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.
Highlights
Liver metastasis is a common consequence of many carcinomas.The detection of hepatic metastases is necessary for exact staging and planning of the treatment.The recent technological improvements have enabled quantitative imaging of hepatic parenchymal and tumoral blood flow.The demonstration of the altered hepatic hemodynamics during the tumoral angiogenesis within the liver metastases may subsequently indicate the presence of metastases even in the absence of manifest tumours.The functional changes are generally detectable before any structural abnormality is apparent, as it is the degree of physiological change rather than its size that determines whether an abnormality is detected (Fuentes et al, 2002)
The aim of this study is to investigate hepatic perfusion changes of the patients with liver metastasis by means of DPI measurements and find out any correlation between liver hemodynamics and tumour metabolism measured by FDG-PET/CT scan and to research any complementary diagnostic or predictive role in the clinical management
In patients with liver metastase(s) mean DPI value was 0.2 ± 0.13; in control group mean DPI value was 0.13 ± 0.05; and DPI was significantly higher in liver metastases group (p=0.008)
Summary
Liver metastasis is a common consequence of many carcinomas.The detection of hepatic metastases is necessary for exact staging and planning of the treatment.The recent technological improvements have enabled quantitative imaging of hepatic parenchymal and tumoral blood flow.The demonstration of the altered hepatic hemodynamics during the tumoral angiogenesis within the liver metastases may subsequently indicate the presence of metastases even in the absence of manifest tumours.The functional changes are generally detectable before any structural abnormality is apparent, as it is the degree of physiological change rather than its size that determines whether an abnormality is detected (Fuentes et al, 2002). Liver metastasis is a common consequence of many carcinomas. The detection of hepatic metastases is necessary for exact staging and planning of the treatment. The recent technological improvements have enabled quantitative imaging of hepatic parenchymal and tumoral blood flow. The demonstration of the altered hepatic hemodynamics during the tumoral angiogenesis within the liver metastases may subsequently indicate the presence of metastases even in the absence of manifest tumours. Quantitative perfusion measures may be used for the characterization of hepatic tumours and their biologic aggressiveness and monitoring the therapeutic response. Increase in tumoral vascularity and glucose metabolism are prominently important factors in the growth and detection of many tumours (Miles and Williams, 2008; Haider et al, 2010). For correct staging and treatment optimization, the resolving capacity of imaging modalities needs to be improved. The use of these imaging tools are not common because of their high cost, lower availability and, the necessity of ionising radiation or nephrotoxic contrast agent requirements
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