The effect of resecting the primary tumour on the Doppler Perfusion Index in patients with colorectal cancer

Effects of Platelet-Derived Endothelial Cell Growth Factor and Doppler Perfusion Index in Patients with Colorectal Hepatic Metastases

BACKGROUND

We aimed to find out if there is a correlation between Doppler perfusion index (DPI) and platelet- derived endothelial cell growth factor (PD-ECGF), which is an angiogenic factor with angiopoietic function, in patients with colorectal carcinoma.

METHODS

50 colorectal carcinoma patients (22 cases with liver metastases, 28 cases without liver metastases) and 50 healthy controls were assessed with Doppler ultrasound as a preoperative evaluation. PD-ECGF expression in postoperative specimens of the 50 cases with colorectal carcinoma was assayed by immunohistochemistry and real-time polymerase chain reaction methods.

RESULTS

The mean DPI value was 0.29 ± 0.05 in patients suffering from colon cancer with hepatic metastases and 0.12 ± 0.03 in the healthy control group. The DPI value was significantly higher in patients with liver metastases (p < 0.05). PD-ECGF expression in patients with colorectal liver metastases was significantly higher than that in the group without liver metastases (p < 0.05). A positive correlation was found between DPI value and PD-ECGF expression in patients with liver metastases (p < 0.05).

CONCLUSIONS

DPI and PD-ECGF may be valuable factors when screening hepatic metastases in patients with colorectal cancer and serve as practical measurements in postoperative follow-up.

Relationship between CT volumetric measurements and Doppler perfusion indices in gastrointestinal liver metastasis

PURPOSE

This study investigated how the volume of hepatic metastatic lesions can affect liver haemodynamics and whether these perfusion parameters may help to differentiate benign and malignant liver lesions.

MATERIALS AND METHODS

The Doppler perfusion index (DPI the ratio of arterial to total liver blood flow) was measured in 46 patients aged 29-83 years, exhibiting up to four focal hyperechoic liver lesions at ultrasound examination. They comprised histopathologically proven liver metastasis of colorectal (19 cases) and gastric (10 cases) adenocarcinoma without local recurrence at the site of the previously resected primary tumour, along with 17 subjects with haemangioma. All patients underwent volumetric assessment using multislice computed tomography to calculate total volume of hepatic lesions.

RESULTS

The mean DPI of patients with colorectal (36 ± 2 %) and gastric (39 ± 6 %) metastasis was significantly higher than those with haemangioma (14 ± 2 %) (both p < 0.001), whereas metastatic groups did not exhibit any difference in terms of mean DPI. Statistically significant correlations were found between DPI values and calculated total volume of lesions in patients with colorectal and gastric metastasis (r = 0.55, p = 0.01 and r = 0.85, p = 0.002, respectively) while this correlation was not demonstrated in the haemangioma group. Simple linear regression analysis revealed that every 1 cm(3) increment in total volume of metastatic lesions increased DPI by 0.2 % [95 % confidence interval (CI) 0.1-0.3, p = 0.001].

CONCLUSION

Doppler perfusion index alterations are directly correlated with total volume of metastatic deposits, and DPI measurement can be a valuable method to distinguish haemangioma from hyperechoic colorectal and gastric metastatic lesions.

Interrelationship between liver hemodynamics and tumor metabolism in liver metastases: diagnostic value of Doppler perfusion index revisited

It should be expected that the hepatic blood flow increase in the cases with liver metastasis. We aimed to find out if there is a correlation between Doppler parameters and hepatic metabolic activity in oncology patients. 35 patients with hepatic metastases who were identified by 18F-fluorodeoxyglucose positron emission tomography scan and assessed with Doppler ultrasound were included in this prospective study. Patients with hepatic disease, cardiac dysfunction, dehydration, history of alcoholism, intake of antihypertensive or vasoactive medication were excluded. Volume flow of the proper hepatic artery and the portal vein were measured in the hepatoduodenal ligament by Doppler sonography. Doppler perfusion index (the ratio of the hepatic artery flow to the total liver blood flow) and flow volumes of 31 age matched subjects were compared. Both flow of the proper hepatic artery and portal vein were found to be significantly higher in patients with liver metastasis. The mean Doppler perfusion index value was 0.2 ± 0.13 in hepatic metastases whereas 0.13 ± 0.05 in control group. Doppler perfusion index was significantly higher in liver metastases (p=0.008). A positive correlation was found between the maximum standardized uptake value of the liver and flow volume of the proper hepatic artery (r=0.774, p=0). Blood flow of the proper hepatic artery and Doppler perfusion index correlates with hepatic standardized uptake value. Flow measurements of the liver may become an important parameter for selecting patients for further positron emission tomography scan and following-up the response after systemic and local therapeutic procedures.

The role of Doppler Perfusion Index as screening test in the characterization of focal liver lesions

PURPOSE

Doppler Perfusion Index (DPI) has been used in the detection of overt liver metastatic disease. In the present prospective study we evaluated the use of DPI in the differential diagnosis of liver tumours.

MATERIALS AND METHODS

We have included in our study 76 patients with focal hepatic lesion and 39 subjects as control group. All patients were evaluated by Color Doppler Ultrasound, and/or Spiral Computerised Tomography, Magnetic Resonance Imaging and biopsy. The radiologist performed DPI measurements was blind from the final diagnosis of the other methods.

RESULTS

DPI measurements in the control group ranged from 0.07 to 0.22 (mean value 0.14), in 42 cases with benign lesions (group A) ranged from 0.05 to 0.53 (mean 0.15) and in 34 cases with malignant lesions (group B) ranged from 0.39 to 0.75 (mean 0.53). There was a statistically significant difference in DPI measurements between the control group and group B.

CONCLUSIONS

Our results suggest that the DPI may differentiate malignant from benign focal hepatic lesions and therefore can be used as a screening test in the routine clinical practice.

Doppler perfusion index fails to predict the presence of occult hepatic colorectal metastases

AIMS

To assess the predictive value of the Doppler perfusion index (DPI) in a cohort of patients with colorectal cancer with and without initial metastatic disease and present the data of at least 4 years follow-up.

METHODS

We studied 133 patients admitted with stage I-IV colorectal cancer. In all patients hepatic flow measurements were performed in the week before surgery. All patients who underwent curative surgery on intention were followed up for at least 4 years.

RESULTS

Reliable DPI measurements were not possible in 29 patients. Three groups were defined for comparison: (A) 57 patients who remained disease free, (B) 11 patients who presented with metachronous liver metastases during follow-up and (C) 19 patients with liver metastases at initial presentation. No significant difference was found for DPI data between the three groups. There was a trend for a higher hepatic artery flow in patients with initial liver metastases compared to those who remained disease free (p=0.07). The previously reported cut-off point for maximal normal DPI (0.3) did not have any predictive value in this patient cohort.

CONCLUSION

The present data do not confirm the usefulness of DPI measurements in daily clinical practice for the early identification of patients with colorectal cancer at high risk for recurrent disease.