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Lueders C, Gladitz J, Bauer G, Jenssen C, Belaschki J, von Kirchbach A, Schneider C, Kiefer T, Voeller H, Merkel D. The Doppler Perfusion Index of the Liver and the Underlying Duplex Sonography of Visceral Vessels-A Systematic and Comprehensive Evaluation of Reproducibility. Diagnostics (Basel) 2024; 14:778. [PMID: 38611692 PMCID: PMC11012103 DOI: 10.3390/diagnostics14070778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Prior to the curative resection of colorectal carcinoma (CRC) or pancreatic ductal adenocarcinoma (PDAC), the exclusion of hepatic metastasis using cross-sectional imaging is mandatory. The Doppler perfusion index (DPI) of the liver is a promising method for detecting occult liver metastases, but the underlying visceral duplex sonography is critically viewed in terms of its reproducibility. The aim of this study was to investigate systematically the reproducibility of the measured variables, the calculated blood flow, and the DPI. Between February and September 2023, two examinations were performed on 80 subjects within a period of 0-30 days and at two previously defined quality levels, aligned to the German standards of the DEGUM. Correlation analyses were carried out using Pearson's correlation coefficient (PCC) and the intraclass correlation coefficient (ICC). The diameters, blood flow, and DPI showed a high degree of agreement (PCC of 0.9 and ICC of 0.9 for AHP). Provided that a precise standard of procedure is adhered to, the Doppler examination of AHC, AHP, and PV yields very reproducible blood flows and DPI, which is a prerequisite for a comprehensive investigation of its prognostic value for the prediction of metachronous hepatic metastasis in the context of curatively treated CRC or PDAC.
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Affiliation(s)
- Christian Lueders
- Klinik am See, Rehabilitation Center for Internal Medicine, 15562 Rüdersdorf bei Berlin, Germany; (T.K.); (H.V.)
- Brandenburg Medical School (MHB), 16816 Neuruppin, Germany
| | | | - Georg Bauer
- Department of General Surgery, Krankenhaus Maerkisch-Oderland, 15344 Strausberg, Germany; (G.B.); (J.B.)
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Maerkisch-Oderland, 15344 Strausberg, Germany;
- Brandenburg Institute of Clinical Ultrasound (BIKUS), Medical University Brandenburg, 16816 Neuruppin, Germany;
| | - Jana Belaschki
- Department of General Surgery, Krankenhaus Maerkisch-Oderland, 15344 Strausberg, Germany; (G.B.); (J.B.)
| | - Arndt von Kirchbach
- Heart Center Brandenburg, Department of Surgery, University Hospital of the Brandenburg Medical School (MHB), 16321 Bernau, Germany;
| | - Christoph Schneider
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School (MHB), 15562 Rüdersdorf bei Berlin, Germany;
| | - Thomas Kiefer
- Klinik am See, Rehabilitation Center for Internal Medicine, 15562 Rüdersdorf bei Berlin, Germany; (T.K.); (H.V.)
- Brandenburg Medical School (MHB), 16816 Neuruppin, Germany
| | - Heinz Voeller
- Klinik am See, Rehabilitation Center for Internal Medicine, 15562 Rüdersdorf bei Berlin, Germany; (T.K.); (H.V.)
- Center of Rehabilitation Research, University of Potsdam, 14476 Potsdam, Germany
| | - Daniel Merkel
- Brandenburg Institute of Clinical Ultrasound (BIKUS), Medical University Brandenburg, 16816 Neuruppin, Germany;
- Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School (MHB), 15562 Rüdersdorf bei Berlin, Germany;
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DOĞAN K, ARIBAŞ BK. KOLOREKTAL KANSER HEPATİK METASTAZLARININ SAPTANMASINDA DOPPLER PERFÜZYON İNDEKSİ. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.824106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lo Dico R, Tijeras-Raballand A, Bonnin P, Launay JM, Kaci R, Pimpie C, Malgras B, Dohan A, Lo Dico GM, Pocard M. Hepatectomy increases metastatic graft and growth in an immunocompetent murine model of peritoneal metastases. Eur J Surg Oncol 2018. [PMID: 29525466 DOI: 10.1016/j.ejso.2018.01.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Curative surgery of synchronous peritoneal metastases (PM) and colorectal liver metastases (LM) has been recently investigated as feasible option. When synchronous peritoneal and liver resection is not achievable, the sequence of the surgery remains unknown. Our hypothesis was that liver resection (LR) promotes peritoneal growth resulting in a non-resectable PM. We sought to analyse the effects of major LR and liver regeneration after hepatectomy in a murine model of PM and the associated angiogenesis. METHODS Murine model of colorectal PM in Balb/C mice was developed by intraperitoneal injection of different CT-26 tumour cell concentrations. Five days after the injection, mice were randomized into three groups: 68% hepatectomy group, sham laparotomy and control group without surgery. On post-operative days 1, 5 and 20, PM was evaluated macroscopically, tumour growth and liver regeneration by immunohistochemistry, and angiogenesis by immunofluorescence. Circulating progenitor cells, plasmatic cytokines and digestive arterial blood flow velocity measurements were also analysed. RESULTS Reproducible murine model of limited colorectal PM was obtained. Surgery induced PM increases and promoted neo-angiogenesis. Major hepatectomy influence the tumour growth in the late phase after surgery, the extent of extra-peritoneal metastasis and the increase of Ki-67 expression in the remnant liver. CONCLUSIONS This animal model confirms the pro-tumoural and pro-angiogenic role of surgery, laparotomy and major LR, which promotes the increase of angiogenic factors and their participation in PM growth. These results suggest that peritoneal resection should be first step in the case of two-step liver and peritoneal surgery for patients with colorectal PM and LM.
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Affiliation(s)
- Rea Lo Dico
- Inserm U965, Carcinomatosis, Angiogenesis and Translational Research (CART), Paris 7-Diderot University, Sorbonne Paris Cité, France; Department of Digestive and Oncological Surgery, Lariboisière Hospital, AP-HP, Paris 7-Diderot University, Sorbonne Paris Cité, France.
| | | | - Philippe Bonnin
- Inserm U965, Carcinomatosis, Angiogenesis and Translational Research (CART), Paris 7-Diderot University, Sorbonne Paris Cité, France; Department of Functional Exploration, Lariboisière Hospital, AP-HP, Paris 7-Diderot University, France
| | - Jean Marie Launay
- Department of Biochemistry, Lariboisière Hospital, AP-HP, Paris 7-Diderot University, France
| | - Rachid Kaci
- Inserm U965, Carcinomatosis, Angiogenesis and Translational Research (CART), Paris 7-Diderot University, Sorbonne Paris Cité, France; Department of Pathology, Lariboisière Hospital, AP-HP, Paris 7-Diderot University, France
| | - Cynthia Pimpie
- Inserm U965, Carcinomatosis, Angiogenesis and Translational Research (CART), Paris 7-Diderot University, Sorbonne Paris Cité, France
| | - Brice Malgras
- Inserm U965, Carcinomatosis, Angiogenesis and Translational Research (CART), Paris 7-Diderot University, Sorbonne Paris Cité, France; Department of Digestive and Oncological Surgery, Lariboisière Hospital, AP-HP, Paris 7-Diderot University, Sorbonne Paris Cité, France
| | - Anthony Dohan
- Inserm U965, Carcinomatosis, Angiogenesis and Translational Research (CART), Paris 7-Diderot University, Sorbonne Paris Cité, France; Department of Radiology, Cochin Hospital, AP-HP, Paris-Descartes University, France
| | | | - Marc Pocard
- Inserm U965, Carcinomatosis, Angiogenesis and Translational Research (CART), Paris 7-Diderot University, Sorbonne Paris Cité, France; Department of Digestive and Oncological Surgery, Lariboisière Hospital, AP-HP, Paris 7-Diderot University, Sorbonne Paris Cité, France
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Hudson JM, Williams R, Milot L, Wei Q, Jago J, Burns PN. In Vivo Validation of Volume Flow Measurements of Pulsatile Flow Using a Clinical Ultrasound System and Matrix Array Transducer. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:579-585. [PMID: 27979667 DOI: 10.1016/j.ultrasmedbio.2016.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 10/18/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
The goal of this study was to evaluate the accuracy of a non-invasive C-plane Doppler estimation of pulsatile blood flow in the lower abdominal vessels of a porcine model. Doppler ultrasound measurements from a matrix array transducer system were compared with invasive volume flow measurements made on the same vessels with a surgically implanted ultrasonic transit-time flow probe. For volume flow rates ranging from 60 to 750 mL/min, agreement was very good, with a Pearson correlation coefficient of 0.97 (p < 0.0001) and a mean bias of -4.2%. The combination of 2-D matrix array technology and fast processing gives this Doppler method clinical potential, as many of the user- and system-dependent parameters of previous methods, including explicit vessel angle and diameter measurements, are eliminated.
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Affiliation(s)
- John M Hudson
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Ross Williams
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Laurent Milot
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Qifeng Wei
- Philips Ultrasound, Bothell, Washington, USA
| | - James Jago
- Philips Ultrasound, Bothell, Washington, USA
| | - Peter N Burns
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.
