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

Zusammenfassung

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

Abstract

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

Key words

abdomen - ultrasound - CT - MR-imaging - CEUS

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