1
|
DOĞAN K, ARIBAŞ BK. KOLOREKTAL KANSER HEPATİK METASTAZLARININ SAPTANMASINDA DOPPLER PERFÜZYON İNDEKSİ. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.824106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
2
|
Jiang X, Zhang Z, Zhao N, He X, Guo H. Effects of Platelet-Derived Endothelial Cell Growth Factor and Doppler Perfusion Index in Patients with Colorectal Hepatic Metastases. Visc Med 2016; 32:206-10. [PMID: 27493949 DOI: 10.1159/000438916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Xueming Jiang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China, Tianjin, China
| | - Zhixiang Zhang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China, Tianjin, China
| | - Na Zhao
- Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xianghui He
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China, Tianjin, China; Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Hao Guo
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China, Tianjin, China; Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
3
|
Whole-liver diffusion-weighted MRI histogram analysis: effect of the presence of colorectal hepatic metastases on the remaining liver parenchyma. Eur J Gastroenterol Hepatol 2015; 27:399-404. [PMID: 25874512 DOI: 10.1097/meg.0000000000000316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To explore whether whole-liver diffusion-weighted MRI analysis (of the apparently normal liver parenchyma) can help differentiate between patients with colorectal liver metastasis and controls without liver disease. MATERIALS AND METHODS Ten patients with colorectal liver metastasis and 10 controls with no focal/diffuse liver disease underwent liver MRI at 1.5 T including diffusion-weighted imaging (DWI; b-values 0, 50, 100, 500, 750, 1000). Apparent diffusion coefficient (ADC) maps were calculated from the DWI images to carry out quantitative diffusion analyses. An experienced reader performed segmentation of the apparently nondiseased liver (excluding metastases/focal liver lesions) on the ADC maps. Histogram ADC parameters were calculated and compared between the patients and the controls. RESULTS The mean liver ADC was 0.95×10⁻³ mm²/s for the patients versus 1.03×10⁻³ mm²/s for the controls (P=0.42). The fifth percentile of the ADC was significantly lower for the patients compared with the controls (0.45 vs. 0.69 10⁻³ mm²/s, P=0.01). The SD was significantly higher in the patient group (0.30 vs. 0.22, P<0.001). Median, skewness, kurtosis, and 30th-95th percentile were not significantly different between the two groups. Areas under the receiver operator characteristics curves to differentiate patients with metastatic liver involvement from healthy controls without liver disease were 0.79 for the fifth percentile and 0.95 for the SD. CONCLUSION Whole-liver diffusion-weighted MRI histogram analysis showed a significant shift towards lower fifth percentile ADC values and higher SD in patients with colorectal liver metastasis compared with controls without liver disease.
Collapse
|
4
|
Kopljar M, Patrlj L, Korolija-Marinic D, Horzic M, Cupurdija K, Bakota B. High Expression of DARPP-32 in Colorectal Cancer Is Associated With Liver Metastases and Predicts Survival for Dukes A and B Patients: Results of a Pilot Study. Int Surg 2015; 100:213-20. [PMID: 25692420 PMCID: PMC4337432 DOI: 10.9738/intsurg-d-14-00022.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to investigate prognostic significance of Dopamine and cAMP-Regulated neuronal Phosphoprotein 32 (DARPP-32) expression in primary colorectal cancer. The study material consisted of clinical and histopathological data of 100 patients operated for colorectal cancer between 1994 and 1997. For immunohistochemical analysis, specific rabbit antibodies for DARPP-32 were used and the percentage of stained tumor cells was calculated under gross magnification (400 times) on a sample of 500 tumor cells. DARPP-32 expression in the primary tumor was significantly greater in patients with distant metastases compared to patients with no distant metastases (p=0.002). In multivariate regression analysis, DARPP-32 expression in the primary tumor was a significant predictor of distant metastases. With a cut-off point of 76.5%, DARPP-32 expression in the primary tumor significantly influenced both overall and disease free survival, especially for Dukes A and B patients (p=0.037). The results of this study indicate that DARPP-32 may be a potential marker of worse prognosis and a valuable tool for managing further adjuvant treatment in patients with stages Dukes A and B colorectal cancer.