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Tampellini M, Gned D, Baratelli C, Brizzi MP, Ottone A, Alabiso I, Bertaggia C, Di Maio M, Scagliotti GV, Veltri A. Changes in hepatic perfusion assessed by dynamic contrast enhanced MRI, associated with morphologic evaluation, in patients with liver metastases from colorectal cancer treated with first-line chemotherapy. Radiol Med 2016; 121:950-957. [PMID: 27601143 DOI: 10.1007/s11547-016-0685-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/29/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Blood perfusion of liver metastases can be non-invasively assessed by dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). The aim of this study was to explore whether the ratio of hepatic arterial to total liver blood flow (Hepatic Perfusion Index-HPI) and the area under the enhancement curve (AUC) of selected liver areas in patients with hepatic metastases from colorectal cancer treated with first-line chemotherapy could predict response and/or be a prognostic variable. PATIENTS AND METHODS Sequential liver DCE-MRI studies with morphological imaging reconstruction were performed in 43 consecutive patients at baseline and every 3 months during oxaliplatin-based first-line chemotherapy. Data about HPI of the whole liver, and AUC of metastatic and healthy areas were calculated at each time-point and compared both at baseline and sequentially during the treatment. RESULTS Baseline HPI and AUC values did not discriminate patients responsive to chemotherapy, nor those with better survival outcomes. HPI and AUC values at 3 months decreased significantly more in responders than non-responders. AUCs calculated from areas of the liver with or without neoplastic lesions varied consistently, being increased in progressing patients and decreased in responding patients. DISCUSSION Our results did not support the hypothesis of a predictive or prognostic role of HPI and AUCs calculated by DCE-MRI in liver metastatic CRC patients, thus the primary endpoint of the study was not reached. However, reduced arterial blood flow in metastatic liver can be obtained by chemotherapy alone, without any anti-angiogenic agent; interestingly, HPI and AUC data suggest a possible relationship between tumor metabolism and entire liver perfusion.
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Affiliation(s)
- Marco Tampellini
- Division of Medical Oncology at S. Luigi Hospital, University of Torino, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Dario Gned
- Division of Radiology at S. Luigi Hospital, University of Torino, Orbassano, Turin, Italy
| | - Chiara Baratelli
- Division of Medical Oncology at S. Luigi Hospital, University of Torino, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, Turin, Italy.
| | - Maria Pia Brizzi
- Division of Medical Oncology at S. Luigi Hospital, University of Torino, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Azzurra Ottone
- Division of Medical Oncology at S. Luigi Hospital, University of Torino, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Irene Alabiso
- Division of Medical Oncology at S. Luigi Hospital, University of Torino, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Chiara Bertaggia
- Division of Radiology at S. Luigi Hospital, University of Torino, Orbassano, Turin, Italy
| | - Massimo Di Maio
- Division of Medical Oncology at S. Luigi Hospital, University of Torino, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Giorgio Vittorio Scagliotti
- Division of Medical Oncology at S. Luigi Hospital, University of Torino, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Andrea Veltri
- Division of Radiology at S. Luigi Hospital, University of Torino, Orbassano, Turin, Italy
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Kopljar M, Patrlj L, Korolija-Marinic D, Horzic M, Cupurdija K, Bakota B. High Expression of DARPP-32 in Colorectal Cancer Is Associated With Liver Metastases and Predicts Survival for Dukes A and B Patients: Results of a Pilot Study. Int Surg 2015; 100:213-20. [PMID: 25692420 PMCID: PMC4337432 DOI: 10.9738/intsurg-d-14-00022.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to investigate prognostic significance of Dopamine and cAMP-Regulated neuronal Phosphoprotein 32 (DARPP-32) expression in primary colorectal cancer. The study material consisted of clinical and histopathological data of 100 patients operated for colorectal cancer between 1994 and 1997. For immunohistochemical analysis, specific rabbit antibodies for DARPP-32 were used and the percentage of stained tumor cells was calculated under gross magnification (400 times) on a sample of 500 tumor cells. DARPP-32 expression in the primary tumor was significantly greater in patients with distant metastases compared to patients with no distant metastases (p=0.002). In multivariate regression analysis, DARPP-32 expression in the primary tumor was a significant predictor of distant metastases. With a cut-off point of 76.5%, DARPP-32 expression in the primary tumor significantly influenced both overall and disease free survival, especially for Dukes A and B patients (p=0.037). The results of this study indicate that DARPP-32 may be a potential marker of worse prognosis and a valuable tool for managing further adjuvant treatment in patients with stages Dukes A and B colorectal cancer.
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Affiliation(s)
- Mario Kopljar
- Department of Surgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Leonardo Patrlj
- Department of Surgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - Matija Horzic
- Department of Surgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - Bore Bakota
- Department of Surgery, General Hospital Karlovac, Karlovac, Croatia
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Keravnou CP, Mannaris C, Averkiou MA. Accurate measurement of microbubble response to ultrasound with a diagnostic ultrasound scanner. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2015; 62:176-184. [PMID: 25585401 DOI: 10.1109/tuffc.2014.006664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Ultrasound and microbubbles are often used to enhance drug delivery and the suggested mechanisms are extravasation and sonoporation. Drug delivery schemes with ultrasound and microbubbles at both low and high acoustic amplitudes have been suggested. A diagnostic ultrasound scanner may play a double role as both an imaging and a therapy device. It was not possible to accurately measure microbubble response with an ultrasound scanner for a large range of acoustic pressures and microbubble concentrations until now, mainly because of signal saturation issues. A method for continuously adjusting the receive gain of a scanner and limiting signal saturation was developed to accurately measure backscattered echoes from microbubbles for mechanical indexes (MIs) up to 2.1. The intensity of backscattered echoes from microbubbles increased quarticly with MI without reaching any limit. The signal intensity from microbubbles was found to be linear with concentration at both low and high MIs. However, at very high concentrations, acoustic shadowing occurs which limits the delivered acoustic pressure in deeper areas. The contrastto- tissue ratio was also measured and found to stay constant with MI. These results can be used to better guide drug delivery approaches and to also develop imaging techniques for therapy procedures.
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Rao SX, Lambregts DM, Schnerr RS, van Ommen W, van Nijnatten TJ, Martens MH, Heijnen LA, Backes WH, Verhoef C, Zeng MS, Beets GL, Beets-Tan RG. Whole-liver CT texture analysis in colorectal cancer: Does the presence of liver metastases affect the texture of the remaining liver? United European Gastroenterol J 2014; 2:530-8. [PMID: 25452849 DOI: 10.1177/2050640614552463] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/25/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Liver metastases limit survival in colorectal cancer. Earlier detection of (occult) metastatic disease may benefit treatment and survival. OBJECTIVE The objective of this article is to evaluate the potential of whole-liver CT texture analysis of apparently disease-free liver parenchyma for discriminating between colorectal cancer (CRC) patients with and without hepatic metastases. METHODS The primary staging CT examinations of 29 CRC patients were retrospectively analysed. Patients were divided into three groups: patients without liver metastases (n = 15), with synchronous liver metastases (n = 10) and metachronous liver metastases within 18 months following primary staging (n = 4). Whole-liver texture analysis was performed by delineation of the apparently non-diseased liver parenchyma (excluding metastases or other focal liver lesions) on portal phase images. Mean grey-level intensity (M), entropy (E) and uniformity (U) were derived with no filtration and different filter widths (0.5 = fine, 1.5 = medium, 2.5 = coarse). RESULTS Mean E1.5 and E2.5 for the whole liver in patients with synchronous metastases were significantly higher compared with the non-metastatic patients (p = 0.02 and p = 0.01). Mean U1.5 and U2.5 were significantly lower in the synchronous metastases group compared with the non-metastatic group (p = 0.04 and p = 0.02). Texture parameters for the metachronous metastases group were not significantly different from the non-metastatic group or synchronous metastases group (p > 0.05), although - similar to the synchronous metastases group - there was a subtle trend towards increased E1.5, E2.5 and decreased U1.5, U2.5 values. Areas under the ROC curve for the diagnosis of synchronous metastatic disease based on the texture parameters E1.5,2.5 and U1.5,2.5 ranged between 0.73 and 0.78. CONCLUSION Texture analysis of the apparently non-diseased liver holds promise to differentiate between CRC patients with and without metastatic liver disease. Further research is required to determine whether these findings may be used to benefit the prediction of metachronous liver disease.
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Affiliation(s)
- Sheng-Xiang Rao
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Radiology, Zhongshan Hospital, Fudan University, China
| | - Doenja Mj Lambregts
- Department of Radiology, Maastricht University Medical Center, The Netherlands
| | - Roald S Schnerr
- Department of Radiology, Maastricht University Medical Center, The Netherlands
| | - Wenzel van Ommen
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Radiology, Catharina Hospital Eindhoven, The Netherlands
| | | | - Milou H Martens
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Surgery, Maastricht University Medical Center, The Netherlands
| | - Luc A Heijnen
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Surgery, Maastricht University Medical Center, The Netherlands
| | - Walter H Backes
- Department of Radiology, Maastricht University Medical Center, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, The Netherlands
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, China
| | - Geerard L Beets
- Department of Surgery, Maastricht University Medical Center, The Netherlands ; GROW School for Oncology and Developmental Biology, The Netherlands
| | - Regina Gh Beets-Tan
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; GROW School for Oncology and Developmental Biology, The Netherlands
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Kopljar M, Patrlj L, Bušić Z, Kolovrat M, Rakić M, Kliček R, Zidak M, Stipančić I. Potential use of Doppler perfusion index in detection of occult liver metastases from colorectal cancer. Hepatobiliary Surg Nutr 2014; 3:259-67. [PMID: 25392837 PMCID: PMC4207836 DOI: 10.3978/j.issn.2304-3881.2014.09.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 08/31/2014] [Indexed: 02/05/2023]
Abstract
Many clinical and preclinical studies demonstrated that measurements of liver hemodynamic [Doppler perfusion index (DPI)] may be used to accurately diagnose and predict liver metastases from primary colorectal cancer in a research setting. However, Doppler measurements have some serious limitations when applied to general population. Ultrasound is very operator-dependent, and requires skilled examiners. Also, many conditions may limit the use of Doppler ultrasound and ultrasound in general, such as the presence of air in digestive tract, cardiac arrhythmias, vascular anomalies, obesity and other conditions. Therefore, in spite of the results from clinical studies, its value may be limited in everyday practice. On the contrary, scientific research of the DPI in detection of liver metastases is of great importance, since current research speaks strongly for the presence of systemic vasoactive substance responsible for observed hemodynamic changes. Identification of such a systemic vasoactive substance may lead to the development of a simple and reproducible laboratory test that may reliably identify the presence of occult liver metastases and therefore increase the success of adjuvant chemotherapy through better selection of patients. Further research in this subject is therefore of great importance.
