Ultrasonographic evaluation of chemotherapeutic response in hepatic metastases

Ultrasonic patterns observed in hepatic metastases from breast carcinoma: diagnosis and evolution

A retrospective analysis was made of 78 patients presenting breast neoplasm with hepatic metastases confirmed by ultrasound. Clinical hepatomegaly was present in 61%. The serum glutamic-oxaloacetic transaminase (SGOT) was elevated in 72%, the serum glutamic-pyruvic transaminase (SGPT) in 56%, the serum alkaline phosphatase (Aph) in 86%, and the gamma-glutamil transpeptidase (GGT) in 76%. A hypoechogenic multiple nodular pattern (HMN) was observed in 69%, a diffuse hypoechogenic pattern (DH) in 15%, and a mixed multiple nodular pattern (MMN) in 11%. No single nodular pattern was presented in any patient. The univariate analysis showed a better survival rate in patients with a mixed pattern (mean 11 months, range 1-29 months) (p = 0.027). No significant differences were observed regarding the remaining patterns, age, presence or not of hepatomegaly, or altered enzymatic values.

Ultrasound, CT, and MRI comparison in primary and secondary tumors of the liver

Thirty-five patients with surgically removed or percutaneous biopsy-proven tumors were examined by ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). This retrospective study describes the appearance of the primary tumors and metastases and compares the sensitivity and specificity of the 3 imaging methods. Ultrasound, CT, and MRI examinations as well as clinical, operative, and/or histologic data were available for all 35 patients. Paramagnetic contrast agent gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) was used in 23 patients and a short TI inversion recovery MRI sequence was used in 23 patients, in addition to various spin echo MRI sequences. Thirteen patients were examined using both Gd-DTPA and the short TI inversion recovery sequence. Our comparative study--based on the following criteria: detection, size, location of the tumor, and portal vein involvement and bile duct dilatation--demonstrated an advantage of MRI over ultrasound in 16 of 35 cases, equal results in 17 of 35 cases and a disadvantage of MRI compared to ultrasound in 2 of 35 cases. With the identical criteria, MRI proved to be more informative than CT in 10 of 35 cases, equal in 21 of 35 cases, and less informative in 4 of 35 cases.

Ultrasonographic studies in hepatic neoplasms: patterns and comparisons with radiological contrast studies

A prospective blind study of 100 patients with hepatic neoplasms was performed using the grey-scale linear-array ultrasonographic technique. Seventy-four patients had hepatocellular carcinoma, eight had cholangiocarcinoma, 17 had metastases and one had haemangiosarcoma. The overall diagnostic accuracy was 96%, comparable to the 98% diagnostic accuracy of other radiological studies which were performed in 70 patients. The sites and extent of the lesions and the state of the portal system were identical in both the ultrasonographic and radiological contrast studies. No false positives were found in 254 patients who had ultrasonography of the liver for non-maligant disorders during the period of study. We conclude that linear-array ultrasonography is a simple, sensitive, specific and non-invasive procedure for the investigation of suspected hepatic neoplasms and is useful in assessing operability.

Prospective serial liver ultrasound scanning in resectable colorectal cancer treated with adjuvant razoxane

Prospective serial ultrasound scanning (U/S) of the liver at 3-monthly intervals has been used to detect the presence of hepatic metastases from successfully resected Dukes' A, B and C grade colorectal carcinomas in a trial of the antimetastatic agent razoxane (ICRF 159). One hundred and twenty-six consecutive patients were randomly allocated to either adjuvant razoxane treatment (61) or to no further treatment (65). Twenty-six patients, 15 in the control group (23 per cent) and 11 in the razoxane treatment group (18 per cent) have developed hepatic metastases. All but three patients in the treated group and four in the controls were detected by U/S. In the control group four patients had definite metastases when metastases were first seen by ultrasound and three more, among the eight who initially had probable metastases, became definite metastases on ultrasound. In the treated group four patients had definite metastases and four more developed them amongst 12 who had probable metastases. The remaining eight of these 12 all regressed completely. This compared with only one complete regression (additionally on 5-FU for lung secondaries) amongst the eight controls who had probable metastases. The median time to development of liver metastases detected by U/S and other means was 59 weeks in the control group and 91 weeks in the razoxane treatment group. Ultrasound has proved to be a safe, sensitive and acceptable serial imaging technique for detecting colorectal liver metastases. Used prospectively, U/S has been valuable in monitoring the natural history of liver metastases and their behaviour during razoxane treatment.

