Detection of Hepatic Metastases Using Duplex/Color Doppler Sonography

Leen, Edward; Goldberg, J. A.; Robertson, John; Sutherland, G. R.; Hemingway, David; Cooke, Timothy G.; McArdle, C. S.

doi:10.1097/00000658-199111000-00010

Cited by 53 publications

(33 citation statements)

References 17 publications

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“…In previous studies using DCDS, we have demonstrated the accuracy of this technique in vitro and the reproducibility of HABF measurements in vivo (Leen et al, 1991;Robertson et al, 1992). In the present study, our primary interest was in relative changes in flow rather than absolute values.…”

Section: Discussionmentioning

confidence: 80%

“…The effects of an angiotensin II infusion (given as 15 micrograms in 3 ml of normal saline over 90 s on hepatic arterial blood flow (HABF) were measured using DCDS (Diasonics Spectra, Diansonics Sonotron Ltd, Bedford, UK) in conscious, fasted patients. The technique for measuring HABF, which was calculated as the product of the time average velocity and arterial cross-sectional area, has been described previously (Leen et al, 1991 The cross-sectional area of the artery was measured by mapping the perimeter of the vessel lumen with the 'tracker ball'. As it was not possible to do this simultaneously with blood velocity measurement during the AT-II infusion, a single value for the area was used to calculate flow rates for a given patient.…”

Section: Methodsmentioning

confidence: 99%

“…The effects of an angiotensin II infusion (given as 15 micrograms in 3 ml of normal saline over 90 s on hepatic arterial blood flow (HABF) were measured using DCDS (Diasonics Spectra, Diansonics Sonotron Ltd, Bedford, UK) in conscious, fasted patients. The technique for measuring HABF, which was calculated as the product of the time average velocity and arterial cross-sectional area, has been described previously (Leen et al, 1991). The Diasonics Spectra scanner consists of duplex and colour Doppler facilities and a 3.5 MHz convex linear array probe was used.…”

mentioning

confidence: 99%

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Duplex/colour Doppler sonography: measurement of changes in hepatic arterial haemodynamics following intra-arterial angiotensin II infusion

Leen

Angerson²,

Warren³

et al. 1993

Br J Cancer

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Summary Angiotensin II (AT-IT) has been used to target regionally-administered cytotoxic microspheres in patients with intrahepatic tumours. The optimisation of vasoconstrictor targeting requires a knowledge of the blood flow changes induced by agents such as AT-IT. We therefore assessed duplex/colour Doppler sonography (DCDS) as a means of evaluating the effects of AT-TI infusion on hepatic arterial blood flow (HABF) and arterial resistance in patients with intrahepatic tumours.HABF was measured continuously in nine patients using DCDS before, during and after an infusion of AT-II (15 MethodsNine patients (age range 48-69 years) with colorectal liver metastases were studied. All patients had an indwelling hepatic artery catheter with a subcutaneous injection port (Portacath, Pharmacia, or Infusaid, Shiley Infusaid Inc.) for administration of regional chemotherapy. The effects of an angiotensin II infusion (given as 15 micrograms in 3 ml of normal saline over 90 s on hepatic arterial blood flow (HABF) were measured using DCDS (Diasonics Spectra, Diansonics Sonotron Ltd, Bedford, UK) in conscious, fasted patients. The technique for measuring HABF, which was calculated as the product of the time average velocity and arterial cross-sectional area, has been described previously (Leen et al., 1991). The Diasonics Spectra scanner consists of duplex and colour Doppler facilities and a 3.5 MHz convex linear array probe was used. In the Doppler mode ultrasound waves were emitted and received by a single probe at a frequency of 3 MHz with a repitition frequency of 3.7 MHz.A transverse scan was made at the epigastrium to locate the common hepatic artery in its longitudinal axis. The Doppler cursor was placed over the lumen of the artery segment as near to the origin as possible, at the point where it first became horizontally straight. Spectral analysis was performed using fast Fourier transformation and the Doppler shift signal was displayed on the monitor. The system was equipped with software to compute the time average velocity from the spectral display automatically following placement of the calipers at the start and end of four cardiac cycles. This was done every 30 s while 15 micrograms of AT-II in 3 ml saline was infused through the hepatic arterial catheter over a period of 90 s.The cross-sectional area of the artery was measured by mapping the perimeter of the vessel lumen with the 'tracker ball'. As it was not possible to do this simultaneously with blood velocity measurement during the AT-II infusion, a single value for the area was used to calculate flow rates for a given patient. This was the mean of four individual measurements taken at the same location in the vessel at random phases of the cardiac cycle. In five patients, arterial cross-sectional area was measured every 30 s during a separate AT-II infusion. No systemic change in area was observed during the infusion, and the mean coefficient of variation of the area was only 3.9%, justifying the assumption that it could be regarded as constant.