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Affiliation(s)
- Mario Kopljar
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Leonardo Patrlj
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Zeljko Bušić
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marijan Kolovrat
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Mislav Rakić
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Robert Kliček
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marcel Zidak
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Igor Stipančić
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
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Kim SH, Kamaya A, Willmann JK. CT perfusion of the liver: principles and applications in oncology. Radiology 2014; 272:322-44. [PMID: 25058132 DOI: 10.1148/radiol.14130091] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With the introduction of molecularly targeted chemotherapeutics, there is an increasing need for defining new response criteria for therapeutic success because use of morphologic imaging alone may not fully assess tumor response. Computed tomographic (CT) perfusion imaging of the liver provides functional information about the microcirculation of normal parenchyma and focal liver lesions and is a promising technique for assessing the efficacy of various anticancer treatments. CT perfusion also shows promising results for diagnosing primary or metastatic tumors, for predicting early response to anticancer treatments, and for monitoring tumor recurrence after therapy. Many of the limitations of early CT perfusion studies performed in the liver, such as limited coverage, motion artifacts, and high radiation dose of CT, are being addressed by recent technical advances. These include a wide area detector with or without volumetric spiral or shuttle modes, motion correction algorithms, and new CT reconstruction technologies such as iterative algorithms. Although several issues related to perfusion imaging-such as paucity of large multicenter trials, limited accessibility of perfusion software, and lack of standardization in methods-remain unsolved, CT perfusion has now reached technical maturity, allowing for its use in assessing tumor vascularity in larger-scale prospective clinical trials. In this review, basic principles, current acquisition protocols, and pharmacokinetic models used for CT perfusion imaging of the liver are described. Various oncologic applications of CT perfusion of the liver are discussed and current challenges, as well as possible solutions, for CT perfusion are presented.
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Affiliation(s)
- Se Hyung Kim
- From the Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, 300 Pasteur Dr, Room H1307, Stanford, CA 94305-5621 (S.H.K., A.K., J.K.W.); and Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea (S.H.K.)
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Relationship between CT volumetric measurements and Doppler perfusion indices in gastrointestinal liver metastasis. Radiol Med 2014; 120:171-9. [PMID: 24916462 DOI: 10.1007/s11547-014-0423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study investigated how the volume of hepatic metastatic lesions can affect liver haemodynamics and whether these perfusion parameters may help to differentiate benign and malignant liver lesions. MATERIALS AND METHODS The Doppler perfusion index (DPI the ratio of arterial to total liver blood flow) was measured in 46 patients aged 29-83 years, exhibiting up to four focal hyperechoic liver lesions at ultrasound examination. They comprised histopathologically proven liver metastasis of colorectal (19 cases) and gastric (10 cases) adenocarcinoma without local recurrence at the site of the previously resected primary tumour, along with 17 subjects with haemangioma. All patients underwent volumetric assessment using multislice computed tomography to calculate total volume of hepatic lesions. RESULTS The mean DPI of patients with colorectal (36 ± 2 %) and gastric (39 ± 6 %) metastasis was significantly higher than those with haemangioma (14 ± 2 %) (both p < 0.001), whereas metastatic groups did not exhibit any difference in terms of mean DPI. Statistically significant correlations were found between DPI values and calculated total volume of lesions in patients with colorectal and gastric metastasis (r = 0.55, p = 0.01 and r = 0.85, p = 0.002, respectively) while this correlation was not demonstrated in the haemangioma group. Simple linear regression analysis revealed that every 1 cm(3) increment in total volume of metastatic lesions increased DPI by 0.2 % [95 % confidence interval (CI) 0.1-0.3, p = 0.001]. CONCLUSION Doppler perfusion index alterations are directly correlated with total volume of metastatic deposits, and DPI measurement can be a valuable method to distinguish haemangioma from hyperechoic colorectal and gastric metastatic lesions.
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Paschos KA, Majeed AW, Bird NC. Natural history of hepatic metastases from colorectal cancer - pathobiological pathways with clinical significance. World J Gastroenterol 2014; 20:3719-3737. [PMID: 24744570 PMCID: PMC3983432 DOI: 10.3748/wjg.v20.i14.3719] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/12/2013] [Accepted: 01/06/2014] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer hepatic metastases represent the final stage of a multi-step biological process. This process starts with a series of mutations in colonic epithelial cells, continues with their detachment from the large intestine, dissemination through the blood and/or lymphatic circulation, attachment to the hepatic sinusoids and interactions with the sinusoidal cells, such as sinusoidal endothelial cells, Kupffer cells, stellate cells and pit cells. The metastatic sequence terminates with colorectal cancer cell invasion, adaptation and colonisation of the hepatic parenchyma. All these events, termed the colorectal cancer invasion-metastasis cascade, include multiple molecular pathways, intercellular interactions and expression of a plethora of chemokines and growth factors, and adhesion molecules, such as the selectins, the integrins or the cadherins, as well as enzymes including matrix metalloproteinases. This review aims to present recent advances that provide insights into these cell-biological events and emphasizes those that may be amenable to therapeutic targeting.
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Fujishiro T, Shuto K, Hayano K, Satoh A, Kono T, Ohira G, Tohma T, Gunji H, Narushima K, Tochigi T, Hanaoka T, Ishii S, Yanagawa N, Matsubara H. Preoperative hepatic CT perfusion as an early predictor for the recurrence of esophageal squamous cell carcinoma: initial clinical results. Oncol Rep 2014; 31:1083-8. [PMID: 24452736 PMCID: PMC3926648 DOI: 10.3892/or.2014.2992] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 12/27/2013] [Indexed: 12/13/2022] Open
Abstract
Reports suggest that hepatic blood flow may have an association with cancer progression. The aim of the present study was to evaluate whether the hepatic blood flow measured by CT perfusion (CTP) may identify patients at high-risk for postoperative recurrence of esophageal squamous cell carcinoma (ESCC). Prior to surgery, hepatic CTP images were obtained using a 320-row area detector CT. The data were analyzed by a commercially available software based on the dual input maximum slope method, and arterial blood flow (AF, ml/min/100 ml tissue), portal blood flow (PF, ml/min/100 ml tissue) and perfusion index [PI (%) = AF/AF + PF × 100] were measured. These parameters were compared with the pathological stage and outcome of the ESCC patients. Forty-five patients with ESCC were eligible for this study. The median follow-up period was 17 months, and recurrences were observed in 9 patients (20%). The preoperative PI values of the 9 patients with recurrence were significantly higher than those of the 36 patients without recurrence (23.9 vs. 15.9, P=0.0022). Patients were categorized into the following two groups; high PI (>20) and low PI (<20). The recurrence-free survival of the low PI group was significantly better than that of the high PI group (P<0.0001). A multivariate analysis showed that a high PI was an independent risk factor for recurrence (odds ratio, 19.1; P=0.0369). Therefore, the preoperative PI of the liver may be a useful imaging biomarker for predicting the recurrence of patients with esophageal cancer.
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Affiliation(s)
- Takeshi Fujishiro
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Medical Center, Ichihara, Chiba 299-0111, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Asami Satoh
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Tsuguaki Kono
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Takayuki Tohma
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Hisashi Gunji
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Kazuo Narushima
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Toru Tochigi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Toshiharu Hanaoka
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Sayaka Ishii
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
| | - Noriyuki Yanagawa
- Department of Radiological Technology, Chiba University Hospital, Chuo-ku, Chiba, Chiba 260-8677, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
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Alicioglu B, Sarikaya A, Bulakbasi N. Interrelationship between liver hemodynamics and tumor metabolism in liver metastases: diagnostic value of Doppler perfusion index revisited. Prague Med Rep 2013; 114:103-12. [PMID: 23777801 DOI: 10.14712/23362936.2014.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
It should be expected that the hepatic blood flow increase in the cases with liver metastasis. We aimed to find out if there is a correlation between Doppler parameters and hepatic metabolic activity in oncology patients. 35 patients with hepatic metastases who were identified by 18F-fluorodeoxyglucose positron emission tomography scan and assessed with Doppler ultrasound were included in this prospective study. Patients with hepatic disease, cardiac dysfunction, dehydration, history of alcoholism, intake of antihypertensive or vasoactive medication were excluded. Volume flow of the proper hepatic artery and the portal vein were measured in the hepatoduodenal ligament by Doppler sonography. Doppler perfusion index (the ratio of the hepatic artery flow to the total liver blood flow) and flow volumes of 31 age matched subjects were compared. Both flow of the proper hepatic artery and portal vein were found to be significantly higher in patients with liver metastasis. The mean Doppler perfusion index value was 0.2 ± 0.13 in hepatic metastases whereas 0.13 ± 0.05 in control group. Doppler perfusion index was significantly higher in liver metastases (p=0.008). A positive correlation was found between the maximum standardized uptake value of the liver and flow volume of the proper hepatic artery (r=0.774, p=0). Blood flow of the proper hepatic artery and Doppler perfusion index correlates with hepatic standardized uptake value. Flow measurements of the liver may become an important parameter for selecting patients for further positron emission tomography scan and following-up the response after systemic and local therapeutic procedures.
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Affiliation(s)
- B Alicioglu
- Department of Radiology, Trakya University Medical Faculty, Edirne, Turkey.
