Perfusion CT and US of colorectal cancer liver metastases: a correlative study of two dynamic imaging modalities.

The purpose of this study was to evaluate the correlation between dynamic-contrast-enhanced computed tomography (DCE-CT) and first-pass dynamic-contrast-enhanced ultrasound (DCE-US) of normal appearing liver parenchyma and of colorectal cancer liver metastases. Thirty patients with hepatic metastases from colorectal cancer underwent DCE-CT and DCE-US. To obtain DCE-US reproducibility measurements, double contrast-passages (2 × 2.4 mL SonoVue intravenous) were acquired. From several DCE-US-derived perfusion indices, the slope-value scored best with a reproducibility concordance correlation coefficient ranging from 0.75-0.93 and overall highest correlation to DCE-CT-derived variables (r = 0.52 to 0.73). The DCE-US-based tumor-to-liver perfusion gradient also showed a low test-retest variability and moderately correlated to DCE-CT (concordance correlation coefficient 0.87-0.92; r = 0.57 to 0.59). To conclude, DCE-US-based slope-value and tumor-to-liver perfusion gradient correlate best with DCE-CT perfusion values. However, both techniques cannot be used interchangeably. DCE-US should be restricted for studies in which a considerable change in perfusion is expected and for patients with a relatively high tumor blood flow at baseline.

[1]  H. Kauczor,et al.  Quantification of perfusion of liver tissue and metastases using a multivessel model for replenishment kinetics of ultrasound contrast agents. , 2004, Ultrasound in medicine & biology.

[2]  Linda Chami,et al.  Gastrointestinal stromal tumors treated with imatinib: monitoring response with contrast-enhanced sonography. , 2006, AJR. American journal of roentgenology.

[3]  Jack Valentin,et al.  Radiation and your patient: A guide for medical practitioners , 2001, Annals of the ICRP.

[4]  M. Okada,et al.  [New response evaluation criteria in solid tumours-revised RECIST guideline (version 1.1)]. , 2009, Gan to kagaku ryoho. Cancer & chemotherapy.

[5]  N. Holalkere,et al.  Early antiangiogenic activity of bevacizumab evaluated by computed tomography perfusion scan in patients with advanced hepatocellular carcinoma. , 2008, The oncologist.

[6]  Jun Aoki,et al.  Quantitative perfusion map of malignant liver tumors, created from dynamic computed tomography data. , 2004, Academic radiology.

[7]  Nathalie Lassau,et al.  Validation of a New Method for Quantifying In Vivo Murine Tumor Necrosis by Sonography , 2004, Investigative radiology.

[8]  Science to practice: Will improved assessment of response to antiangiogenic therapies be achieved with contrast-enhanced gray-scale US? , 2006, Radiology.

[9]  T. Maeno,et al.  Advanced dynamic flow imaging with contrast-enhanced ultrasonography for the evaluation of tumor vascularity in liver tumors. , 2005, Clinical imaging.

[10]  M. P. Hayball,et al.  Colour perfusion imaging: a new application of computed tomography , 1991, The Lancet.

[11]  N Weissman,et al.  Ultrasound imaging with SonoVue: low mechanical index real-time imaging. , 2002, Academic radiology.

[12]  L. Torbeck,et al.  Coefficient of accuracy and concordance correlation coefficient: new statistics for methods comparison. , 1998, PDA journal of pharmaceutical science and technology.

[13]  M. Christian,et al.  [New guidelines to evaluate the response to treatment in solid tumors]. , 2000, Bulletin du cancer.

[14]  Robert C Brasch,et al.  Imaging of tumor angiogenesis: current approaches and future prospects. , 2006, Current pharmaceutical design.

[15]  H. Kauczor,et al.  Low Mechanical Index Contrast-Enhanced Ultrasound Better Reflects High Arterial Perfusion of Liver Metastases Than Arterial Phase Computed Tomography , 2004, Investigative radiology.

[16]  P. Vrignaud,et al.  Early Quantitative Evaluation of a Tumor Vasculature Disruptive Agent AVE8062 Using Dynamic Contrast-Enhanced Ultrasonography , 2008, Investigative radiology.

[17]  S Rees,et al.  Measurement of tissue perfusion by dynamic computed tomography. , 1992, The British journal of radiology.

[18]  K. Miles,et al.  Measurement of tissue perfusion by dynamic computed tomography. , 1991, The British journal of radiology.

[19]  K. Miles,et al.  Colorectal cancer: diagnostic potential of CT measurements of hepatic perfusion and implications for contrast enhancement protocols. , 1997, Radiology.

