Ultraschall Med 2010; 31(5): 500-505
DOI: 10.1055/s-0028-1109751
Originalarbeiten/Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Detection of Hepatic Metastases from Colorectal Cancer: Prospective Evaluation of Gray Scale US Versus SonoVue® Low Mechanical Index Real Time-Enhanced US as Compared with Multidetector-CT or Gd-BOPTA-MRI

Lebermetastasendetektion bei kolorektalen Karzinomen: Prospektive Beurteilung von Grauwert-Sonografie gegenüber SonoVue®-verstärkter Echtzeit-Sonografie mit niedrigem mechanischen Index im Vergleich zu Mulitdetektor-CT oder Gd-BOPTA-MRIV. Cantisani1 , P. Ricci1 , M. Erturk2 , E. Pagliara3 , F. Drudi1 , F. Calliada4 , K. Mortele5 , U. D’Ambrosio1 , C. Marigliano1 , C. Catalano1 , D. Marin1 , M. Di Seri6 , F. Longo6 , R. Passariello1
  • 1Department of Radiology, University ”La Sapienza”, Rome
  • 2Department of Radiology, Sisli Etfal Training and Research Hospital
  • 3Department of Radiology, Campus Biomedico
  • 4Department of Radiology, Policlinico San Matteo
  • 5Department of Radiology, Brigham and Women’s Hospital – Harvard Medical School
  • 6Oncology Department, Policlinico Umberto I, Univ. Sapienza, Rome
Further Information

Publication History

received: 7.1.2009

accepted: 25.7.2009

Publication Date:
20 April 2010 (online)

Zusammenfassung

Ziel: Der Vergleich von Ultraschall (US), kontrastverstärktem Ultraschall (CEUS) mit niedrigem mechanischem Index und Multidetektor-CT (MDCT) zur Lebermetastasendetektion bei kolorektalen Karzinomen. Material und Methoden: Von Januar bis Juni 2006 wurden 110 Patienten (65 männlich, 45 weiblich) mit Verdacht auf hepatische Filiae bei kolorektalem Karzinom prospektiv mit US, CEUS und MDCT durch 2 unabhängige Untersucher evaluiert. Der intraoperative US (IOUS, n = 45) oder ein Follow-up über mindestens 6 Monate mithilfe von MDCT oder Gadobenate-dimeglumine(Gd-BOPTA)-verstärktem MRI galten als Gold-Standard. Der McNemar-Test wurde angewandt. Ergebnisse: Der Referenz-Standard zeigte 430 Metastasen bei 110 Patienten. In der „Patient-by-patient-Analyse” verbesserte CEUS die Sensitivität des US von 67,4 – 71,6 % auf 93,4 – 95,8 % (p < 0,05). Auf Basis der „Lesion-by-lesion-Analyse” verbesserte CEUS die Sensitivität des US von 60,9 – 64,9 % auf 85,3 – 92,8 % (p < 0,001). Die Spezifität erhöhte sich von 50 – 60 % auf 76,7 – 83,3 %. Zwischen CEUS und MDCT wurden keine signifikanten Unterschiede bezüglich der Sensitivität und der Spezifität gefunden. Der CEUS war signifikant sensitiver als der native US in der Detektion von Metastasen, die kleiner als 1 cm waren (p < 0,001) mit einem Sensitivitätsanstieg von 29,1 – 35 % auf 63,3 – 76,6 % hier fanden sich keine signifikanten Unterschiede im Vergleich zur MDCT (Sensitivität von 73,3 – 75,8 %). Schlussfolgerung: CEUS ist deutlich präziser als nativer US und in hohem Maße vergleichbar mit MDCT zur Detektion von Lebermetastasen bei kolorektalen Karzinomen. Daher sollte die US-Untersuchung bei Patienten mit Verdacht auf hepatische Filiae bei kolorektalem Karzinom immer mit Kontrastverstärkung erfolgen.