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Gauthier TP, Muhammad A, Wasan HS, Abel PD, Leen ELS. Reproducibility of quantitative assessment of altered hepatic hemodynamics with dynamic contrast-enhanced ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1413-1420. [PMID: 22922621 DOI: 10.7863/jum.2012.31.9.1413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The aim of this clinical study was to evaluate the reproducibility of quantitative assessment of altered hepatic hemodynamics with dynamic contrast-enhanced ultrasound. METHODS Fifteen patients with colorectal liver metastases and 5 volunteers were studied. The hepatic artery proper and the portal vein were imaged simultaneously with dynamic contrast-enhanced ultrasound. The examination was repeated with 2 different contrast bolus volumes (1.2 and 2.4 mL), and time-intensity curves were formed from dynamic contrast-enhanced ultrasound image loops. The rise time, peak intensity, and wash-in slope were derived from hepatic artery and portal vein time-intensity curves. Inter-reader, intra-reader, and inter-scan agreement was assessed by 2 independent readers. Quantitative (intraclass correlation coefficients and coefficients of variation [CVs]) and qualitative (Landis and Koch classification) analyses were performed. RESULTS Intra-reader and inter-reader agreement was "almost perfect" for the hepatic artery (CV, 10%-15% and 8%-9%, respectively), portal vein (CV, 5%-8% and 6%-12%), and hepatic artery/portal vein ratio (CV, 8%-14% and 10%-15%) measurements of 3 all studied parameters. In contrast, inter-scan agreement was only "slight" to "moderate" (CV, 25%-27%) and "fair" to "moderate" (CV, 19%-24%) for rise time and peak intensity measurements in the hepatic artery and portal vein, respectively. CONCLUSIONS Quantitative assessment of altered hepatic hemodynamics with dynamic contrast-enhanced ultrasound is reproducible provided that measurements in the hepatic artery are normalized by those in the portal vein.
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Affiliation(s)
- Thomas P Gauthier
- Department of Medicine, Division of Experimental Medicine, Faculty of Medicine, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, England.
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16
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Hohmann J, Newerla C, Müller A, Reinicke C, Skrok J, Frericks BB, Albrecht T. Hepatic transit time analysis using contrast enhanced MRI with Gd-BOPTA: A prospective study comparing patients with liver metastases from colorectal cancer and healthy volunteers. J Magn Reson Imaging 2012; 36:1389-94. [PMID: 22893441 DOI: 10.1002/jmri.23772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 06/29/2012] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To find out if the hepatic transit time (HTT) shortening, which was already proven in patients with liver metastases by other modalities, can also be detected with MRI. MATERIALS AND METHODS The Patient group consisted of 20 subjects with liver metastases from colorectal cancer and the control group of 21 healthy subjects. Baseline and post contrast images were acquired before and after administration of Gd-BOPTA, using a T1-weighted bolus test sequence. Arrival times (AT) of the contrast agent for the aorta, the hepatic artery, the portal vein and one hepatic vein were determined. Based on arrival time measurements HTT were calculated. RESULTS All analyses showed significantly shorter HTT in patients with metastases compared with healthy volunteers (P < 0.05). There were no false positives using a threshold of 10.4 s for arterial to venous HTT. For aortal to venous and portal to venous HTT a threshold of 12.5 s and 4 s was calculated, respectively. No significant correlation between HTT and involved liver segments, overall volume of metastases or subject age was found. CONCLUSION We conclude that HTT measurements using contrast enhanced MRI with Gd-BOPTA can detect hemodynamic changes due to metastatic liver disease from colorectal cancer.
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Affiliation(s)
- Joachim Hohmann
- Department of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
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17
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Eveno C, Le Henaff C, Audollent R, Soyer P, Rampanou A, Nemeth J, Brouland JP, Dupuy E, Pocard M, Bonnin P. Tumor and non-tumor liver angiogenesis is traced and evaluated by hepatic arterial ultrasound in murine models. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1195-1204. [PMID: 22542260 DOI: 10.1016/j.ultrasmedbio.2012.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/22/2012] [Accepted: 03/04/2012] [Indexed: 05/31/2023]
Abstract
We studied the relationships between hepatic and mesenteric mean blood-flow velocities (mBFVs) measured by ultrasound imaging and (1) downstream tumor angiogenesis during liver metastasis induced by spleen injection of LS174 human colon cells overexpressing the antiangiogenic Netrin4 (LS174-NT4) or not (LS174-WT) and (2) downstream normal angiogenesis during hepatic regeneration after 50% hepatectomy. Liver volume and mBFVs were measured before and after surgery, at day 30 in the first model and at days 2, 7 and 16 in the second model. LS174-NT-4 vs. LS174-WT mice presented fewer metastases (25% vs. 90%, p < 0.001) and decreased hepatic mBFVs (16.5 ± 0.8 vs. 21.8 ± 1.4 cm s(-1), p < 0.01), without difference in mesenteric mBFVs. After partial hepatectomy, hepatic and mesenteric mBFVs increased at day 7, from 12.4 ± 1.7 and 11.8 ± 2.6 to 19.1 ± 1.8 and 17.5 ± 2.4 cm s(-1), respectively, (p < 0.01) then returned to baseline as liver volume. Duplex Doppler ultrasonography reliably assesses normal or tumor angiogenesis and may provide follow-up functional evaluation.
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Affiliation(s)
- Clarisse Eveno
- Université Paris-Diderot, Sorbonne Paris Cité, INSERM, UMR-S 965, Paris, France
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18
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Mannaris C, Averkiou MA. Investigation of microbubble response to long pulses used in ultrasound-enhanced drug delivery. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:681-91. [PMID: 22341047 DOI: 10.1016/j.ultrasmedbio.2011.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 12/13/2011] [Accepted: 12/17/2011] [Indexed: 05/05/2023]
Abstract
In current drug delivery approaches, microbubbles and drugs can be co-administered while ultrasound is applied. The mechanism of microbubble interaction with ultrasound, the drug and the cells is not fully understood. The aim of this study was to investigate microbubble response to long ultrasonic pulses used in drug delivery approaches. Two different in vitro set-ups were considered: with the microbubbles diluted in an enclosure and with the microbubbles flowing in a capillary tube. Acoustic streaming, which influences the observed bubble response, was observed in "typical" drug delivery conditions in the first set-up. With the capillary set-up, streaming effects were avoided and accurate bubble responses were recorded. The diffraction pattern of the source greatly influences the bubble response and in different locations of the field different bubble responses are observed. At low nondestructive pressures, microbubbles can oscillate for thousands of cycles repeatedly. At high acoustic pressures (at 1 MHz), most bubble activity disappeared within about 100 μs despite the length of the pulse, mainly due to violent bubble destruction and subsequent accelerated diffusion.
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19
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Zhuang ZG, Xu JR, Qian LJ, Xia Q, Chi JC. Computed tomography perfusion study of hemodynamic changes and portal hyperperfusion in a rabbit model of small-for-size liver. Hepatobiliary Pancreat Dis Int 2012; 11:74-80. [PMID: 22251473 DOI: 10.1016/s1499-3872(11)60128-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Portal hyperperfusion in the small-for-size (SFS) liver can threaten survival of rabbits. Therefore, it is important to understand the hemodynamic changes in the SFS liver. METHODS Twenty rabbits were divided into two groups: a control group and a modulation group. The control group underwent an extended hepatectomy. The modulation group underwent the same procedure plus splenectomy to reduce portal blood flow. CT perfusion examinations were performed on all rabbits before and after operation. Perfusion parameter values, especially portal vein perfusion (PVP), were analyzed. RESULTS PVP in the modulation group was lower than in the control group after operation (P=0.002). In the control group, postoperative PVP increased by 193.7+/-55.1% compared with preoperative PVP. A weak correlation was found between the increased percentage of PVP and resected liver-to-body weight ratio (RLBWR) (r=0.465, P=0.033). In the modulation group, postoperative PVP increased by 101.4+/-32.5%. No correlation was found between the increased percentage of PVP and RLBWR (r=0.167, P=0.644). Correlations were found between PVP and serum alanine aminotransferase, aspartate aminotransferase, and total bilirubin after surgery (P<0.05). CONCLUSION We successfully evaluated the characteristics of hemodynamic changes as well as the effects of splenectomy in the SFS liver in rabbits by the CT technique.
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Affiliation(s)
- Zhi-Guo Zhuang
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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20
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Banerji A, Naish JH, Watson Y, Jayson GC, Buonaccorsi GA, Parker GJM. DCE-MRI model selection for investigating disruption of microvascular function in livers with metastatic disease. J Magn Reson Imaging 2011; 35:196-203. [PMID: 21987457 DOI: 10.1002/jmri.22692] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 05/23/2011] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the Akaike information criterion (AIC) model selection technique as a method for detecting differences in microvascular characteristics between tumorous and non-tumor liver tissue. MATERIALS AND METHODS The AIC was applied to six patient datasets with liver metastases to determine, on a per voxel basis, which of two physiologically plausible candidate models gave a more appropriate description of the data. The dual-input single-compartment Materne model, extended to incorporate a novel portal input function estimation method, was chosen to represent liver tissue and the single-input dual-compartment extended Kety model was used for tumor. RESULTS Median AIC probabilities when comparing tumor versus liver and tumor versus tumor-margins were significantly different (P ≤ 0.01) in five of the six patient datasets. Comparisons between tumor margins and liver regions were significantly different in four datasets. Median AIC probabilities selected for the extended Kety model in all tumor regions, with the Materne model being progressively more probable through tumor margins into liver. CONCLUSION We present a viable method for assessing the spatially varying microvascular characteristics of tumor-bearing livers, with possible applications in lesion detection, assessment of tumor invasion, and measurement of drug efficacy.