[20]  Nathalie Lassau,et al.  Methodology for quantifying interactions between perfusion evaluated by DCE-US and hypoxia throughout tumor growth. , 2007, Ultrasound in medicine & biology.

[21]  S. Koscielny,et al.  New hemodynamic approach to angiogenesis: color and pulsed Doppler ultrasonography. , 1999, Investigative radiology.

[22]  Icrp.  ICRP Publication 60: 1990 Recommendations of the International Commission on Radiological Protection , 1991 .

[23]  D A Clevert,et al.  Evaluation of quantitative contrast harmonic imaging to assess malignancy of liver tumors: a prospective controlled two-center study. , 2007, World journal of gastroenterology.

[24]  T. Maeno,et al.  Usefulness of contrast-enhanced ultrasonography with dynamic flow imaging to evaluate therapeutic effects for hepatocellular carcinoma. , 2003, Hepato-gastroenterology.

[25]  Y. Tsushima,et al.  Measuring portal venous perfusion with contrast-enhanced CT: comparison of direct and indirect methods. , 2002, Academic radiology.

[26]  Curzio Rüegg,et al.  Biomarkers of angiogenesis for the development of antiangiogenic therapies in oncology: tools or decorations? , 2008, Nature Clinical Practice Oncology.

[27]  S. Koscielny,et al.  Prognostic value of high-frequency sonography and color Doppler sonography for the preoperative assessment of melanomas. , 1999, AJR. American journal of roentgenology.

[28]  J D Pickard,et al.  Reproducibility of quantitative CT perfusion imaging. , 2001, The British journal of radiology.

[29]  Xiaoling Yu,et al.  Time‐Intensity–Based Quantification of Vascularity With Single‐Level Dynamic Contrast‐Enhanced Ultrasonography , 2005, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[30]  Linda Chami,et al.  Dynamic contrast-enhanced ultrasonography (DCE-US) with quantification of tumor perfusion: a new diagnostic tool to evaluate the early effects of antiangiogenic treatment , 2007, European radiology.

[31]  S. Sanada,et al.  Development of perfusion CT software for personal computers. , 2002, Academic radiology.

[32]  R. Sievert,et al.  Book Reviews : Recommendations of the International Commission on Radiological Protection (as amended 1959 and revised 1962). I.C.R.P. Publication 6. 70 pp. PERGAMON PRESS. Oxford, London and New York, 1964. £1 5s. 0d. [TB/54] , 1964 .

[33]  S. Meijer,et al.  Total-liver-volume perfusion CT using 3-D image fusion to improve detection and characterization of liver metastases , 2008, European Radiology.

[34]  P. Opolon,et al.  Evaluation of Contrast-Enhanced Color Doppler Ultrasound for the Quantification of Angiogenesis In Vivo , 2001, Investigative radiology.

[35]  M. Lipton,et al.  Splenic blood flow: evaluation with computed tomography. , 1997, Academic radiology.

[36]  T. de Baère,et al.  Prognostic value of angiogenesis evaluated with high-frequency and color Doppler sonography for preoperative assessment of melanomas. , 2002, AJR. American journal of roentgenology.

[37]  D W McRobbie,et al.  Radiation Exposure in Computed Tomography: Fundamentals, Influencing Parameters, Dose Assessment, Optimisation, Scanner Data, Terminology , 2001 .

[38]  D. Sahani,et al.  Assessing tumor perfusion and treatment response in rectal cancer with multisection CT: initial observations. , 2005, Radiology.

[39]  O. Bouché,et al.  Imaging techniques to evaluate the response to treatment in oncology: current standards and perspectives. , 2009, Critical reviews in oncology/hematology.

[40]  Martijn R. Meijerink,et al.  The use of perfusion CT for the evaluation of therapy combining AZD2171 with gefitinib in cancer patients , 2007, European Radiology.

[41]  J M Bland,et al.  Statistical methods for assessing agreement between two methods of clinical measurement , 1986 .

[42]  J. Blay,et al.  Limb salvage with isolated perfusion for soft tissue sarcoma: could less TNF-alpha be better? , 2005, Annals of oncology : official journal of the European Society for Medical Oncology.

[43]  T. Byrt.  How good is that agreement? , 1996, Epidemiology.

[44]  Chin-Shang Li,et al.  Angiogenesis inhibitors in a murine neuroblastoma model: quantitative assessment of intratumoral blood flow with contrast-enhanced gray-scale US. , 2006, Radiology.

[45]  A K Dixon,et al.  Functional images of hepatic perfusion obtained with dynamic CT. , 1993, Radiology.

[46]  J. Blay,et al.  Limb salvage with isolated perfusion for soft tissue sarcoma: could less TNF-α be better? , 2005 .