Collapse
Affiliation(s)
- Mario Kopljar
- Department of Surgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Leonardo Patrlj
- Department of Surgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - Matija Horzic
- Department of Surgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - Bore Bakota
- Department of Surgery, General Hospital Karlovac, Karlovac, Croatia
| |
Collapse
|
5
|
Rao SX, Lambregts DM, Schnerr RS, van Ommen W, van Nijnatten TJ, Martens MH, Heijnen LA, Backes WH, Verhoef C, Zeng MS, Beets GL, Beets-Tan RG. Whole-liver CT texture analysis in colorectal cancer: Does the presence of liver metastases affect the texture of the remaining liver? United European Gastroenterol J 2014; 2:530-8. [PMID: 25452849 DOI: 10.1177/2050640614552463] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/25/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Liver metastases limit survival in colorectal cancer. Earlier detection of (occult) metastatic disease may benefit treatment and survival. OBJECTIVE The objective of this article is to evaluate the potential of whole-liver CT texture analysis of apparently disease-free liver parenchyma for discriminating between colorectal cancer (CRC) patients with and without hepatic metastases. METHODS The primary staging CT examinations of 29 CRC patients were retrospectively analysed. Patients were divided into three groups: patients without liver metastases (n = 15), with synchronous liver metastases (n = 10) and metachronous liver metastases within 18 months following primary staging (n = 4). Whole-liver texture analysis was performed by delineation of the apparently non-diseased liver parenchyma (excluding metastases or other focal liver lesions) on portal phase images. Mean grey-level intensity (M), entropy (E) and uniformity (U) were derived with no filtration and different filter widths (0.5 = fine, 1.5 = medium, 2.5 = coarse). RESULTS Mean E1.5 and E2.5 for the whole liver in patients with synchronous metastases were significantly higher compared with the non-metastatic patients (p = 0.02 and p = 0.01). Mean U1.5 and U2.5 were significantly lower in the synchronous metastases group compared with the non-metastatic group (p = 0.04 and p = 0.02). Texture parameters for the metachronous metastases group were not significantly different from the non-metastatic group or synchronous metastases group (p > 0.05), although - similar to the synchronous metastases group - there was a subtle trend towards increased E1.5, E2.5 and decreased U1.5, U2.5 values. Areas under the ROC curve for the diagnosis of synchronous metastatic disease based on the texture parameters E1.5,2.5 and U1.5,2.5 ranged between 0.73 and 0.78. CONCLUSION Texture analysis of the apparently non-diseased liver holds promise to differentiate between CRC patients with and without metastatic liver disease. Further research is required to determine whether these findings may be used to benefit the prediction of metachronous liver disease.
Collapse
Affiliation(s)
- Sheng-Xiang Rao
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Radiology, Zhongshan Hospital, Fudan University, China
| | - Doenja Mj Lambregts
- Department of Radiology, Maastricht University Medical Center, The Netherlands
| | - Roald S Schnerr
- Department of Radiology, Maastricht University Medical Center, The Netherlands
| | - Wenzel van Ommen
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Radiology, Catharina Hospital Eindhoven, The Netherlands
| | | | - Milou H Martens
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Surgery, Maastricht University Medical Center, The Netherlands
| | - Luc A Heijnen
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; Department of Surgery, Maastricht University Medical Center, The Netherlands
| | - Walter H Backes
- Department of Radiology, Maastricht University Medical Center, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, The Netherlands
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, China
| | - Geerard L Beets
- Department of Surgery, Maastricht University Medical Center, The Netherlands ; GROW School for Oncology and Developmental Biology, The Netherlands
| | - Regina Gh Beets-Tan
- Department of Radiology, Maastricht University Medical Center, The Netherlands ; GROW School for Oncology and Developmental Biology, The Netherlands
| |
Collapse
|
6
|
Kopljar M, Patrlj L, Bušić Z, Kolovrat M, Rakić M, Kliček R, Zidak M, Stipančić I. Potential use of Doppler perfusion index in detection of occult liver metastases from colorectal cancer. Hepatobiliary Surg Nutr 2014; 3:259-67. [PMID: 25392837 PMCID: PMC4207836 DOI: 10.3978/j.issn.2304-3881.2014.09.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 08/31/2014] [Indexed: 02/05/2023]
Abstract
Many clinical and preclinical studies demonstrated that measurements of liver hemodynamic [Doppler perfusion index (DPI)] may be used to accurately diagnose and predict liver metastases from primary colorectal cancer in a research setting. However, Doppler measurements have some serious limitations when applied to general population. Ultrasound is very operator-dependent, and requires skilled examiners. Also, many conditions may limit the use of Doppler ultrasound and ultrasound in general, such as the presence of air in digestive tract, cardiac arrhythmias, vascular anomalies, obesity and other conditions. Therefore, in spite of the results from clinical studies, its value may be limited in everyday practice. On the contrary, scientific research of the DPI in detection of liver metastases is of great importance, since current research speaks strongly for the presence of systemic vasoactive substance responsible for observed hemodynamic changes. Identification of such a systemic vasoactive substance may lead to the development of a simple and reproducible laboratory test that may reliably identify the presence of occult liver metastases and therefore increase the success of adjuvant chemotherapy through better selection of patients. Further research in this subject is therefore of great importance.
