Evaluation of the Possibilities of Contrast-Enhaced Ultrasound (CEUS) in the Diagnosis of Colorectal Liver Metastases (CRLM)

Purpose: To evaluate the capability of CEUS in the detection of CRLM in comparison with conventional grayscale B-mode.

Material and methods: 18 patients with CRLM underwent CEUS using the contrast agent SonoVue® (Bracco, Italy). The patients were divided into two groups: the first group - 10 patients (55 %) before to chemotherapy; the second group - 8 patients (45 %) after chemotherapy with the stabilization of the process. The enhancement patterns of liver metastases were evaluated during the vascular phases: arterial, venous, and delayed.

Results: The enhancement patterns of liver metastases on CEUS were categorized as diffuse homogeneous enhancement (30 % - in the first group; such enhancement wasn’t observed in the second group), rim-like hyperenhancement (70 % of the patients from the first group, 75 % of patients from the second group) and isoenhancement, such as intact liver parenchyma (25 % of the patients from the second group). There were detected additional metastases in 4 (22,2 %) of patients in the delayed phase. There were significant differences in time of the beginning the vascular phases between patients from the first and second groups. The latest beginning of the wash-in stage was observed in liver metastases in patients from the second group (25.8 s from the injection of the contrast). The earliest beginning of the wash out stage was observed in liver metastases in patients from the first group (42.4 s from the injection of contrast).

Conclusion: CEUS improves visualization of CRLM, in comparison with the grayscale B-mode. It is also possible to apply this technique in the assessment of chemotherapy in patients with CRLM, as there was a difference between the moments of the beginning wash-in and wash-out stages.

1. Давыдов М.И. Аксель Е.М. Статистика злокачественных новообразований в России и странах СНГ в 2009 г. // Вестник Российского онкологического центра им. Н.Н. Блохина РАМН. 2011. Т. 22. № 3 (85). Прил. 1.

2. Гребенкин Е.Н., Станоевич УС, Чхиквадзе В.Д. и со-авт. Роль радиочасточной аблации в лечении больных с метастазами колоректального рака в печень // Врач. 2012. № 6. С. 48-51.

3. Алиев В.А., Барсуков Ю.А., Николаев А.В. и соавт. // Онкологическая колопроктология. 2012. № 4. С. 1521.

4. Данзанова Т.Ю., Синюкова Г.Т., Гудилина Е.А. и соавт. Значение ультразвуковой диагностики метастатического поражения печени в определении тактики хирургического лечения // Росс. онкол. журнал. 2015. №3. С. 23-27.

5. Albrecht T., Hohmann J., ldenburg A. et al. Detection and characterisation of liver metastases // Eur. Radiol. 2004. Vol. 14. Suppl 8. P. 25-33.

6. Konopke R., Kersting S., Saeger H.D., Bunk A. Detection of liver lesions by contrast-enhanced ultrasound -comparison to intraoperative findings // Ultraschall Med. 2005. Vol. 26. P. 107-113.

7. Larsen L.P, Rosenkilde M., Christensen H. et al. The value of contrast enhanced ultrasonography in detection of liver metastases from colorectal cancer: a prospective double-blinded study // Eur. J. Radiol. 2007. Vol 62. P. 302-307.

8. Wernecke K., Rummeny E., Bongartz G. et al. Detection of hepatic masses in patients with carcinoma: comparative sensitivities of sonography, CT, and MR imaging // Amer. J. Roentgenol. 1991. Vol. 157. P 731-739.

9. Jones E.C., Chezmar J.L., Nelson R.C., Bernardino M.E. The frequency and significance of small (less than or equal to 15 mm) hepatic lesions detected by CT // Amer. J. Roentgenol. 1992. Vol. 158. P 535-539.

10. Kreft B., Pauleit D., Bachmann R. et al. Incidence and significance of small focal liver lesions in MRI // Rofo. 2001. Vol. 173. P 424-429.

11. Schwartz L.H., Gandras E.J., Colangelo S.M. et al. Prevalence and importance of small hepatic lesions found at CT in patients with cancer // Radiology. 1999. Vol. 210. P. 71-74.

12. Konopke R., Kersting S., Bergert H. et al. Contrast-enhanced ultrasonography to detect liver metastases : a prospective trial to compare transcutaneous unenhanced and contrast-enhanced ultrasonography in patients undergoing laparotomy // Int. J. Colorectal Dis. 2007. Vol. 22. P. 201-207.

13. Claudon M., Dietrich C.F., Choi B.I. et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver - update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS // Ultraschall. Med. 2013. Vol. 34. P. 11-29.

14. Lassau N., Bonastre J., Kind M. et al. Validation of dynamic contrast-enhanced ultrasound in predicting outcomes of antiangiogenic therapy for solid tumors: the French multicenter support for innovative and expensive techniques study // Invest. Radiol. 2014. Vol. 49. P. 794800.

15. Lassau N., Chebil M., Chami L. et al. Dynamic contrast-enhanced ultrasonography (DCE-US): a new tool for the early evaluation of antiangiogenic treatment // Target Oncol. 2010. Vol. 5. P. 53-58.

16. Arita J., Ono Y., Takahashi M. et al. Usefulness ofcontrast-enhanced intraoperative ultrasound in identifying disappearing liver metastases from colorectal carcinoma after chemotherapy // Ann. Surg. Oncol. 2014. Vol. 21. Suppl. 3. P. 390-397.

17. Yoshida K., Hirokawa T., Moriyasu F. et al. Arterial-phase contrast-enhanced ultrasonography for evaluating anti-angiogenesis treatment: a pilot study // World. J. Gastroenterol. 2011. Vol. 17. P. 1045-1450.

18. Larsen L.P. Role of contrast enhanced ultrasonography in the assessment of hepatic metastases: A review // World J. Hepatol. 2010. Vol. 2. № 1. P. 8-15.

19. Cosgrove D., Blomley M. Liver tumors: evaluation with contrast-enhanced ultrasound // Abdom. Imaging. 2004. Vol. 29. P. 446-454.

20. Albrecht T., Hoffmann C.W., Schmitz S.A. et al. Phase-inversion sonographyduring the liver-specific late phase of contrast enhancement: improved detection of liver metastases // Amer. J. Roentgenol. 2001. Vol. 176. P. 1191-1198.

21. Naoyuki U., Haruki N., Naoko S. et al. Contrast-enhanced ultrasonography in evaluation of the therapeutic effect of chemotherapy for patients with liver metastases // Yonago Acta Medica. 2016. Vol. 59. P 255-261.

22. Lassau N., Koscielny S., Chami L. et al. Advanced hepatocellular carcinoma: early evaluation of response to bevacizumab therapy at dynamic contrast-enhanced US with quantification - preliminary results // Radiology. 2011. Vol. 258. P. 291-300.

23. Moschouris H., Malagari K., Marinis A. et al. Hepatocellular carcinoma treated with transarterial chemo embolization: Evaluation with parametric contrast-enhanced ultrasonography // World J. Radiol. 2012. Vol. 4. P. 379-386.

24. Schirin-Sokhan R., Winograd R., Roderburg C. et al. Response evaluation of chemotherapy in metastatic colorectal cancer by contrast enhanced ultrasound // World J. Gastroenterol. 2012. Vol. 18. P 541-545.