1bM0Stage3b)手术的47岁女性通过对比增强计算机断层扫描(CT)和g二甲氧基苄基二乙基三胺-ta乙酸(Gd-EOB-DTPA)磁共振成像(MRI)显示第2段表面有肝肿瘤。然而,术前US无法识别同一部位的肿瘤病变.最可能的术前诊断是乙状结肠癌转移,并进行了腹腔镜肝切除术。术中超声检查(IOUS)未发现肿瘤,但是在第2段的表面用吲哚菁绿(ICG)荧光可视化。腹腔镜肝切除术在荧光引导下进行。病理检查显示假瘤,切缘阴性。
结论:ICG荧光成像可以使在US上检测不到的肝肿瘤可视化。
BACKGROUND: Ultrasonography (US) is widely used for pre-operative detection of liver tumors. However, US does not have high resolution and very small tumors, tumors located near the liver surface, or those in cirrhotic livers are often not detected.
METHODS: A 47-year-old woman with a previous surgery for sigmoid colon cancer (T3N1bM0 Stage3b) showed a liver tumor on the surface of segment 2 by contrast-enhanced computed tomography (CT) and gadoliniumethoxybenzyldiethlenetriaminepen-taacetic acid (Gd-EOB-DTPA) magnetic resonance imaging (MRI). However, preoperative US could not identify a tumor lesion at the same site. The most likely preoperative diagnosis was metastasis from her sigmoid colon cancer and laparoscopic liver resection was performed. Intraoperative ultrasonography (IOUS) did not identify the tumor, but it was visualized with indocyanine green (ICG) fluorescence at the surface of segment 2. Laparoscopic liver resection was performed under fluorescence guidance. Pathological examination showed a pseudotumor with negative margins.
CONCLUSIONS: ICG fluorescence imaging can allow visualization of liver tumors that are undetectable on US.