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Ultraschall Med 2008; 29: 203-209
DOI: 10.1055/s-2008-1027795
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© Georg Thieme Verlag KG Stuttgart · New York

Contrast-Enhanced Ultrasonography in Patients with Colorectal Liver Metastases after Chemotherapy

Kontrastverstärkte Ultraschalldiagnostik bei Patienten mit kolorektalen Lebermetastasen nach ChemotherapieR. Konopke1 , A. Bunk1 , S. Kersting1
  • 1Department of Visceral, Thoracic, and Vascular Surgery, University of Dresden, Germany, Director: Prof. Dr. med. H. D. Saeger
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Publication History

Publication Date:
02 October 2008 (online)

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Zusammenfassung

Ziel: Eine systematische Single-Center-Analyse zur Beurteilung der Wirksamkeit von kontrastverstärkter Ultraschalldiagnostik (CEUS) für die Erkennung von kolorektalen Lebermetastasen bei Patienten mit systemischer Chemotherapie. Material und Methoden: Zwischen Mai 2005 und Dezember 2007 wurden 48 Patienten zur weiteren Beurteilung nach chemotherapeutischer Behandlung von kolorektalen Lebermetastasen an unsere Institution überwiesen. In jedem Fall wurde die Leber sowohl ohne als auch mit SonoVue®-kontrastverstärkter Ultraschalldiagnostik untersucht, um Lebermetastasen zu detektieren. Die Ergebnisse der sonografischen Untersuchungen wurden gesammelt und mit intraoperativen Ergebnissen einschließlich histopathologischen Ergebnissen als Referenz verglichen. Ergebnisse: Ingesamt 40 Patienten wurden laparotomiert und in die Analyse einbezogen. Die Detektionsrate erhöhte sich von 24 Patienten (60 %) mit 35 Metastasen (57,4 %) auf 31 Patienten (77,5 %) mit 50 Metastasen (82 %) nach Verabreichung von SonoVue®. Folglich zeigte CEUS eine stark verbesserte Sensitivität im Vergleich zu nicht verstärkter Ultraschalldiagnostik in patientspezifischer Analyse (79,5 % im Vergleich zu 63,2 %, p = 0,041) und läsionspezifischer Analyse (82 % im Vergleich zu 60,3 % p = 0,0008). Aufgrund der Ultraschallergebnisse musste in 16 untersuchten Fällen (40 %) mit unverstärkter Ultraschalldiagnostik im Vergleich zu nur neun untersuchten Fällen (22,5 %) mit CEUS (p = 0,002) die chirurgische Strategie geändert werden. Mit CEUS wurde eine höhere Läsionenzahl mit erhöhter Metastasengröße identifiziert. Schlussfolgerung: Nach chemotherapeutischer Vorbehandlung sollte zur Detektion kolorektaler Lebermetastasen der unverstärkte Ultraschall durch CEUS ersetzt werden.

Abstract

Purpose: A systematic single-center analysis was performed to evaluate the efficacy of contrast-enhanced ultrasonography (CEUS) in the detection of colorectal liver metastases in patients with systemic chemotherapy in their medical history. Materials and Methods: Between May 2005 and December 2007, 48 patients were referred to our institution for further evaluation after chemotherapeutic pretreatment for colorectal liver metastases. In all cases, the liver was screened by both unenhanced and contrast-enhanced ultrasonography with SonoVue® to detect focal liver lesions. The results of sonographic explorations were prospectively collected and compared with intraoperative findings including histopathological results as reference. Results: A total of 40 patients underwent laparotomy and were included in the analysis. The rate of correct ultrasound findings (rate of detection) increased from 24 patients (60 %) with 35 metastases (57.4 %) to 31 patients (77.5 %) with 50 metastases (82.0 %) after administration of SonoVue®. Thus CEUS showed a significantly improved sensitivity compared to unenhanced US in both patient-by-patient analysis (79.5 versus 63.2 %, p = 0.041) and lesion-by-lesion analysis (82.0 vs. 60.3 %, p = 0.0008). On the basis of the ultrasound results, the surgical strategy had to be changed in 16 (40.0 %) cases examined by unenhanced US compared to only nine cases (22.5 %) examined by CEUS (p = 0.002). In CEUS a higher number of lesions were identified with an increasing metastasis size. Conclusion: After chemotherapeutic pretreatment, unenhanced US should be replaced by CEUS for the detection of liver metastases from colorectal carcinoma.

Key words

contrast enhanced ultrasonography - colorectal liver metastases - chemotherapy - surgery

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Stephan Kersting, M.D

Department of Visceral, Thoracic, and Vascular Surgery, University of Technology, Dresden

Fetscherstr. 74

01307 Dresden, Germany

Phone: ++ 49/3 51/45 81 82 73

Fax: ++ 49/3 51/4 49 21 03 01

Email: stephan.kersting@uniklinikum-dresden.de

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