Department of Gastroenterology and Hepatology, Kantonsspital, St. Gallen, Switzerland.
Center for Medical Oncology & Hematology, Spital STS Thun, Switzerland; Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland.
J Hepatol. 2021 Feb;74(2):419-427. doi: 10.1016/j.jhep.2020.09.036. Epub 2020 Oct 14.
BACKGROUND & AIMS: CT may miss up to 30% of cases of colorectal liver metastases (CRLMs). We assessed the impact of contrast-enhanced ultrasound (CEUS) on the detection of CRLMs and on changes to the therapeutic strategy; additionally, we assessed the accuracy of CEUS in differentiating unclear focal liver lesions (FLLs) compared to staging-CT.
We prospectively analyzed all patients with newly diagnosed and histologically confirmed colorectal cancer (CRC) at our tertiary gastroenterological center between December 2015 and May 2019. CEUS was performed in a total of 296 patients without CRLMs after staging-CT using the contrast agent (SonoVue®). Standard of reference was obtained by MRI or histology to diagnose CRLMs missed by CT. Benign FLLs were confirmed by MRI or follow-up CT (mean follow-up interval: 18 months).
Eight additional CRLMs were detected by CEUS (overall 2.7%; sensitivity 88.9%, specificity 99.0%, positive predictive value 100%, negative predictive value 99.6%). All patients with CRLMs detected only by CEUS were in tumor stage T3/T4 (4.0% additionally detected CRLMs). The number needed to screen to detect 1 additional CRLM by CEUS was 37 in all patients and 24.5 in T3/T4-patients. When results were reviewed by a board-certified radiologist and oncologist, the therapeutic strategy changed in 6 of these 8 patients. Among the 62 patients (20.9%) with unclear FLLs after staging-CT, CEUS determined the dignity (malignant vs. benign) of 98.4% of the FLLs.
Overall, CEUS detected 2.7% additional CRLMs (including 4.0% in tumor stage T3/T4) with a significant impact on the oncological therapeutic strategy for 75% of these patients. Patients with tumor stage T3/T4 would particularly benefit from CEUS. We propose CEUS as the first imaging modality for CT-detected lesions of unknown dignity.
In patients with newly diagnosed colorectal cancer, contrast-enhanced ultrasound (CEUS) detected additional liver metastases after computed tomography (CT). In the majority of these patients, the oncological therapy was changed after obtaining the CEUS results. After staging-CT, 21% of hepatic lesions remained unclear. In these cases, CEUS was accurate to either reveal or exclude liver metastasis in nearly all patients and could reduce costs (e.g., number of MRI scans).
CT 可能会漏诊高达 30%的结直肠癌肝转移（CRLMs）。我们评估了增强超声（CEUS）对检测 CRLMs 和改变治疗策略的影响；此外，我们评估了 CEUS 在区分分期 CT 中不明确的局灶性肝脏病变（FLLs）方面的准确性。
我们前瞻性分析了 2015 年 12 月至 2019 年 5 月在我们的三级胃肠病学中心新诊断和组织学证实的结直肠癌（CRC）的所有患者。对 296 例无 CRLMs 的患者在分期 CT 后使用造影剂（声诺维®）进行了 CEUS。通过 MRI 或组织学获得诊断 CT 遗漏的 CRLMs 的标准参考。通过 MRI 或后续 CT（平均随访间隔：18 个月）证实良性 FLLs。
CEUS 检测到 8 例额外的 CRLMs（总体为 2.7%；敏感性 88.9%，特异性 99.0%，阳性预测值 100%，阴性预测值 99.6%）。所有仅通过 CEUS 检测到 CRLMs 的患者均处于肿瘤分期 T3/T4（另外检测到 4.0%的 CRLMs）。通过 CEUS 检测 1 例额外 CRLM 的筛查人数在所有患者中为 37 例，在 T3/T4 患者中为 24.5 例。当由一名具有董事会认证的放射科医生和肿瘤学家审查结果时，这些患者中有 6 例的治疗策略发生了变化。在 62 例（20.9%）分期 CT 后 FLL 不明确的患者中，CEUS 确定了 98.4%的 FLL 良恶性。
总的来说，CEUS 检测到 2.7%的额外 CRLMs（包括肿瘤分期 T3/T4 中的 4.0%），这对 75%的患者的肿瘤治疗策略产生了重大影响。T3/T4 期患者将特别受益于 CEUS。我们建议将 CEUS 作为 CT 检测到的未知良恶性病变的首选影像学检查方法。
在 CT 检测到的肝脏转移中，CEUS 检测到了另外的肝脏转移。CEUS 可以改变大部分患者的治疗策略。CEUS 可以确定 CT 分期中不明确的局灶性肝脏病变（FLLs）的良恶性，减少 MRI 检查的次数。
在我们的三级胃肠病学中心，对 296 例无 CRLMs 的患者在分期 CT 后使用造影剂（声诺维®）进行了 CEUS。CEUS 确定了 8 例额外的 CRLMs（总体为 2.7%；敏感性 88.9%，特异性 99.0%，阳性预测值 100%，阴性预测值 99.6%）。CEUS 可以确定肿瘤分期 T3/T4 的 CRLMs。在 62 例（20.9%）分期 CT 后 FLL 不明确的患者中，CEUS 确定了 98.4%的 FLL 的良恶性。
CEUS 可以确定 CT 检测到的肝脏转移的良恶性，改变大部分患者的治疗策略。