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Affiliation(s)
- Anita Banerji
- Imaging Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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21
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Gauthier TP, Wasan HS, Muhammad A, Owen DR, Leen ELS. Assessment of global liver blood flow with quantitative dynamic contrast-enhanced ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:379-385. [PMID: 21357560 DOI: 10.7863/jum.2011.30.3.379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES This study assessed the potential of quantitative analysis of contrast bolus kinetics to reflect global liver blood flow. METHODS A dynamic contrast-enhanced ultrasound flow phantom was developed. A peristaltic pump established constant volume flow ranging between 16.5 and 49.5 mL/min (2-mm tube) and 85.5 and 256.5 mL/min (5-mm tube). After bolus injection of 2 doses of a contrast agent, a region of interest was drawn over the cross section of the tube used for a particular acquisition; the rise time, peak intensity, and wash-in slope were derived from time-intensity curves. Twenty healthy volunteers and 25 patients with biopsy-proven colorectal liver metastases were scanned with dynamic contrast-enhanced ultrasound. The rise time, peak intensity, and wash-in slope were derived from hepatic artery and portal vein time-intensity curves. Hepatic artery/portal vein ratios of the parameters were also calculated. RESULTS In the in vitro experiment, the rise time decreased while the peak intensity and wash-in slope increased with increasing volume flow for both tube diameters and contrast bolus volumes. In the clinical study, the rise time was lowered in the hepatic artery but elevated in the portal vein, and the peak intensity and wash-in slope were elevated in the hepatic artery but lowered in the portal vein in patients with colorectal liver metastases compared with healthy volunteers, although not in a statistically significant manner. This finding was consistent with an increase in hepatic artery blood flow, a decrease in portal vein blood flow, or both in patients with colorectal liver metastases compared with healthy volunteers. Only the 3 hepatic artery/portal vein ratios of the parameters achieved statistical significance in differentiating healthy volunteers from patients with colorectal liver metastases (P < .05). CONCLUSIONS Surrogate measurements of liver blood flow may be derived from quantitative analysis of dynamic contrast-enhanced ultrasound studies. They may have potential for quick and easy assessment of altered hepatic hemodynamics.
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Affiliation(s)
- Thomas P Gauthier
- Imperial College London, London, England; Philips Healthcare, Bothell, Washington, USA.
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22
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Edrei Y, Gross E, Corchia N, Tsarfaty G, Galun E, Pappo O, Abramovitch R. Vascular profile characterization of liver tumors by magnetic resonance imaging using hemodynamic response imaging in mice. Neoplasia 2011; 13:244-53. [PMID: 21390187 PMCID: PMC3050867 DOI: 10.1593/neo.101354] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/02/2010] [Accepted: 12/08/2010] [Indexed: 12/12/2022]
Abstract
Recently, we have demonstrated the feasibility of using hemodynamic response imaging (HRI), a functional magnetic resonance imaging (MRI) method combined with hypercapnia and hyperoxia, for monitoring vascular changes during liver pathologies without the need of contrast material. In this study, we evaluated HRI ability to assess changes in liver tumor vasculature during tumor establishment, progression, and antiangiogenic therapy. Colorectal adenocarcinoma cells were injected intrasplenically to model colorectal liver metastasis (CRLM) and the Mdr2 knockout mice were used to model primary hepatic tumors. Hepatic perfusion parameters were evaluated using the HRI protocol and were compared with contrast-enhanced (CE) MRI. The hypovascularity and the increased arterial blood supply in well-defined CRLM were demonstrated by HRI. In CRLM-bearing mice, the entire liver perfusion was attenuated as the HRI maps were significantly reduced by 35%. This study demonstrates that the HRI method showed enhanced sensitivity for small CRLM (1-2 mm) detection compared with CE-MRI (82% versus 38%, respectively). In addition, HRI could demonstrate the vasculature alteration during CRLM progression (arborized vessels), which was further confirmed by histology. Moreover, HRI revealed the vascular changes induced by rapamycin treatment. Finally, HRI facilitates primary hepatic tumor characterization with good correlation to the pathologic differentiation. The HRI method is highly sensitive to subtle hemodynamic changes induced by CRLM and, hence, can function as an imaging tool for understanding the hemodynamic changes occurring during CRLM establishment, progression, and antiangiogenic treatment. In addition, this method facilitated the differentiation between different types of hepatic lesions based on their vascular profile noninvasively.
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Affiliation(s)
- Yifat Edrei
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- MRI/MRS Laboratory HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eitan Gross
- Department of Pediatric Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Nathalie Corchia
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Galia Tsarfaty
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Eithan Galun
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Orit Pappo
- Department of Pathology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Rinat Abramovitch
- The Goldyne Savad Institute for Gene Therapy, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- MRI/MRS Laboratory HBRC, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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23
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Lewis JR, Mohanty SR. Nonalcoholic fatty liver disease: a review and update. Dig Dis Sci 2010; 55:560-78. [PMID: 20101463 DOI: 10.1007/s10620-009-1081-0] [Citation(s) in RCA: 227] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 12/01/2009] [Indexed: 12/13/2022]
Abstract
The spectrum of nonalcoholic fatty liver disease (NAFLD) ranges from asymptomatic steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. Hepatic steatosis occurs when free fatty acids, released in the setting of insulin resistance and the metabolic syndrome, are taken up by the liver. Additional biochemical insults, including oxidative stress, upregulation of inflammatory mediators, and dysregulated apoptosis, can result in inflammation (producing NASH) and fibrosis. Noninvasive methods (e.g., abdominal ultrasonography) are safe ways to support a diagnosis of hepatic steatosis, but advanced liver histopathologic findings including NASH and fibrosis cannot be identified without pursuing liver biopsy. Recent advances in serologic and imaging methods aim to determine severity of inflammation and fibrosis noninvasively. Currently, therapeutic options for NAFLD are limited to medications that reduce risk factors, but the future holds promise for therapies that might slow the progression of this increasingly prevalent disorder.
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Affiliation(s)
- Jeffrey R Lewis
- Department of Medicine, Center for Liver Diseases, University of Chicago, Chicago, IL 60637, USA.
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Hohmann J, Müller C, Oldenburg A, Skrok J, Frericks BB, Wolf KJ, Albrecht T. Hepatic transit time analysis using contrast-enhanced ultrasound with BR1: A prospective study comparing patients with liver metastases from colorectal cancer with healthy volunteers. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1427-1435. [PMID: 19540656 DOI: 10.1016/j.ultrasmedbio.2009.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 03/24/2009] [Accepted: 04/08/2009] [Indexed: 05/27/2023]
Abstract
We prospectively compared hepatic transit time (HTT) measurements in subjects with liver metastases from colorectal cancer (group a) and healthy volunteers (group b) using contrast-enhanced ultrasound with BR1. The purpose of this study was to verify our hypothesis that the hemodynamic changes of the liver, which occur during metastasis seeding, would shorten the HTT, and we expect that such changes could be used for the detection of occult liver metastases from colorectal cancer in the future. The study had institutional review board approval and all subjects gave informed written consent. Group a and group b consisted of 22 subjects each. Baseline and post contrast images were acquired starting 10 s before and ending 40 s after administration of BR1, using nonlinear imaging at a frame rate of 5/s. The baseline images were used to determine the signal intensity without contrast enhancement as the reference signal. Arrival times (AT) of the contrast agent for the hepatic artery, the portal vein and one hepatic vein were determined using (i) quantitative analysis and (ii) subjective analysis by two blinded readers. HTT was calculated based on arrival time measurements. Quantitative and subjective analysis showed significantly shorter arterial to venous and portal to venous HTT in group a compared with group b (p < 0.001). Arterial to venous HTT (quantitative analysis) was < or = 9 s in 19 of 22 subjects of group a and >9 s in 18 of 22 subjects of group b (sensitivity 86%, specificity 82%, positive predictive value 83%, negative predictive value 86%, area under the curve [AUC] 0.87). Portal to venous HTT (quantitative analysis) was < 7 s in 21 of 22 subjects of group a and > 7s in 15 of 22 subjects of group b (sensitivity 95%, specificity 68%, PPV 75%, NPV 94%, AUC 0.85). There was an inverse relation with number of liver segments involved for arterial to venous and portal to venous HTT in group a (p < 0.05), but no correlation between HTT and overall volume of metastases (group a) or subject age (group b). From the results of our study, we conclude that HTT measurements using contrast-enhanced ultrasound with BR1 can detect hemodynamic changes caused by metastatic liver disease from colorectal cancer. However, comparison with the literature suggests that the use of other contrast agents might provide better results. Comparison of different contrast agents for the purpose of transit time analysis would therefore be useful before embarking on a prospective trial looking at the detection of occult liver metastases in patients with colorectal cancer. (E-mail: jhohmann@uhbs.ch).
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Affiliation(s)
- Joachim Hohmann
- Department of Radiology, University Hospital Basel, Switzerland.
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Zhuang ZG, Qian LJ, Wang BX, Zhou Y, Li QG, Xu JR, Cheng YF. Computed tomography perfusion in living donor liver transplantation: an initial study of normal hemodynamic changes in liver grafts. Clin Transplant 2009; 23:692-9. [DOI: 10.1111/j.1399-0012.2009.00991.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Kyriakopoulou K, Antoniou A, Fezoulidis IV, Kelekis NL, Dalekos GN, Vlychou M. The role of Doppler Perfusion Index as screening test in the characterization of focal liver lesions. Dig Liver Dis 2008; 40:755-60. [PMID: 18294941 DOI: 10.1016/j.dld.2007.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 12/20/2007] [Indexed: 12/11/2022]
Abstract
PURPOSE Doppler Perfusion Index (DPI) has been used in the detection of overt liver metastatic disease. In the present prospective study we evaluated the use of DPI in the differential diagnosis of liver tumours. MATERIALS AND METHODS We have included in our study 76 patients with focal hepatic lesion and 39 subjects as control group. All patients were evaluated by Color Doppler Ultrasound, and/or Spiral Computerised Tomography, Magnetic Resonance Imaging and biopsy. The radiologist performed DPI measurements was blind from the final diagnosis of the other methods. RESULTS DPI measurements in the control group ranged from 0.07 to 0.22 (mean value 0.14), in 42 cases with benign lesions (group A) ranged from 0.05 to 0.53 (mean 0.15) and in 34 cases with malignant lesions (group B) ranged from 0.39 to 0.75 (mean 0.53). There was a statistically significant difference in DPI measurements between the control group and group B. CONCLUSIONS Our results suggest that the DPI may differentiate malignant from benign focal hepatic lesions and therefore can be used as a screening test in the routine clinical practice.
