Keywords:
Liver, Ultrasound, Contrast agent-other, Metastases
Authors:
O. Catalano1, A. Nunziata2, E. de Lutio di Castelguidone1, G. Nasti1, F. Tatangelo1, A. Petrillo1; 1Naples/IT, 2Ercolano/IT
DOI:
10.1594/ecr2013/C-1606
Methods and Materials
Patient Population
From January 2007 to October 2010 39 patients with liver-limited metastases (synchronous or metachronous to a colorectal cancer,
M1a stage) were enrolled as part of a phase II study.
These subjects underwent neoadjuvant therapy with the anti-VEGF agent bevacizumab and with the Folfiri protocol (folinic acid,
fluorouracil,
and irinotecan).
The primary purpose of the study was to determine the percentage of progression-free patients at 12 months from neoadjuvant therapy and surgery.
As an under project of the phase II study,
we meant to assess the feasibility,
accuracy,
and imaging findings of CEUS in comparison with multidetector CT (and PET,
as well) and with the pathological standard reference.
All liver lesions were resectable,
i.e.
there were at least two uninvolved,
adjacent liver segments with adequate vascular inflow and outflow.
In after ChT the end,
35/39 patients underwent surgery.
Imaging technique
All subjects were imaged before and during chemotherapy,
as well as after liver resection (35 cases).
The timing of patient treatment and imaging is shown in Fig. 1.
Low-mechanical index CEUS (Technos MPX and MyLab 70 XVG scanner – Esaote) was carried out injecting 2.4 ml/lobe of the microbubble contrast medium SonoVue (Bracco).
A two-phase or three-phase acquisition with a 16-row MDCT scanner (Brilliance 16 – Philips) was performed.
Images analysis
We evaluated: lesion diameter (according to RECIST),
intralesional enhancement (homogeneous vs.
heterogeneous),
lesion-to-liver interface (sharp vs.Illdefined) and the enhancing rim (persistent vs.
vanished).
All resected lesions were evaluated pathologically for the presence and extent of ChT-induced necrosis.