Radiologic staging of gastrointestinal neoplasms

In this article, the ability of computed tomography as well as other imaging methods to detect local and distant metastases in patients with either newly diagnosed or suspected recurrent gastrointestinal tumors is discussed. The role of the radiologic examination in the diagnosis of complications resulting from different types of treatment is also addressed.

Ultrasonography of Hodgkin's disease in the liver and spleen

Ultrasound findings of 39 spleens and 68 livers in which histology was obtained at laparotomy or autopsy within a month of the examination and four livers in which abnormalities were found clinically by other methods during long-term follow-up were reviewed to evaluate the various sonographic appearances and the accuracy in detecting involvement of the spleen and liver. Only one out of 17 positive spleens had definite ultrasonic focal lesions. Not only small splenic Hodgkin's foci but also larger ones were overlooked. Of 10 positive livers, six showed diffuse inhomogeneity throughout the liver, two showed multiple, well-defined, echo-poor lesions but two showed no significant ultrasonic abnormality even in retrospect. No correlation was found between the type of Hodgkin's disease and the ultrasonic appearance of involved livers. Ultrasonic examination, however, could differentiate other liver abnormalities, such as fatty changes, a cyst and a thrombosed haemangioma from infiltration of Hodgkin's disease. In one case, splenic lesions became echogenic following-chemotherapy.

Ultrasonographic evaluation of hepatic metastases in testicular tumour

The hundred and fifty-seven ultrasonographic examinations were carried out in 200 patients with testicular tumour. In 16 cases (8.0%) liver metastases were demonstrated. There were three main patterns: well- or ill-defined echopoor lesions, well-defined echogenic lesions, and "target" lesions. Echopoor liver lesions were found in metastatic seminoma, whilst metastatic teratoma may give any of these three patterns. The value of ultrasound for evaluating the therapeutic response of hepatic metastases from testicular tumour is discussed.

Echographic aspects of hepatic metastases of nephroblastomas

We report a retrospective study of 293 cases of nephroblastoma treated at the Gustave Roussy Institute (I.G.R.) from 1971 to 1980, and 39 similar cases treated at the Curie Institute (I.C), from June 1977 to June 1981. Twenty-two cases of hepatic metastases were found. We were primarily interested in the echographic aspects of the lesions and particularly in their evolution. Despite the fact that the patients came from different centers with varying types of work-up, ten cases were fully documented and are presented in detail. They show the use to which ultrasound may be put.

Current aspects of nuclear imaging in clinical oncology

This presentation will focus on the recent developments in nuclear medicine that relate to diagnosis and staging in the cancer patient. The commercial availability of new Agar cameras as well as longitudinal tomographic scanning devices has improved gallium imaging significantly. This has enhanced tumor detection and resulted in better use of gallium scanning in the cancer patient. Areas of controversy have also developed. In particular, the question of whether or not the gallium scan can be used to avoid mediastinoscopy in some case of bronchogenic carcinoma will be detailed. Techniques in nuclear medicine must be carefully integrated with other noninvasive investigation such as CT and ultrasound. At Yale, the authors have gathered considerable data indicating the best way to interact nuclear medicine radionuclide scintigraphy of the liver with the ultrasound examination. Our approach to this problem for the detection of focal disease in the liver will be discussed. 99mTc-HIDA has been proven useful in a wide variety of biliary disorders. Use of scintigraphy in the evaluation of cholangio-enteric bypass procedures in the cancer patient will be reviewed.

The role of vascularization in the formation of echographic patterns of hepatic metastases: microangiographic and echographic study

An experimental microangiograhic and echographic study was carried out on metastatic autopsy livers which were also examined histologically. Relationships between the echographic pattern and vascularization are explored. In most cases, hypervascular lesions correspond to hyperechogenic patterns, while hypovascular lesions furnish hypoechogenic images.