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Can perfusion CT assessment of primary colorectal adenocarcinoma blood flow at staging predict for subsequent metastatic disease? A pilot study. Eur Radiol 2008; 19:79-89. [PMID: 18704434 DOI: 10.1007/s00330-008-1128-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 06/20/2008] [Indexed: 02/06/2023]
Abstract
We aimed to determine whether perfusion CT measurements at colorectal cancer staging may predict for subsequent metastatic relapse. Fifty two prospective patients underwent perfusion CT at staging to estimate tumour blood flow, blood volume, mean transit time, and permeability surface area product. Patients considered metastasis free and suitable for surgery underwent curative resection subsequently. At final analysis, a median of 48.6 months post-surgery, patients were divided into those who remained disease free, and those with subsequent metastases. Vascular parameters for these two groups were compared using t-testing, and receiver operator curve analysis was performed to determine the sensitivity and specificity of these vascular parameters for predicting metastases. Thirty seven (71%) patients underwent curative surgery; data were available for 35: 26 (74%) remained disease free; 9 (26%) recurred (8 metastatic, 1 local). Tumour blood flow differed significantly between disease-free and metastatic patients (76.0 versus 45.7 ml/min/100 g tissue; p = 0.008). With blood flow <64 ml/min/100 g tissue, sensitivity and specificity (95% CI) for development of metastases were 100% (60-100%) and 73% (53-87%), respectively. Our preliminary findings suggest that primary tumour blood flow might potentially be a useful predictor warranting further study.
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Gout S, Huot J. Role of cancer microenvironment in metastasis: focus on colon cancer. CANCER MICROENVIRONMENT 2008; 1:69-83. [PMID: 19308686 PMCID: PMC2654352 DOI: 10.1007/s12307-008-0007-2] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2007] [Accepted: 02/13/2008] [Indexed: 12/13/2022]
Abstract
One person on three will receive a diagnostic of cancer during his life. About one third of them will die of the disease. In most cases, death will result from the formation of distal secondary sites called metastases. Several events that lead to cancer are under genetic control. In particular, cancer initiation is tightly associated with specific mutations that affect proto-oncogenes and tumour suppressor genes. These mutations lead to unrestrained growth of the primary neoplasm and a propensity to detach and to progress through the subsequent steps of metastatic dissemination. This process depends tightly on the surrounding microenvironment. In fact, several studies support the point that tumour development relies on a continuous cross-talk between cancer cells and their cellular and extracellular microenvironments. This signaling cross-talk is mediated by transmembrane receptors expressed on cancer cells and stromal cells. The aim of this manuscript is to review how the cancer microenvironment influences the journey of a metastatic cell taking liver invasion by colorectal cancer cells as a model.
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Affiliation(s)
- Stéphanie Gout
- Le Centre de recherche en cancérologie de l'Université Laval, L'Hôtel-Dieu de Québec, 9 rue McMahon, Quebec, Canada
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Kruskal JB. Can optical imaging assist in characterization of the onset of angiogenesis in developing hepatic metastases in mice livers? Radiology 2007; 243:307-8. [PMID: 17456860 DOI: 10.1148/radiol.2432061988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Optical imaging currently can be used to characterize some of the early steps in the angiogenic pathway in vivo in animals. Liu and Matsui have provided valuable information in regard to the sequential changes in the origin and nature of newly formed blood vessels during progressive stages of growth of hepatic colorectal cancer metastases. The short-term challenge is to image cellular events that precede visible vessel formation and that occur during drug-induced vascular regression.
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Affiliation(s)
- Jonathan B Kruskal
- Department of Radiology, Beth Israel Deaconess Medical Center-West, Boston, MA 02215, USA.
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Abstract
Angiogenesis is a key factor in the growth and dissemination of colorectal cancer, with significant implications for its clinical management. Previous trials have provided proof-of-principle that inhibition of angiogenesis has the potential to enhance the effectiveness of treatment for this disease. Characterisation of the angiogenic status of the tumour on an individual patient basis could allow for a more targeted approach to treatment. In vivo imaging techniques that assess tumour microvessel function have the potential to improve the management of treatment for patients with colorectal cancer. This review focuses on MRI and CT assessment of colorectal cancer angiogenesis. We discuss the effects that these two techniques have had in the assessment of this disease, including tumour staging and therapeutic assessment. Their comparability with other imaging techniques, in particular ultrasound, and their limitations are also addressed.
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Affiliation(s)
- Vicky Goh
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Middlesex, UK.
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Oktar SO, Yücel C, Demirogullari T, Uner A, Benekli M, Erbas G, Ozdemir H. Doppler sonographic evaluation of hemodynamic changes in colorectal liver metastases relative to liver size. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:575-82. [PMID: 16632780 DOI: 10.7863/jum.2006.25.5.575] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE The mechanisms of hemodynamic alterations in colorectal liver metastases are not clearly understood yet. Considering that an increase in liver size in patients with metastases could also result in an alteration in total liver flow, we aimed to analyze hemodynamic changes relative to the liver volume and to search for the possibility of any intrinsic factors affecting blood flow in patients with metastases. METHODS Twenty-eight patients with colorectal liver metastases and 20 control subjects with no liver disease were evaluated sonographically. All patients were examined prospectively by Doppler sonography and helical computed tomography. Hepatic hemodynamic parameters, including blood flow in the hepatic artery and portal vein, total blood flow to the liver, and Doppler perfusion index, were calculated, and values relative to liver volume were obtained. Hepatic perfusion changes in liver metastases were then compared with those in a control group. RESULTS The liver volume of the patients with liver metastases was greater than that of the control group (P=.003). Hepatic arterial blood flow rates were higher, whereas portal flow rates were lower, in patients with liver metastases compared with control subjects (P<.05). Total liver blood flow was not significantly different between the two groups. However, total blood flow relative to liver volume was significantly lower in the metastatic group (P<.001). Doppler perfusion index values in the patients with metastasis were significantly higher than in the control group (P=.000). CONCLUSIONS Our findings may support the hypothesis that a humoral mediator-induced portal venous flow reduction causes perfusion changes in liver metastases from colorectal disease. However, an additional intrinsic hepatic hemodynamic event should also be present. Doppler perfusion index measurements can provide additional information in the evaluation of patients with colorectal liver metastases.
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Affiliation(s)
- Suna Ozhan Oktar
- Department of Radiology, Gazi University, School of Medicine, Ankara, Turkey.
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Pandharipande PV, Krinsky GA, Rusinek H, Lee VS. Perfusion imaging of the liver: current challenges and future goals. Radiology 2005; 234:661-73. [PMID: 15734925 DOI: 10.1148/radiol.2343031362] [Citation(s) in RCA: 243] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Improved therapeutic options for hepatocellular carcinoma and metastatic disease place greater demands on diagnostic and surveillance tests for liver disease. Existing diagnostic imaging techniques provide limited evaluation of tissue characteristics beyond morphology; perfusion imaging of the liver has potential to improve this shortcoming. The ability to resolve hepatic arterial and portal venous components of blood flow on a global and regional basis constitutes the primary goal of liver perfusion imaging. Earlier detection of primary and metastatic hepatic malignancies and cirrhosis may be possible on the basis of relative increases in hepatic arterial blood flow associated with these diseases. To date, liver flow scintigraphy and flow quantification at Doppler ultrasonography have focused on characterization of global abnormalities. Computed tomography (CT) and magnetic resonance (MR) imaging can provide regional and global parameters, a critical goal for tumor surveillance. Several challenges remain: reduced radiation doses associated with CT perfusion imaging, improved spatial and temporal resolution at MR imaging, accurate quantification of tissue contrast material at MR imaging, and validation of parameters obtained from fitting enhancement curves to biokinetic models, applicable to all perfusion methods. Continued progress in this new field of liver imaging may have profound implications for large patient groups at risk for liver disease.
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Affiliation(s)
- Pari V Pandharipande
- MRI-Basement, Schwartz Bldg, NYU Medical Center, 530 First Ave, New York, NY 10016, USA
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Roumen RMH, Scheltinga MRM, Slooter GD, van der Linden AWM. Doppler perfusion index fails to predict the presence of occult hepatic colorectal metastases. Eur J Surg Oncol 2005; 31:521-7. [PMID: 15922888 DOI: 10.1016/j.ejso.2004.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Revised: 12/30/2004] [Accepted: 12/30/2004] [Indexed: 01/16/2023] Open
Abstract
AIMS To assess the predictive value of the Doppler perfusion index (DPI) in a cohort of patients with colorectal cancer with and without initial metastatic disease and present the data of at least 4 years follow-up. METHODS We studied 133 patients admitted with stage I-IV colorectal cancer. In all patients hepatic flow measurements were performed in the week before surgery. All patients who underwent curative surgery on intention were followed up for at least 4 years. RESULTS Reliable DPI measurements were not possible in 29 patients. Three groups were defined for comparison: (A) 57 patients who remained disease free, (B) 11 patients who presented with metachronous liver metastases during follow-up and (C) 19 patients with liver metastases at initial presentation. No significant difference was found for DPI data between the three groups. There was a trend for a higher hepatic artery flow in patients with initial liver metastases compared to those who remained disease free (p=0.07). The previously reported cut-off point for maximal normal DPI (0.3) did not have any predictive value in this patient cohort. CONCLUSION The present data do not confirm the usefulness of DPI measurements in daily clinical practice for the early identification of patients with colorectal cancer at high risk for recurrent disease.
