Evaluation of the Liver for Metastatic Disease

Erik K. Paulson, MD1, 1Department of Radiology, Duke University Medical Center, Durham, North Carolina.

Semin Liver Dis. 2001;21(2) 

In This Article

Imaging in Anticipation of Hepatic Resection

In patients undergoing evaluation for hepatic resection, it is important to define not only the number of lesions but also their specific anatomic location.[61,62,63,64] Whether using MRI or CT, prehepatic resection imaging implies maximizing scan quality. Lesions should be measured and counted. Those lesions that are indeterminate should be characterized and described. Not only should lesions be localized to the Couinaud segments, but the relationship of lesions to major anatomic structures (portal and hepatic artery bifurcation, inferior vena cava, and hepatic veins) should be detailed.

Knowledge of the number and specific location of lesions will allow the surgeon to plan an operative approach and to counsel the patient appropriately. Be aware that, with recent advances in hepatic surgery, many patients will not require formal segmental resection. Rather, local therapies including wedge resection, ablative therapy (radio-frequency ablation or cryoablation), or a combination of these techniques with or without segmental resection may be used.[65] Note that with many patients it is difficult to delineate precisely the specific segmental location of a tumor. The more important issue is the relationship of lesions to the major portal, venous, or arterial branches. Knowledge of these relationships allows anticipation of the width of a disease-free surgical margin.[66] Most surgeons will now use open or laparoscopic intraoperative US to detect additional lesions and to localize the disease. Indeed, with the increasing utilization of intraoperative US and the increased number of tools and techniques available to the surgeon, the need to detect all lesions preoperatively is less critical than it was previously.[1] We believe patient care is enhanced by interactively reviewing each case with the surgeon preoperatively.