Journal of Ultrasound in Medicine, Vol 20, Issue 5 545-548, Copyright © 2001 by American Institute of Ultrasound in Medicine
Identification of hepatic venous territories in liver resection by using color Doppler ultrasonography: report of two cases
H. Kitamura, Y. Miyagawa, T. Yokoyama, A. Kobayashi, S. Miwa, S. Miyagawa and S. Kawasaki
First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
OBJECTIVE: Resection of the hepatic vein because of the proximity of tumors
may result in increased congestion in the noncancerous parenchyma, which in
turn may lead to functional hepatic volume loss and postoperative hepatic
failure, especially in a case of low hepatic reserve. However, to our
knowledge, no technique for estimating the extent of dependent hepatic
venous territories before hepatic resection has been established. We
examined the possibility of using color Doppler ultrasonography for this
purpose. METHODS: A color Doppler system and a linear array transducer
equipped with multiple Doppler frequencies ranging from 7 to 13 MHz were
used intraoperatively. Two patients with hepatocellular carcinomas were
examined. By tracking entire branches of the targeted vessel, from the
trunk to the terminal branches extending to the liver surface, it was
possible for the boundaries of the dependent areas to be projected and
marked on the liver surface with either ink or electrocautery. RESULTS: In
both cases, this method was effective for either minimizing the congestive
area or preserving the hepatic mass that was being drained via aberrant
routes. CONCLUSIONS: Identification of hepatic venous territories by means
of color Doppler ultrasonography may provide new information about
intrahepatic blood circulation and may increase the safety and curability
of hepatic resection.