Abstract

Purpose: To compare ultrasound (US), low-mechanical index contrast enhanced US (CEUS) and multidetector-CT (MDCT) for the detection of hepatic metastases from colorectal cancer. Methods and Materials: From January to June 2006, 110 patients (65 males, 45 females; mean age 62 years; range 39 – 78) with suspected hepatic lesions from colorectal cancer were prospectively evaluated with US, CEUS and MDCT by two independent readers. Intraoperative ultrasonography (IOUS, n = 45) or a follow-up up for at least 6 months by using MDCT or Gd-BOPTA-enhanced MRI was considered the gold standard. McNemar test was employed. Results: Reference standards revealed 430 metastases in 110 patients. On a patient-by-patients analysis, CEUS improved US sensitivity from 67.4 – 71.6 % to 93.4 – 95.8 % (p < 0.05). On a lesion-by-lesion analysis, CEUS improved the sensitivity of US from 60.9 – 64.9 % to 85.3–92.8 % (p < 0.001). The specificity increased from 50 – 60 % to 76.7 – 83.3 %. No significant differences in sensitivity or specificity between CEUS and MDCT were found. Contrast- enhanced US was significantly more sensitive than baseline US in the detection of metastases smaller than 1 cm (p < 0.001) with an increase in sensitivity from 29.1 – 35 % to 63.3 – 76.6 % no significant statistical difference was identified when compared with MDCT (sensitivity of 73.3 – 75.8 %). Conclusions: CEUS is significantly more accurate than US and highly comparable with MDCT in the detection of liver metastases from colorectal cancer. Therefore, in the evaluation of patients with suspected hepatic metastases from colorectal tumour, US examination must be performed after contrast administration.

