Abstracts
2000 Digestive Disease Week

# 2272 Three Dimensional Magnetic Resonance Technique (3D-MR) in the Preoperative Evaluation of Liver Tumours.
Rune P. Sandbu, Thomas Bjerner, Hakan Ahlstrom, Ulf H Haglund, Uppsala, Sweden

Could the preoperative difficulties to define the segmental involvement of liver tumours and evaluate resectability, despite conventional cross sectional CT or MR, be overcome by a 3D reconstruction? Methods: We adopted a computerized method for 3D reconstruction of liver vessels and lesions from different MR data sets. The technique allowed us to view the tumour and relevant vessels from any angle, to give different colours, and make transparent to aid the understanding. Patients: 3D-MR was applied when 2D-images were considered insufficient to define the extent of the lesion and thus decide resectability. During the last 4 years we have performed 61 liver resections, and 16 of these patients were examined with 3D-MR. In addition, 7 patients underwent open surgical exploration which verified the 3D-MR findings. 10 of these 23 patients had primary liver cancer, 8 colorectal metastasis, 3 other malign tumours, and 2 had benign lesions. Results: The relationship between tumour(s), portal, and hepatic veins was precisely shown in 21 of 23 patients. Extensive tumour growth in the hilar region obscured the 3D interpretation in 2 patients. Third generation of vascular branches could be demonstrated, and in 3 patients a major right aberrant hepatic vein was found. Preoperatively 18 patients were considered to be resectable. In 16 of these the resection was performed as planned. Two additional patients only had an exploration due to advanced chirrosis and severe intraoperative cardiac ischemia, respectively. Based on the information obtained by 3D-MR we could plan and perform parenchymasaving segmental resections in 5 patients. 5 patients underwent exploration despite 3D-MR indicated their tumours were unresectable. The 3DMR findings were verified in all relevant details possible to control in 21 out of 23 patients (95%). Extensive tumour growth was underestimated in 2 patients. Conclusion: Preoperative 3D-MR reconstruction of liver tumours, portal and hepatic veins can be a valuable tool for surgical decision making concerning resectability and for planning of liver surgery, especially for planning segmental resections. A finding of an unresectable tumour does not need to be confirmed with laparotomy.