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Affiliation(s)
- R M H Roumen
- Department of Surgery, Máxima Medisch Centrum, P.O. Box 7777, 5500 MB Veldhoven, The Netherlands.
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Nakashige A, Horiguchi J, Tamura A, Asahara T, Shimamoto F, Ito K. Quantitative measurement of hepatic portal perfusion by multidetector row CT with compensation for respiratory misregistration. Br J Radiol 2004; 77:728-34. [PMID: 15447957 DOI: 10.1259/bjr/41168942] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Our purpose was to determine whether hepatic portal perfusion assessed by multidetector row CT using compensation for respiratory misregistration can predict the severity of chronic liver disease. We carried out dynamic CT in 43 patients (chronic hepatitis: n=9; cirrhosis: n=24; normal liver: n=10). In this series, 20 patients had liver tumours. The CT protocol was designed to avoid respiratory artefacts and included two interscan breathing periods during the study. To compensate for respiratory misregistration, image sets in the same z-axis position were acquired from four-slice data on each scan, and the portal perfusion calculations were made according to the maximum slope method. Portal perfusion was compared with and without compensation for respiratory misregistration, and the different types of hepatic disease. In the liver tumour patients in particular, portal perfusion was compared with the degree of hepatic fibrosis in the liver sections. Portal perfusion in the patients without compensation for respiratory misregistration (1.10 ml min(-1)ml(-1)) was higher than that of those with compensation (0.99 ml min(-1)ml(-1); p=0.036). Hepatic portal perfusion of patients with chronic hepatitis (0.97 ml min(-1)ml(-1)) and liver cirrhosis (0.88 ml min(-1)ml(-1)) was less than that of patients with normal liver (1.32 ml min(-1)ml(-1); p=0.03, 0.001). Moderate correlation was seen between portal perfusion and the percentage of fibrosis in patients with liver tumours (r=0.55). Hepatic portal perfusion obtained by multidetector row dynamic CT using compensation for respiratory misregistration has the potential to improve non-invasive assessment of the degree of chronic liver disease.
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Affiliation(s)
- A Nakashige
- Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, School of Medicine, Hiroshima University, Hiroshima 734-8551, Japan
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Kopljar M, Brkljacic B, Doko M, Horzic M. Nature of Doppler perfusion index changes in patients with colorectal cancer liver metastases. JOURNAL OF ULTRASOUND IN MEDICINE 2004; 23:1295-300. [PMID: 15448318 DOI: 10.7863/jum.2004.23.10.1295] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Occult hepatic metastases from colorectal cancer result in an increase of the ratio of arterial hepatic blood flow to total hepatic blood flow, described as the Doppler perfusion index. Whether this alteration is due to an increase in arterial blood flow or a decrease in portal venous inflow has not yet been unequivocally determined. The purpose of this study was to analyze changes in hepatic perfusion in patients with liver metastases from colorectal cancer by standardization of hemodynamic parameters to body surface area. METHODS Hemodynamic parameters (crosssectional area, blood flow, and congestive index) were measured for the common hepatic artery and portal vein with duplex color Doppler sonography in 20 patients with liver metastases and 20 healthy control subjects and evaluated relative to body surface area. RESULTS No statistically significant differences in age, body surface area, cross-sectional area of the common hepatic artery, and congestion index of the common hepatic artery and portal vein were observed between control subjects and patients with liver metastases. Patients with liver metastases had significantly greater arterial hepatic blood flow and Doppler perfusion index and significantly smaller portal cross-sectional area portal blood flow as well as total liver blood flow (P <.001). CONCLUSIONS This study supports the theory that the primary mechanism of alteration in liver perfusion is the reduction of portal inflow with subsequently increased arterial hepatic blood flow.
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Affiliation(s)
- Mario Kopljar
- Department of Surgery, University Hospital Dubrava, Avenija G. Suska 6, HR-10000 Zagreb, Croatia.
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Kruskal JB, Thomas P, Kane RA, Goldberg SN. Hepatic perfusion changes in mice livers with developing colorectal cancer metastases. Radiology 2004; 231:482-90. [PMID: 15128993 DOI: 10.1148/radiol.2312030160] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate whether intrahepatic flow alterations occur during formation of hepatic colorectal cancer metastases and to identify possible causes of these alterations. MATERIALS AND METHODS Intravital imaging of exteriorized livers was performed in 72 live mice. Three groups of mice were studied: a sham-operated control group (n = 24), a group with nonmetastasizing subcutaneous gliomas (n = 24), and a group with developing hepatic CX-1 colon cancer metastases (n = 24). Microvascular flow parameters, leukocyte-endothelial interactions, and wall shear stress were directly measured in hepatic sinusoids and postsinusoidal venules at 2-day intervals prior to and during the development of metastases. The Kruskal-Wallis test was used initially to test for overall equality of medians in each data group. Single posttest comparisons of independent samples were performed with the Mann-Whitney test, with an overall statistical significance of .05. RESULTS Prior to the development of visible colorectal cancer metastases, significant (P <.05) reductions occurred in sinusoidal and postsinusoidal flow and wall shear rates, coupled with increased leukocyte rolling and adherence. With tumor growth, flow was further compromised in 92% of tumors larger than 0.5 mm in diameter by extrinsic compression of sinusoids and portal venules and narrowing caused by adherent leukocytes. CONCLUSION Significant intrahepatic flow alterations occur in mouse livers prior to growth of visible metastases and provide a rational explanation for elevation in the Doppler perfusion index that occurs prior to tumor formation.
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Affiliation(s)
- Jonathan B Kruskal
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Rd, West Campus 302B, Boston, MA 02215, USA.
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Hohmann J, Albrecht T, Oldenburg A, Skrok J, Wolf KJ. Liver metastases in cancer: detection with contrast-enhanced ultrasonography. ACTA ACUST UNITED AC 2004; 29:669-81. [PMID: 15185032 DOI: 10.1007/s00261-004-0175-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In patients with known or suspected malignancy, ultrasonography (US) is often the first choice for liver imaging because of its widespread availability and low cost. Compared with contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), the sensitivity of conventional US for detecting hepatic metastases is relatively poor. The advent of microbubble contrast agents changed this situation. Sensitivity and specificity increased substantially with the use of these contrast agents and contrast-specific imaging modes in recent years. Currently, numerous US imaging methods exist, based on Doppler techniques or harmonic imaging. They exploit the complex nonlinear behavior of microbubbles in a sound field to achieve marked augmentation of the US signal. Although microbubble contrast agents are essentially blood pool agents, some have a hepatosplenic specific late phase. Imaging during this late phase is particularly useful for improving the detection of malignant liver lesions and allows US to perform similarly to spiral CT as shown by recent studies. In addition, this late phase imaging is very helpful for lesion characterization. Low mechanical index imaging with the newer perfluor agents permits real-time imaging of the dynamic contrast behavior during the arterial, portal venous, and late phases and is particularly helpful for lesion characterization. The use of US for hemodynamic studies of the liver transit time may detect blood flow changes induced by micrometastases even before they become visible on imaging. In this field of functional imaging, further research is required to achieve conclusive results, which are not yet available.
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Affiliation(s)
- J Hohmann
- Klinik und Poliklinik für Radiologie und Nuklearmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Germany.
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Abstract
Ultrasound contrast agents consist of tiny gas bubbles encapsulated by a stabilising membrane or shell. When combined with recent contrast-specific ultrasound techniques, they provide substantial enhancement of vessels and solid organs. The clinical use and the diagnostic value of ultrasound contrast agents are in principle comparable to those of contrast agents for CT and MRI. They add an additional dimension of information to sonography, which results in considerable improvement of diagnostic accuracy in many cases. This paper reviews the physicochemical properties of various microbubble contrast agents, discusses non-linear bubble behaviour and contrast-specific imaging techniques. An overview of the most important radiological clinical applications in the liver, kidney and spleen is given.
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Affiliation(s)
- T Albrecht
- Klinik und Poliklinik für Radiologie und Nuklearmedizin, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin.
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Tranquart F, Correas JM, Bleuzen A, Tchuenbou J. Place actuelle de l’échographie de contraste dans l’exploration des lésions focales hépatiques. ACTA ACUST UNITED AC 2004; 28:337-49. [PMID: 15146149 DOI: 10.1016/s0399-8320(04)94934-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Goh V, Halligan S, Bartram CI. Local radiological staging of rectal cancer. Clin Radiol 2004; 59:215-26. [PMID: 15037133 DOI: 10.1016/j.crad.2003.08.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2003] [Revised: 08/13/2003] [Accepted: 08/18/2003] [Indexed: 11/27/2022]
Abstract
Rectal cancer is a common malignancy with a highly variable outcome. Local recurrence is dependent upon tumour stage and surgical technique. The role of pre-operative imaging is to determine which patients may be safely managed by surgery alone and which need additional therapy in order to facilitate surgery and improve outcome. This decision depends on the distinction between those with early and advanced disease. While trans-rectal ultrasound has traditionally been used to answer this question, a role for magnetic resonance imaging (MRI) is increasingly argued. This review will focus on the treatment options for rectal cancer and the clinical questions that subsequently arise for the radiologist to answer.
