Regional Hepato-Pancreatico-Biliary Unit - Surrey and Sussex

Associated sites:   Liver.co.uk,    Liver.org.uk,   Bowel-cancer.com

Staging Investigations

Liver tumours may be staged by radiological investgations including  Ultrasound scanning (US), Spiral Computed Tomography (CT) scanning, Magnetic Resonance Imaging (MRI) and PET scanning.

The evidence would suggest that multiple forms of imaging are often required to identify and characterise different types of liver lesion. Ultrasound is relatively cheap and easy to perform although the results are operator dependent. 

CT scanning is the most commonly used technique and with the advent of contrast enhanced spiral CT scanning definition of liver lesions has improved enormously. Figure 1 is a  CT scan image showing a large deposit in the centre of the liver and a further small lesion in the left hemi-liver which was subsequently shown to be a liver cyst on operative ultrasound. Figure 2 ia a CT scan image of the same patient 3 years after an extended right hemi-hepatectomy. There is hypertrophy of the left hemi-liver and the cyst previously noted has remained unchanged.

Figure 1                         Figure 2         

Magnetic Resonance Imaging (MRI) with conventional contrast agents is a useful technique but the sensitivity and specificity for liver tumours is lower. However the new contrast agents such as Endorem, Teslascan etc have improved the sensitivity and specificity and this technique is highly sensitive. Figure 3 is an  MRI showing lesion in segment 4 of the left hemi-liver. 

Figure 3                   

Laparoscopy carried out as a day procedure prior to formal surgical exploration or actually carried out on the day of main surgery is useful for spotting small nodules of disseminated disease not evident on ultrasound, CT or MRI scanning. When combined with laparoscopic ultrasound the technique is even more accurate. Widespread adoption of this technique will reduce the number of "open and shut" cases in any series.