Gastroenterology Unit II, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via F Sforza 35, 20122 Milano, Italy.
Dig Liver Dis. 2010 Sep;42(9):635-41. doi: 10.1016/j.dld.2010.01.009. Epub 2010 Feb 20.
At presentation, gastroenteropancreatic neuroendocrine tumours (GEP NETs) frequently show prognostically negative hepatic involvement. The aim of this study was to characterise hepatic metastases of GEP NETs as revealed by contrast-enhanced ultrasonography (CEUS), which allows the fine definition of the microvascular system, and to correlate these findings to the biological behaviour of the tumour.
Eighteen out of 62 GEP NET patients examined between January 2007 and September 2008 had histologically proven hepatic metastases from primary ileal (#6), gastric (#1) or rectal (#1) carcinoids, pancreatic tumours (#7), or primary duodenal (#2) or occult gastrinomas (#1), and all underwent low mechanical index real-time CEUS with SonoVue injection.
Strong early enhancement in the arterial phase was observed in 15 cases (83%), and a rapid wash-out in the portal venous phase in 14 (78%). In the late venous phase, the lesions were hypoechoic in 12 cases (67%), isoechoic in five (28%), and hyperechoic in one (0.05%). The time of arterial enhancement correlated with the Ki-67 proliferative index (r(s)=0.516; p=0.028).
Most of the neuroendocrine liver metastases showed increased arterial enhancement at CEUS, a behaviour that is similar to that of hepatocellular carcinomas and the opposite of that of other metastases. CEUS can be a useful diagnostic means of characterising such metastases.
在初次就诊时，胃肠胰神经内分泌肿瘤（GEP NET）常表现出预后不良的肝转移。本研究旨在通过对比增强超声（CEUS）来描述 GEP NET 的肝转移，CEUS 可以精细地定义微血管系统，并将这些发现与肿瘤的生物学行为相关联。
2007 年 1 月至 2008 年 9 月期间，对 62 例 GEP NET 患者进行了检查，其中 18 例患者经组织学证实存在肝转移，包括原发性回肠（#6）、胃（#1）或直肠（#1）类癌、胰腺肿瘤（#7）、或原发性十二指肠（#2）或隐匿性胃泌素瘤（#1）。所有患者均接受了低机械指数实时 CEUS 检查，并注射 SonoVue。
在动脉期观察到 15 例（83%）患者有强烈的早期增强，在门静脉期有 14 例（78%）快速洗脱。在静脉晚期，12 例（67%）病变呈低回声，5 例（28%）呈等回声，1 例（0.05%）呈高回声。动脉增强时间与 Ki-67 增殖指数相关（r(s)=0.516；p=0.028）。
大多数神经内分泌肝脏转移在 CEUS 上显示动脉期增强，其行为类似于肝细胞癌，与其他转移相反。CEUS 可以成为一种有用的诊断方法，用于描述此类转移。