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Section: Discussionmentioning

confidence: 80%

Section: Methodsmentioning

confidence: 99%

“…The effects of an angiotensin II infusion (given as 15 micrograms in 3 ml of normal saline over 90 s on hepatic arterial blood flow (HABF) were measured using DCDS (Diasonics Spectra, Diansonics Sonotron Ltd, Bedford, UK) in conscious, fasted patients. The technique for measuring HABF, which was calculated as the product of the time average velocity and arterial cross-sectional area, has been described previously (Leen et al, 1991). The Diasonics Spectra scanner consists of duplex and colour Doppler facilities and a 3.5 MHz convex linear array probe was used.…”

mentioning

confidence: 99%

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Duplex/colour Doppler sonography: measurement of changes in hepatic arterial haemodynamics following intra-arterial angiotensin II infusion

Leen

Angerson²,

Warren³

et al. 1993

Br J Cancer

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“…These can be measured by scintigraphy using 99m technetium-labelled colloid,22 or by using duplex colour Doppler ultrasound. 23 Leveson et al,2' using blood flow scintigraphy, and Leen et al,23 using duplex colour Doppler ultrasound in patients with known colorectal liver metastases, have suggested a high sensitivity for these techniques in detecting patients with liver metastases.…”

Section: Hepatic Perfusion Indexmentioning

confidence: 99%

Colorectal liver metastases

Burke¹,

Allen-Mersh²

1996

Postgraduate Medical Journal

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SummaryEach year in the UK, between 12-14 000 people develop liver metastases from colorectal cancer. These metastases will contribute to the death ofthe patient in about 80% of cases. Treatments aimed at these tumours are best administered when the tumour is small. Current investigative methods allow tumours as small as 0.5 mm to be detected, and should be offered to all colorectal cancer patients at risk of developing liver metastases. Surgery remains the only curative treatment for these tumours, but, unfortunately, only 20% of those who have tumour excision will survive five years. In those patients unsuitable for surgery, chemotherapy with fluoropyrimidines produces the best tumour response. This may be administered systemically or regionally, via a catheter placed within the hepatic artery. The latter approach reduces systemic toxicity, but may produce hepatotoxicity. The results of other forms of systemic chemotherapy currently undergoing clinical trials are awaited. The vast majority of patients will benefit from suitable palliative treatment delivered either locally or systemically. With the wide range of treatments now available for liver metastases, these patients are best assessed in a unit with a special interest in the problem. Natural history of colorectal metastasesIt is thought that the predilection for liver metastases in colorectal cancer arises because of the portal venous drainage from the colonic or rectal primary tumour to the liver. Liver metastases develop within the liver during the period of primary tumour growth prior to diagnosis.3 These are frequently undetected (occult) at the time of primary tumour removal, and subsequently grow until they reach a size when approximately 30% of the liver is replaced.4 The diagnosis is usually subsequently made following the development of either adbominal pain or a mass which is investigated. The average survival from diagnosis of colorectal liver metastases in untreated patients is of the order of seven months,5 but there is considerable variation depending on the growth rate of the tumour -some patients survive for three to five years from diagnosis of liver metastases.6 Factors which correlate with survival after liver metastasis diagnosis in untreated patients are physical symptom score, serum alkaline phosphatase, extent of disease within the liver on computed tomography (CT) scan, Duke's stage of primary tumour and the presence of extra-hepatic disease, for example, hepatic lymph node or lung involvement, or local recurrence.4'6 Detection of colorectal liver metastases CLINICAL DETECTION Clinical detection is possible only after growth of the disease within the liver. At greater than 30% replacement of the liver, the patient develops right upper quadrant abdominal pain and a palpable abdominal mass of metastases within the liver can frequently be felt on examination.5 Jaundice, ascites and lymphoedema suggest a terminal phase of the disease. Treatment of colorectal liver metastases is usually more effective when the treatment is started ...

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“…Von Leen u. Mitarb. wurde erstmals 1991 beschrieben, dass durch dopplersonographische Messung der Leberperfusion die Detektion von Lebermetastasen ermöglicht werden kann [4]. Dieser Ansatz beruht auf der Erkenntnis, dass Lebermetastasen maligner Tumoren fast ausschließlich von Ästen der A. hepatica versorgt werden [5].…”

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