Collapse
Affiliation(s)
- Mario Kopljar
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Leonardo Patrlj
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Zeljko Bušić
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marijan Kolovrat
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Mislav Rakić
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Robert Kliček
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Marcel Zidak
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Igor Stipančić
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| |
Collapse
|
7
|
Alicioglu B, Sarikaya A, Bulakbasi N. Interrelationship between liver hemodynamics and tumor metabolism in liver metastases: diagnostic value of Doppler perfusion index revisited. Prague Med Rep 2013; 114:103-12. [PMID: 23777801 DOI: 10.14712/23362936.2014.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- B Alicioglu
- Department of Radiology, Trakya University Medical Faculty, Edirne, Turkey.
| | | | | |
Collapse
|
8
|
Kyriakopoulou K, Antoniou A, Fezoulidis IV, Kelekis NL, Dalekos GN, Vlychou M. The role of Doppler Perfusion Index as screening test in the characterization of focal liver lesions. Dig Liver Dis 2008; 40:755-60. [PMID: 18294941 DOI: 10.1016/j.dld.2007.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 12/20/2007] [Indexed: 12/11/2022]
Abstract
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.
Collapse
|
9
|
|
10
|
Li Destri G, Lanteri R, Santangelo M, Torrisi B, Di Cataldo A, Puleo S. Can biliary carcinoembryonic antigen identify colorectal cancer patients with occult hepatic metastases? World J Surg 2006; 30:1494-9. [PMID: 16847713 DOI: 10.1007/s00268-005-0698-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Twenty-five percent of radically treated colorectal cancer patients already have occult hepatic metastases (OHM) that will later be observed during postoperative follow-up. Instrumental examinations, i.e., intraoperative ultrasound or Doppler perfusion index, have not improved diagnosis. As carcinoembyonic antigen (CEA) levels are useful to reveal hepatic metastases from colorectal cancer, determination of CEA in the bile rather than the blood may allow preclinical diagnosis of OHM thanks to the reduced volume of bile. METHODS One hundred radically treated colorectal cancer patients were enrolled in the study. Bile was withdrawn from the gallbladder intraoperatively and biliary CEA levels determined using an immuno-enzymatic method (normal value 0-5 ng/ml). Eighty-nine fully evaluable patients were followed up for three years postoperatively to monitor hepatic metastases. Preoperative blood CEA, lymph node metastases and biliary CEA were compared in order to assess which procedure was more efficient in identifying patients who would develop hepatic metastases. RESULTS Eleven of the 89 evaluable patients developed hepatic metastases: 9/11 presented elevated biliary CEA levels (mean: 12.73; range: 5.1-26.2); 8/11 had high preoperative blood CEA values; and 9/11 were at anatomopathological stage N+. In the 78 patients who did not develop hepatic metastases, biliary CEA was within normal limits in 73/78, preoperative blood CEA was normal in 60/78, and 58/78 patients were at anatomopathological stage N-. Hence, the sensitivity of biliary CEA was 81.8%, specificity was 93.6%, and diagnostic accuracy was 92.1%. CONCLUSIONS Determination of biliary CEA seems to be more efficient in identifying patients presenting OHM who require frequent clinical examinations or adjuvant cancer treatment.
Collapse
Affiliation(s)
- Giovanni Li Destri
- Department of Surgical Sciences, Organ Transplantations and Advanced Technologies University of Catania, Via Santa Sofia 36, 95123, Catania, Italy.
| | | | | | | | | | | |
Collapse
|
11
|
Oktar SO, Yücel C, Demirogullari T, Uner A, Benekli M, Erbas G, Ozdemir H. Doppler sonographic evaluation of hemodynamic changes in colorectal liver metastases relative to liver size. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:575-82. [PMID: 16632780 DOI: 10.7863/jum.2006.25.5.575] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE The mechanisms of hemodynamic alterations in colorectal liver metastases are not clearly understood yet. Considering that an increase in liver size in patients with metastases could also result in an alteration in total liver flow, we aimed to analyze hemodynamic changes relative to the liver volume and to search for the possibility of any intrinsic factors affecting blood flow in patients with metastases. METHODS Twenty-eight patients with colorectal liver metastases and 20 control subjects with no liver disease were evaluated sonographically. All patients were examined prospectively by Doppler sonography and helical computed tomography. Hepatic hemodynamic parameters, including blood flow in the hepatic artery and portal vein, total blood flow to the liver, and Doppler perfusion index, were calculated, and values relative to liver volume were obtained. Hepatic perfusion changes in liver metastases were then compared with those in a control group. RESULTS The liver volume of the patients with liver metastases was greater than that of the control group (P=.003). Hepatic arterial blood flow rates were higher, whereas portal flow rates were lower, in patients with liver metastases compared with control subjects (P<.05). Total liver blood flow was not significantly different between the two groups. However, total blood flow relative to liver volume was significantly lower in the metastatic group (P<.001). Doppler perfusion index values in the patients with metastasis were significantly higher than in the control group (P=.000). CONCLUSIONS Our findings may support the hypothesis that a humoral mediator-induced portal venous flow reduction causes perfusion changes in liver metastases from colorectal disease. However, an additional intrinsic hepatic hemodynamic event should also be present. Doppler perfusion index measurements can provide additional information in the evaluation of patients with colorectal liver metastases.
Collapse
Affiliation(s)
- Suna Ozhan Oktar
- Department of Radiology, Gazi University, School of Medicine, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|