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Affiliation(s)
- V Goh
- Intestinal Imaging Centre, St Mark's Hospital, Northwick Park, London, UK
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Chow PKH, Yu WK, Soo KC, Chan STF. The measurement of liver blood flow: a review of experimental and clinical methods. J Surg Res 2003; 112:1-11. [PMID: 12873426 DOI: 10.1016/s0022-4804(03)00127-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Changes in hepatic blood flow reflect adaptive responses of the liver to injury, regeneration, and the development of disease states. The measurement of hepatic blood flow is, however, technically challenging and although theoretically useful has not become routine in clinical work. The different techniques that have been developed for quantitative measurement of hepatic blood flow require careful interpretation of the results obtained but are frequently applied without careful considerations of their technical limitations. In particular, many noninvasive techniques depend on good hepatocellular function and are thus irrelevant under most clinical conditions. Many other potentially useful techniques are poorly validated and standardized and there is a need for further research into smethodology. This review summarizes the salient technical features of the different techniques for quantitative measurement of hepatic blood flow. The techniques are divided into invasive, minimally invasive, and noninvasive categories and the relevance of each technique to both routine clinical application or research is discussed.
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Affiliation(s)
- Pierce K H Chow
- Department of General Surgery, Singapore General Hospital, Singapore.
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Hohmann J, Albrecht T, Hoffmann CW, Wolf KJ. Ultrasonographic detection of focal liver lesions: increased sensitivity and specificity with microbubble contrast agents. Eur J Radiol 2003; 46:147-59. [PMID: 12714231 DOI: 10.1016/s0720-048x(02)00053-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ultrasonography (US) is the first choice for screening patients with suspected liver lesions. However, due to a lack of contrast agents, US used to be less sensitive and specific compared with computed tomography (CT) and magnet resonance imaging (MRI). The advent of microbubble contrast agents increased both sensitivity and specificity dramatically. Rapid developments of the contrast agents as well as of special imaging techniques were made in recent years. Today numerous different US imaging methods exist which based either on Doppler or on harmonic imaging. They are using the particular behaviour of microbubbles in a sound field which varies depending on the energy of insonation (low/high mechanical index, MI) as well as on the properties of the agent themselves. Apart from just blood pool enhancement some agents have a hepatosplenic specific late phase. US imaging during this late phase using relatively high MI in phase inversion mode (harmonic imaging) or stimulated acoustic emission (SAE; Doppler method) markedly improves the detection of focal liver lesions and is also very helpful for lesion characterisation. With regards to detection, contrast enhanced US performs similarly to CT as shown by recent studies. Early results of studies using low MI imaging and the newer perfluor agents are also showing promising results for lesion detection. Low MI imaging with these agents has the advantage of real time imaging and is particularly helpful for characterisation of focal lesions based on their dynamic contrast behaviour. Apart from the techniques which based on the morphology of liver lesions there were some attempts for the detection of occult metastases or micrometastases by means of liver blood flow changes. Also in this field the use of US contrast agents appears to have advantages over formerly used non contrast-enhanced methods although no conclusive results are available yet.
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Affiliation(s)
- J Hohmann
- Klinik und Poliklinik für Radiologie und Nuklearmedizin, Universitätsklinikum Benjamin Franklin der Freien Universität Berlin, Hindenburgdamm 30, Germany.
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Abstract
The real time nature of ultrasound and functional methods such as Doppler ultrasound mean that ultrasound can claim to have always been a functional imaging method, but recent developments in quantitation, dramatic improvement in Doppler performance and now microbubbles have created many exciting new applications. These include methods for assessing the neovascularity of tumours, for following the effects of therapy and for predicting the likelihood of development of metastatic disease at the staging of primary tumours.
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Affiliation(s)
- M J K Blomley
- Imaging Sciences Department, Clinical Sciences Centre, Faculty of Medicine, Imperial College (Hammersmith Hospital Campus), London, UK.
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Ramnarine KV, Leen E, Oppo K, Angerson WJ, McArdle CS. Contrast-enhanced Doppler perfusion index: clinical and experimental evaluation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:1121-1129. [PMID: 12369667 DOI: 10.7863/jum.2002.21.10.1121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To assess the potential of the power Doppler signal intensity rate of enhancement due to contrast agent wash-in for assessment of hepatic hemodynamics. METHODS With the use of standardized settings, power Doppler sonography was performed before and after administration of a contrast agent. Video-recorded examinations were digitized for offline analysis on a personal computer. The temporal changes of the power Doppler signal intensity were quantified to provide contrast agent wash-in curves. The contrast-enhanced Doppler perfusion index was defined by the ratio of the wash-in gradient of the hepatic artery and portal vein as contrast-enhanced Doppler perfusion index = hepatic artery gradient/(hepatic artery gradient + portal vein gradient). The contrast-enhanced Doppler perfusion index was evaluated at 4 contrast agent doses in each of 14 patients with liver metastases and 3 patients with hemangiomas. An in vitro flow model was used to determine the relationships between the power Doppler rate of enhancement and flow in vessels of 4, 8, and 12 mm in diameter. RESULTS In vivo, there was a significantly higher (P < .0001) mean contrast enhanced Doppler perfusion index in patients with liver metastases (mean, 0.59; 95% confidence interval, 0.54-0.63), compared with patients with hemangiomas (mean, 0.33; 95% confidence interval, 0.24-0.41). The corresponding coefficients of variations were 25% for patients with liver metastases and 31% for patients with hemangiomas. In vitro, the power Doppler rate of enhancement was proportional to flow speed and independent of vessel diameter. CONCLUSIONS Measurement of the contrast-enhanced Doppler perfusion index may have potential in assessment of hepatic hemodynamics and focal liver disease.
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Săftoiu A, Ciurea T, Gorunescu F. Hepatic arterial blood flow in large hepatocellular carcinoma with or without portal vein thrombosis: assessment by transcutaneous duplex Doppler sonography. Eur J Gastroenterol Hepatol 2002; 14:167-76. [PMID: 11981341 DOI: 10.1097/00042737-200202000-00011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND As liver cirrhosis progresses, the portal venous blood (PVBF) flow decreases, accompanied by an increase in hepatic arterial blood flow. Large hepatocellular carcinoma is a hypervascular tumour with a rapid growth, which seems to require an increase of the tumoral arterial blood flow. Furthermore, hepatocellular carcinoma is frequently associated with portal vein thrombosis, which subsequently impedes portal blood supply. METHODS The purpose of our study was to estimate alterations in the hepatic arterial blood flow in large hepatocellular carcinomas occurring in liver cirrhosis, in comparison with liver cirrhosis and controls. Liver blood flow measurements were determined by duplex Doppler sonography in 47 patients with large hepatocellular carcinomas (13 with portal vein thrombosis and 34 without this thrombosis), 42 liver cirrhosis patients and 30 controls. The Doppler perfusion index was calculated as the ratio of hepatic arterial blood flow to total hepatic blood flow. RESULTS The patients with liver cirrhosis had a significant increase of hepatic arterial blood flow as compared to controls (P < 0.001), accompanied by a significant reduction in PVBF (P < 0.005). As a result, the Doppler perfusion index was increased in patients with liver cirrhosis as compared to controls (P < 0.001). The hepatic arterial blood flow was increased in patients with hepatocellular carcinoma but without portal vein thrombosis as compared to the cirrhotic patients (P < 0.001), with a significant reduction of PVBF (P < 0.001). Hepatic arterial blood flow was also increased in patients with both hepatocellular carcinoma and portal vein thrombosis as compared to the patients without this thrombosis (P < 0.001). CONCLUSION These results suggest that in large hepatocellular carcinomas there is a decreased PVBF, accompanied by an increased hepatic arterial blood flow. The hepatic arterial buffer response seems to be active in hepatocellular carcinomas and maintains liver perfusion to adequate levels.
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Affiliation(s)
- Adrian Săftoiu
- Department of Internal Medicine, Division of Gastroenterology, University of Medicine and Pharmacy, Craiova, Romania.
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Affiliation(s)
- Y S Bakhle
- Leukocyte Biology, Division of Biomedical Sciences, Faculty of Medicine, Imperial College, London SW7 2AZ.
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Neumaier CE, Cittadini G, Grasso A, Dahmane M. Role of ultrasonography in the staging of gastrointestinal neoplasms. SEMINARS IN SURGICAL ONCOLOGY 2001; 20:86-90. [PMID: 11398202 DOI: 10.1002/ssu.1022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article reviews the capabilities and limits of ultrasonography (US) in the staging of gastrointestinal neoplasms. US is a well-established tool in the investigation of abdominal diseases. Its role is very important in the first approach to liver, gallbladder, biliary, and pancreatic diseases, but its abilities for accurate staging may be limited by various factors, which will be discussed. In the evaluation of the stomach and intestine, US is rarely utilized, but it can occasionally demonstrate an unsuspected gastrointestinal mass that usually must be evaluated further with specific techniques (endoscopy and barium studies) to confirm the diagnosis and to perform an accurate staging (with endosonography and computed tomography).
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Affiliation(s)
- C E Neumaier
- Department of Radiology, Istituto Scientifico Tumori, Genoa, Italy.
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Abstract
Ultrasound contrast agents consist of microbubbles, which are the most effective acoustic backscatters. The interaction between the insonating ultrasound beam and the microbubbles is very complex and basic understanding of their behavior under various sound fields has been fundamental to the development of improved methods of visualizing and displaying the contrast agents. Although echo enhancers have been under development for a long time, their clinical applications have been limited to enhancing the Doppler signals in difficult cases. However, recent advances in harmonic imaging and the development of new tissue-specific contrast agents stand to broaden the scope of ultrasound diagnostic potential beyond simply rescuing failed Doppler examinations. This article reviews the current and potential applications of ultrasound contrast harmonic imaging in the abdomen.
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Affiliation(s)
- E Leen
- Radiology Department, Royal Infirmary, University of Glasgow, Scotland.
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Perhaps not everyone knows that…. Ann Oncol 2000. [DOI: 10.1093/oxfordjournals.annonc.a010421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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