Intracaval endovascular ultrasonography for malignant hepatic tumor: New diagnostic technique for vascular invasion

Successful operation for hepatic tumor extending to the inferior vena cava (IVC) depends heavily on accurate preoperative imaging. We investigate the diagnostic value of intracaval endovascular ultrasonography (US) in the diagnosis of invasion to the IVC, A retrospective study of 26 consecutive patients of hepatic tumor with possible invasion of the IVC was performed using conventional imaging techniques from the right femoral vein with an 8-French, 20-MHz intravascular US. Nineteen of 26 cases were operated on and 15 cases were resected, including three cases of combined resection of the IVC, The sonographic criterion for IVC invasion was obliteration of a single echogenic layer of the IVC wall or intracaval tumor mass. The results of intracaval endovascular US were compared with those of CT and cavography. Vascular invasion was obtained in seven of 26 cases, Vascular invasion was confirmed by pathologic examination of five resected specimens, including two autopsy and two operative findings, The sensitivity, specificity, and overall accuracy of intracaval endovascular US for the diagnosis of the IVC invasion were 100%, 94.7%, and 96.1%, respectively, The values were 85.7%, 63.2%, and 69.2% for CT and 71.4%, 68.4%, and 69.2% for cavography, respectively. The intracaval endovascular US clearly visualized the IVC and established the presence and extent of tumor invasion. Intracaval endovascular US is a useful technique that can precisely evaluate the IVC for possible hepatic tumor invasion, especially when presence or extent of vascular invasion is not definitely established by conventional imaging techniques. (C) 1996 Wiley-Liss, Inc.