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AIM:To find occult metastases during hepatectomy in patients with colorectal cancer liver metastases (CRCLM),contrast-enhanced intraoperative ultrasonography (CE-IOUS) was performed using a new microbubble agent,sonazoid,which provides a parenchyma-specific contrast image based on its accumulation in the Kupffer cells.METHODS:Eight patients with CRCLM underwent CEIOUS using sonazoid before hepatectomy.The liver was investigated during a late Kupffer-phase imaging,which is a valuable characteristic of sonazoid.RESULTS:CE-IOUS using sonazoid provided the early vascular- and sinusoidal-phase images for 10 rain followed by the late Kupffer-phase image up to 30 min after the injection of sonazoid.IOUS did not provide new findings of metastatic lesion in the 8 patients.However,during the late Kupffer-phase image of sonazoid,a metastatic lesion was newly found in two of the 8 patients.These newly detected lesions were removed by an additional hepatectomy and histopathologically diagnosed as a metastasis.CONCLUSION:CE-IOUS using sonazoid can allow surgeons to investigate the whole liver with enough time and to find new metastases intraoperatively.