AIM:
Preliminary reports showed that CE-IOUS is a fesible technique and seems to add important information to that offered by conventional intraoperative ultrasound(IOUS).The aim of this study was to determine the role of CE-IOUS in resective surgery for primary and metastatic liver tumours.

MATERIAL AND METHODS:
Between September 2003 and November 2004 a total of 57 patients underwent liver resection with IOUS and CE-IOUS.There were 35 males and 22 females with a mean age of 65.6 years(range:36-87). Thirty-four patients had an hepatocellular carcinoma (HCC)and 23 had metastases from colorectal cancer (CRC). IOUS was performed in all cases using an Aloka SDD 5500 (Aloka Ltd,Tokyo, Japan) ; CE-IOUS was obtained by injecting intravenously 2,4 mL of sulphur-hexafluoride microbubbles ( SonoVue,Bracco Imaging, Italy) in a vein of foreram during surgery.

RESULTS:
CE-IOUS provided additional information in 21 patients out of 57(37%). In the group of HCC patients, it did not confirm as malignant the new nodules detected by IOUS in 7 patients;it confirmed the malignancy of part of the new nodules detected by IOUS in 4 and it fully confirmed as HCC the additional lesions detected by IOUS in the remaining 2. In the group with CRC liver metastases, CE-IOUS disclosed new lesions missed at preoperative imaging and at IOUS in 4 patients (which accounted for 17% of all patients with CRC liver metastases) and confirmed all the additional lesions detected by IOUS in the remaining 3 patients. Additionaly, CE-IOUS helped in better defining the tumor margins of the main lesion in 5 out of 23 patients.

CONCLUSIONS:
These results show that IOUS accuracy is improved by CE-IOUS with a significant impact on surgical strategy and radicality.