First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases
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First application of intraoperative MRI of the liver during ALPPS procedure for colorectal liver metastases Carina Riediger 1 & Verena Plodeck 2 & Johannes Fritzmann 1 & Alexander Pape 3 & Alexander Kohler 1 & Björn Lachmann 4 & Thea Koch 4 & Jens-Peter Kühn 2 & Ralf-Thorsten Hoffmann 2 & Jürgen Weitz 1 Received: 3 February 2020 / Accepted: 30 April 2020 # The Author(s) 2020
Abstract Purpose Intraoperative detection of intrahepatic lesions can be demanding. The use of preoperative contrast-enhanced magnetic resonance imaging (MRI) or computer tomography (CT) combined with intraoperative ultrasound of the liver is state of the art. Near totally regressed colorectal liver metastases (CRLM) after neoadjuvant chemotherapy or nodules in severely altered liver tissue as steatosis or cirrhosis are often hard to detect during the operative procedure. Especially differentiation between benign atypical nodules and malignant tumors can be very difficult. The intraoperative use of contrast-enhanced ultrasound or intraoperative navigation are helpful tools. However, both methods show relevant limitations. The use of intraoperative MRI (ioMRI) can overcome this problem. Relevant structures can be marked within the operative site or immediate control of complete tumor resection can be achieved. This might allow immediate surgical optimization in case of failure. Methods We report the intraoperative application of ioMRI in a case of a 61-year-old male patient suffering from rectal cancer with 10 synchronous bilobar CRLM who was treated stepwise by multimodal treatment and staged hepatectomy. Intraoperative contrast-enhanced MRI of the liver was used during completion procedure of an extended right hemihepatectomy performed as “Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS)”. Results ioMRI provided excellent images and showed absence of liver metastases in the liver remnant. Procedure of ioMRI was safe, fast and feasible. Conclusion To the best of our knowledge, we describe the first case of intraoperative application of a contrast-enhanced MRI during open liver surgery at the University Hospital of Dresden. Keywords CRLM . Intraoperative MRI . ALPPS
Introduction Carina Riediger and Verena Plodeck contributed equally to this work. * Carina Riediger [email protected] 1
Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
2
Department of Radiology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
3
Department of Traumatology and Orthopaedic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
4
Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
Inspection, palpation, and the use of intraoperative ultrasound (IOUS) are important intraoperative tools to detect
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