THE POSSIBILITIES OF CONTRAST-ENHACED ULTRASOUND (CEUS) IN THE DIAGNOSIS OF COLORECTAL LIVER METASTASES (CRLM)

AIM. To evaluate the capability of CEUS in the detection of CRLM in comparison with conventional grayscale B-mode. MATERIALS AND Mffl'HODS. 18 patents with CRLM underwent CEUS using the contrast agent SonoVue (Bracco, Italy). The patients were divided into two groups: the first group - 10 (55 %) patients before to chemotherapy; the second group - 8 (45 %) patients after chemotherapy and stable disease. 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 hyper enhancement (70 % of the patients from the first group, 75 % of patients from the second group) and is enhancement, such as intact liver parenchyma (25 % of the patients from the second group). There were detected additional metastases in 4 (22,2 %) of patients 18 (100 %) 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 sec. from the injection of the contrast). The earliest beginning of the washout stage was observed in liver metastases in patients from the first group (42,4 sec. 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.

colorectal cancer, liver metastases, contrast-enhanced ultrasound, response prediction to chemotherapy

1. Алиев, В.А. Колоректальный рак с синхронными отдаленными метастазами: обоснование циторедуктивных операций и перспективы - взгляд хирурга / В.А.Алиев, Ю.А.Барсуков, А.В.Николаев и соавт. // Онкологическая колопроктология. - 2012. - № 4. - с. 15-21.

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

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

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

5. Albrecht, T. Detection and characterisation of liver métastases. / T.Albrecht, J.Hohmann, A.ldenburg et al. // Eur.Radiol. - 2004. - № 14 Suppl 8. - р. 25-33.

6. Albrecht, T. Phase-inversion sonographyduring the liver-specific late phase of contrast enhancement: improved detection of liver metastases. / T.Albrecht, C.W.Hoffmann, S.A.Schmitz et al. // AJR Am. J. Roentgenol. - 2001. - № 176. - р. 1191-1198.

7. Arita, J. Usefulness of contrast-enhanced intraoperative ultrasound in identifying disappearing liver metastases from colorectal carcinoma after chemotherapy. / J.Arita, Y.Ono, M.Takahashi et al. // Ann. Surg.Oncol. - 2014. № 21 Suppl. 3. - р. 390-7.

8. Claudon, M. 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. / M.Claudon, C.F.Dietrich, B.I.Choi et al. // Ultraschall Med. - 2013. - № 34. - р. 11-29.

9. Cosgrove, D. Liver tumors: evaluation with contrast-enhanced ultrasound. / D.Cosgrove, M.Blomley // Abdom Imaging. - 2004. - № 29. - р. 446-454.

10. Jones, E.C. The frequency and significance of small (less than or equal to 15 mm) hepatic lesions detected by CT. / E.C.Jones, J.L.Chezmar, R.C.Nelson et al. // AJR Am. J. Roentgenol. - 1992. - № 158. -p. 535-539.

11. Konopke, R. Detection of liver lesions by contrast-enhanced ultrasound - comparison to intraoperative findings. / R.Konopke, S.Kersting, H.D.Saeger et al. // Ultraschall. Med. - 2005. - № 26. - p. 107-113.

12. Konopke, R. Contrast-enhanced ultrasonography to detect liver metastases : a prospective trial to compare transcutaneous unenhanced and contrast-enhanced ultrasonography in patients undergoing laparotomy. / R.Konopke, S.Kersting, H.Bergert et al. // Int.J.Colorectal.Dis. - 2007. - № 22. - p. 201-207.

13. Kreft, B. Incidence and significance of small focal liver lesions in MRI. / B.Kreft, D.Pauleit, R.Bachmann et al. // Rofo. - 2001. - № 173. - p. 424-429.

14. Larsen, L.P. Role of contrast enhanced ultrasonography in the assessment of hepatic metastases: A review. / L.P.Larsen // World J. Hepatol. - 2010 January 27. - № 2 (1). - p. 8-15.

15. Larsen, L.P. The value of contrast enhanced ultrasonography in detection of liver metastases from colorectal cancer: a prospective double-blinded study. / L.P.Larsen, M.Rosenkilde, H.Christensen et al. // Eur. J.Radiol. - 2007. - № 62. - p. 302-307.

16. Lassau, N. 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. / N.Lassau, J.Bonastre, M.Kind et al. // Invest. adiol. - 2014. - № 49. - p. 794-800.

17. Lassau, N. Dynamic contrast-enhanced ultrasonography (DCE-US): a new tool for the early evaluation of antiangiogenic treatment. / N.Lassau, M.Chebil, L.Chami et al. //и Target Oncol. - 2010. - № 5. - p. 53-8.

18. Lassau, N. Advanced hepatocellular carcinoma: early evaluation of response to bevacizumab therapy at dynamic contrast-enhanced US with quantification-preliminary results. / N.Lassau, S.Koscielny, L.Chami et al. // Radiology. - 2011. - № 258. - p. 291-300.

19. Moschouris, H. Hepatocellular carcinoma treated with transarterial chemoembolization: Evaluation with parametric contrast-enhanced ultrasonography. / H.Moschouris, K.Malagari, A.Marinis et al. // World J. Radiol. - 2012. - № 4. - p. 379-86.

20. Naoyuki, U. Contrast-Enhanced Ultrasonography in Evaluation of the Therapeutic Effect of Chemotherapy for Patients with Liver Metastases. / U.Naoyuki, N.Haruki, S.Naoko et al. // Yonago Actamedica. - 2016. - № 59. - p. 255-261.

21. Schirin-Sokhan, R. Response evaluation of chemotherapy in metastatic colorectal cancer by contrast enhanced ultrasound. / R.Schirin-Sokhan, R.Winograd, C.Roderburg et al. // World J. Gastroenterol. - 2012. - № 18. - p. 541-5.

22. Schwartz, L.H. Prevalence and importance of small hepatic lesions found at CT in patients with cancer. / L.H.Schwartz, E.J.Gandras, S.M.Colangelo et al. // Radiology. - 1999. - № 210. - p. 71-74.

23. Wernecke, K. Detection of hepatic masses in patients with carcinoma: comparative sensitivities of sonography, CT, and MR imaging. / K.Wernecke, E.Rummeny, G.Bongartz et al. // AJR Am. J. Roentgenol. - 1991. - № 157. - p. 731-739.

24. Yoshida, K. Arterial-phase contrast-enhanced ultrasonography for evaluating anti-angiogenesis treatment: a pilot study. / K.Yoshida, T.Hirokawa, F.Moriyasu et al. // World J. Gastroenterol. - 2011. -№ 17. - p. 1045-50.