Leen E, Goldberg J A, Robertson J, Angerson W J, Sutherland G R, Cooke T G, McArdle C S
University Department of Surgery, Royal Infirmary, Glasgow, UK.
Br J Surg. 1993 Oct;80(10):1249-51. doi: 10.1002/bjs.1800801009.
Previous studies have shown that overt intrahepatic tumours are associated with subtle changes in liver perfusion that can be measured directly using duplex colour Doppler sonography (DCDS). This study assessed the predictive value of DCDS in the early detection of occult colorectal hepatic metastases. Hepatic arterial and portal venous blood flow was measured in 50 control subjects and 135 patients with colorectal cancer, 67 with overt liver metastases and 68 with an apparently disease-free liver on the basis of computed tomography and laparotomy findings. The Doppler perfusion index (DPI), defined as the ratio of hepatic arterial to total liver blood flow, was calculated. Clear separation of the DPI values of controls and those of patients with overt metastases was observed (P < 0.0001). Thirty-eight of the 68 patients with a disease-free liver also had an abnormally high DPI value. After 1 year of follow-up, 21 patients with an abnormally high DPI at the time of apparently curative primary resection had developed liver metastases and a further four had died without post-mortem examination. The 30 patients with normal DPI remain disease-free. The data suggest that DPI is of value in the early detection of occult liver metastases.
以往研究表明，肝内明显肿瘤与肝脏灌注的细微变化相关，这种变化可通过双功彩色多普勒超声检查（DCDS）直接测量。本研究评估了DCDS在隐匿性结直肠癌肝转移早期检测中的预测价值。基于计算机断层扫描和剖腹手术结果，对50名对照者和135名结直肠癌患者进行了肝动脉和门静脉血流测量，其中67例有明显肝转移，68例肝脏表面无疾病。计算了多普勒灌注指数（DPI），即肝动脉血流与全肝血流之比。观察到对照者与有明显转移患者的DPI值有明显差异（P<0.0001）。68例肝脏表面无疾病的患者中，38例DPI值也异常升高。经过1年的随访，在看似根治性原发切除时DPI值异常升高的21例患者发生了肝转移，另有4例未进行尸检即死亡。30例DPI值正常的患者仍无疾病。数据表明，DPI在隐匿性肝转移的早期检测中有价值。
