Prospective assessment of the hepatic perfusion index in patients with colorectal cancer

Warren, Hugh; Gallagher, H. J.; Hemingway, D.; Angerson, Wilson J.; Bessent, R. G.; Wotherspoon, H. A.; McArdle, C. S.; Cooke, Timothy G.

doi:10.1046/j.1365-2168.1998.00975.x

Cited by 35 publications

(36 citation statements)

References 18 publications

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“…In patients with colorectal cancer without evidence of liver metastases at the time of tumor resection, hepatic perfusion abnormalities that are predictive for the subsequent occurrence of liver metastases have been described. [25][26][27] Although it is unsure whether these perfusion abnormalities affect the diameter of fenestrae, patients with malignancy were excluded for this reason.…”

Section: Discussionmentioning

confidence: 99%

The size of endothelial fenestrae in human liver sinusoids: implications for hepatocyte-directed gene transfer

et al. 2008

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Fenestrae allow the passage of gene transfer vectors from the sinusoidal lumen to the surface of hepatocytes. We have previously shown that the diameter of fenestrae correlates with species and strain differences of transgene expression following intravenous adenoviral transfer. In the current study, we demonstrate that the diameter of fenestrae in humans without liver pathology is 107 ± 1.5 nm. This is similar to the previously reported diameter in New Zealand White (NZW) rabbits (103 ± 1.3 nm) and is significantly smaller than in C57BL/6 mice (141±5.4 nm) and SpragueDawley rats (161 ± 2.7 nm). We show that the diameter of fenestrae in one male NZW rabbit and its offspring characterized by a more than 50-fold increase of transgene expression after adenoviral gene transfer is significantly (113 ± 1.5 nm; Po0.001) larger than in control NZW rabbits. In vitro filtration experiments using polycarbonate filters with increasing pore sizes demonstrate that a relatively small increment of the diameter of pores potently enhances passage of adenoviral vectors, consistent with in vivo data. In conclusion, the small diameter of fenestrae in humans is likely to be a major obstacle for hepatocyte transduction by adenoviral vectors.

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Section: Discussionmentioning

confidence: 99%

The size of endothelial fenestrae in human liver sinusoids: implications for hepatocyte-directed gene transfer

et al. 2008

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“…Since the early 1990s, a single-level, dynamic, contrastenhanced perfusion CT (CTP) technique that allows for the quantification and mapping of hepatic tumor blood-flow parameters such as tissue perfusion has been examined by a relatively small group of investigators [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. CT measurements of hepatic perfusion amongst patients with colon cancer have been shown to correlate with patient survival in two small groups of patients [10,11] and to provide risk stratification possibly even superior to the Dukes' classification [18,19].…”

Section: Introductionmentioning

confidence: 99%

“…CT measurements of hepatic perfusion amongst patients with colon cancer have been shown to correlate with patient survival in two small groups of patients [10,11] and to provide risk stratification possibly even superior to the Dukes' classification [18,19]. Furthermore, the presence of a focal arterial hyperdense blush and a general increase in global hepatic artery tissue perfusion on CTP may indicate the presence of occult micrometastasis [8,9].…”

Section: Introductionmentioning

confidence: 99%

Total-liver-volume perfusion CT using 3-D image fusion to improve detection and characterization of liver metastases

et al. 2008

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The purpose of this study was to evaluate the feasibility of a totalliver-volume perfusion CT (CTP) technique for the detection and characterization of liver metastases. Twenty patients underwent helical CT of the total liver volume before and 11 times after intravenous contrast-material injection. To decrease distortion artifacts, all phases were co-registered using 3-D image fusion before creating blood-flow maps. Lesion-based sensitivity and specificity for liver metastases of first the conventional four phases (unenhanced, arterial, portal venous, and equilibrium) and later all 12 phases including blood-flow maps were determined as compared to intraoperative ultrasound and surgical exploration. Arterial and portal venous perfusion was calculated for normalappearing and metastatic liver tissue.Total-liver-volume perfusion values were comparable to studies using single-level CTP. Compared to fourphase CT, total -liver-volume CTP increased sensitivity to 89.2 from 78.4% (P=0.046) and specificity to 82.6 from 78.3% (P=0.074). Totalliver-volume CTP is a noninvasive, quantitative, and feasible technique. Preliminary results suggest an improved detection of liver metastases for CTP compared to four-phase CT.

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“…t is known from experimental animal studies [1][2][3] and clinical patient studies [4][5][6][7][8][9] that the presence of even microscopic liver metastases is associated with changes in hepatic hemodynamics. The mechanism is not clear, although changes have been shown to originate from the early nonvascular phase of the metastases 3 and may be mediated by circulating vasoactive agents as a response to neoplastic growth.…”

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confidence: 99%

“…The mechanism is not clear, although changes have been shown to originate from the early nonvascular phase of the metastases 3 and may be mediated by circulating vasoactive agents as a response to neoplastic growth. 9 Hepatic metastases receive an increased proportion of their blood supply from the hepatic artery than from the portal vein. Changes have been observed on dynamic scintigraphy 1,7,8,10 and Doppler sonography.…”

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confidence: 99%

Contrast‐Enhanced Doppler Perfusion Index

Ramnarine

Leen

Oppo

et al. 2002

J of Ultrasound Medicine

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Objective. To assess the potential of the power Doppler signal intensity rate of enhancement due to contrast agent wash-in for assessment of hepatic hemodynamics. Methods. With the use of standardized settings, power Doppler sonography was performed before and after administration of a contrast agent. Video-recorded examinations were digitized for offline analysis on a personal computer. The temporal changes of the power Doppler signal intensity were quantified to provide contrast agent wash-in curves. The contrast-enhanced Doppler perfusion index was defined by the ratio of the washin gradient of the hepatic artery and portal vein as contrast-enhanced Doppler perfusion index = hepatic artery gradient/(hepatic artery gradient + portal vein gradient). The contrast-enhanced Doppler perfusion index was evaluated at 4 contrast agent doses in each of 14 patients with liver metastases and 3 patients with hemangiomas. An in vitro flow model was used to determine the relationships between the power Doppler rate of enhancement and flow in vessels of 4, 8, and 12 mm in diameter. Results. In vivo, there was a significantly higher (P < .0001) mean contrast enhanced Doppler perfusion index in patients with liver metastases (mean, 0.59; 95% confidence interval, 0.54-0.63), compared with patients with hemangiomas (mean, 0.33; 95% confidence interval, 0.24-0.41). The corresponding coefficients of variations were 25% for patients with liver metastases and 31% for patients with hemangiomas. In vitro, the power Doppler rate of enhancement was proportional to flow speed and independent of vessel diameter. Conclusions. Measurement of the contrast-enhanced Doppler perfusion index may have potential in assessment of hepatic hemodynamics and focal liver disease.

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Prospective assessment of the hepatic perfusion index in patients with colorectal cancer

Abstract: The HPI predicts a poor outcome in patients with colorectal cancer and may be useful in patient selection for adjuvant chemotherapy.

Cited by 35 publications

References 18 publications

The size of endothelial fenestrae in human liver sinusoids: implications for hepatocyte-directed gene transfer

The size of endothelial fenestrae in human liver sinusoids: implications for hepatocyte-directed gene transfer

Total-liver-volume perfusion CT using 3-D image fusion to improve detection and characterization of liver metastases

Contrast‐Enhanced Doppler Perfusion Index

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