Contrast-enhanced ultrasound perfusion quantification of solid liver lesions: First intraoperative characterization of tumor microvascularization

Aim Aim of the study was to differentiate solid liver lesions according to their microvascularization. Therefore, we analyzed perfusion using time intensity curves (TIC) measured during contrast-enhanced intraoperative ultrasound (CE-IOUS). Material and Methods Data of 40 patients who underwent hepatic surgery with the diagnosis of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CCC), or liver metastases (LM) were retrospectively collected. CE-IOUS was performed using a linear multifrequency T-probe connected to a high-resolution device. Digital Imaging and Communications in Medicine (DICOM) loops were recorded, and TIC were analyzed for time to peak (TTP) and area under the curve (AUC) in tumor center, margin and reference tissue. Results Analyses of the tumor center revealed significant higher AUC in HCC lesions than in CCC ( p = 0.0310). HCC patients also showed longer TTP in reference tissue compared to CCC ( p = 0.0251). Within the HCC cohort, TTP was shorter at tumor margins compared to reference tissue ( p = 0.0420). For LM, AUC measured at tumor margins was higher than in center and reference tissue ( p center-margin = 0.0266, p margin-reference = 0.0064). Conclusion TIC analysis of solid liver lesions during CE-IOUS revealed significant differences in their microvascularization, improving, intraoperative differentiation. Artificial intelligence tools may enhance IOUS in the future by standardization and motion compensation.