• Anatomy of the Liver
• Liver Adenoma
• Cystic Disease
• Bowel Secondaries
• Other Secondaries
• Staging
• Chemotherapy
• Surgery for Secondary Liver Cancer
• Surgical Resections
• Patient Information
• Outcomes for Liver Surgery under Prof. Karanjia
• A Patient's Account
• Radio Frequency Ablation
• HPB Unit Surrey & Sussex

Staging

Staging Investigations

Liver tumours may be staged by radiological investigations including ultrasound (US) scanning, Spiral Computed Tomography (CT) scanning Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (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

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.

1 - 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 1 - click image to enlarge

2 - Figure 2 is 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 2 - click image to enlarge

Magnetic Resonance Imaging (MRI)

MRI with Teslascan has improved the sensitivity and specificity of MRI imaging hugely and this technique is highly sensitive. Recently our Unit has begun to evaluate Prima Vist.

Figure 3 is an MRI showing lesion in segment 3 of the left hemi-liver.	Figure 3 - click image to enlarge

Laparoscopy

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 has reduced the number of 'open and shut' cases in one series from 13% to 7%.

Operative ultrasound

Operative ultrasound carried out at the time of surgery is the most sensitive investigation available provided that the operating surgeon has a high quality machine with a special liver probe.