References

  • 1 McArdle C S, Hole D, Hansell D. et al . A prospective study of colorectal cancer in the west of Scotland: 10-year follow-up.  Br J Surg. 1990;  77 280-282
  • 2 Wernecke K, Rummeny E, Bongartz G. et al . Detection of hepatic masses in patients with carcinoma: comparative sensitivities of sonography, CT, and MR imaging.  Am J Roentgenol. 1991;  157 731-739
  • 3 Clarke M P, Kane R A, Steele Jr G. et al . Prospective comparison of preoperative imaging and intraoperative ultrasonography in the detection of liver tumours.  Surgery. 1989;  106 849-855
  • 4 Ohlsson B, Tranberg K G, Lundstedt C. et al . Detection of hepatic metastases in colorectal cancer: a prospective study of laboratory and imaging methods.  Eur J Surg. 1993;  159 275-281
  • 5 Helmberger T, Rau H, Linke R. et al . Diagnosis and staging of liver metastases with imaging methods.  Chirurg. 1999;  70 114-122
  • 6 Bipat S, Leeuwen M S, Comans E F. et al . Colorectal liver metastases: CT, MR Imaging, and PET for diagnosis – Meta-analysis.  Radiology. 2005;  237 123-131
  • 7 Gehl van H, Bourne M, Grazioli L. et al . Off site evaluation of liver lesion detection by Gd- BOPTA-enhanced MR Imaging.  Eur Radiol. 2001;  11 187-192
  • 8 Albrecht T, Blomley M J, Burn P N. et al . Improved detection of hepatic metastases with pulse-inversion US during the liver-specific phase of SHU 508A: multicenter study.  Radiology. 2003;  227 361-370
  • 9 Albrecht T, Hoffmann C W, Schmitz S A. et al . Phase-inversions sonography during the liver-specific late-phase of contrast-enhancement: improved detection of liver metastases.  AJR. 2001;  5 1191-1198
  • 10 Quaia E, D’Onofrio M, Palumbo A. et al . Comparison of contrast-enhanced ultrasonography versus baseline ultrasound and contrast-enhanced computed tomography in metastastic disease of the liver: diagnostic performance and confidence.  Eur Radiol. 2006;  16 1599-1609
  • 11 Oldenburg A, Hohmann J, Foert E. et al . Detection of hepatic metastases with low MI real time contrast enhanced sonography and SonoVue.  Ultraschall in Med. 2005;  26 277-284
  • 12 Dietrich C F, Kratzer W, Strobel D. et al . Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI.  World J Gastroenterol. 2006;  12 1699-1705
  • 13 Leen E, Ceccotti P, Moug S J. et al . Potential value of contrast-enhanced intraoperative ultrasonography during partial hepatectomy for metastases: an essential investigation before resection?.  Ann Surg. 2006;  243 236-240
  • 14 Konopke R, Kersting S, Bergert H. et al . Contrast-enhanced ultrasonography to detect liver metastases: a prospective trial to compare transcutaneous unenhanced and contrast-enhanced ultrasonography in patients undergoing laparotomy.  Int J Colorectal Dis. 2007;  22 201-207
  • 15 Piscaglia F, Corradi F, Mancini M. et al . Real time contrast enhanced ultrasonography in detection of liver metastases from gastrointestinal cancer.  BMC Cancer. 2007;  7 171
  • 16 Larsen L P, Rosenkilde M, Christensen H. et al . The value of contrast-enhanced ultrasonography in detection of liver metastases from colorectal cancer: a prospective double- blinded study.  Eur J Radiol. 2007;  62 302-307
  • 17 Claudon M, Cosgrove D, Albrecht T. et al . (EFSUMB study group) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – update 2008.  Ultraschall in Med. 2008;  29 28-44
  • 18 Fleiss J L. Statistical methods for rates and proportions. New York, NY; Wiley 1981 2nd Ed: 212-236
  • 19 Dalla Palma L, Bertolotto M, Quaia E. et al . Detection of liver metastases with pulse inversion harmonic imaging: preliminary results.  Eur Radiol. 1999;  9 S382-S387
  • 20 Del Frate C, Zuiani C, Londero V. et al . Comparing Levovist-enhanced pulse inversion harmonic imaging and ferumoxides-enhanced MR imaging of hepatic metastases.  Am J Roentgenol. 2003;  180 1339-1346
  • 21 Ward J, Guthrie J A, Wilson D. et al . Colorectal hepatic metastases: detection with SPIO-enhanced breath-hold MR imaging – comparison of optimized sequences.  Radiology. 2003;  228 709-718
  • 22 Bleuzen A, Huang C, Olar M. et al . Diagnostic accuracy of contrast-enhanced ultrasound in focal lesions of the liver using cadence contrast pulse sequencing.  Ultraschall in Med. 2006;  27 40-48
  • 23 Quaia E, Calliada F, Bertolotto M. et al . Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence.  Radiology. 2004;  232 420-430
  • 24 Seitz K. CEUS for liver tumors: facts, studies, relevance, and reality in the clinical routine.  Ultraschall in Med. 2008;  29 485-487
  • 25 Konopke R, Bunk A, Kersting S. Contrast-enhanced ultrasonography in patients with colorectal liver metastases after chemotherapy.  Ultraschall in Med. 2008;  29 S203-S209
  • 26 Oldenburg A, Albrecht T. Baseline and contrast-enhanced ultrasound of the liver in tumor patients.  Ultrashall in Med. 2008;  29 488-498
  • 27 Strobel D, Seitz K, Blank W. et al . Contrast-enhanced Ultrasound for the Characterization of Focal Liver Lesions – Diagnostic Accuracy in Clinical Practice (DEGUM multicenter trial).  Ultraschall in Med. 2008;  29 499-505
  • 28 Mostbeck G. CEUS from a Radiological Standpoint: Dream and Reality.  Ultraschall in Med. 2009;  30 125

Dr. Vito Cantisani

Department of Radiology, University ”La Sapienza”, Rome

Viale Regina Elena, 324

00161 Rome

Italy

Phone: + 39/34 71 74 39 47

Fax: + 39/06 49 02 43

Email: vito.cantisani@uniroma1.it