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Лучевая диагностика и ПЭТ в оценке очагового поражения печени у пациентов с колоректальным раком (обзор литературы

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В настоящее время более 25% пациентов с колоректальным раком при синхронных метастазах в печени могут быть радикально излечены хирургическим путем. Диагностика метастазов печени основана на методах визуализации, которые позволяют оценить состояние печени, количество и размер очагов и ряд параметров, по которым пациент подходит для радикального хирургического лечения. Последние 10 лет вопрос о ценности и приоритете таких методов лучевой диагностики, как УЗИ с контрастированием, МСКТ и МРТ с неспецифичными и специфичными для печени контрастными веществами, широко обсуждается среди специалистов. Многие исследователи пришли к выводу, что метод МРТ является более точным и чувствительным в сравнении с СКТ. Показано, что УЗИ печени и ПЭТ имеют свои ограничения в истинной оценке метастатического поражения печени и широко используются в динамическом наблюдении у пациентов во время химиотерапии и в случаях мониторинга после проведенного миниинвазивного лечения метастазов печени. Контрастная сонография очагов в печени является перспективным направлением, существенно улучшая точность диагностики по сравнению с традиционным УЗИ.

Ключевые слова:
колоректальный рак, метастазы в печень, диагностика, чувствительность, специфичность, ультразвуковая диагностика, КТ, MPT, ПЭТ.

Литература:
1. Floriani I., Torri V., Rulli E. et al. Performance of imaging
modalities in diagnosis of liver metastases from colorectal
cancer: a systematic review and meta-analysis. J. Magn.
Reson. Imaging 2010; 31(1):19–31.
2. Grundmann R.T., Hermanek P., Merkel S. et al. Diagnosis
and treatment of colorectal liver metastases. Zentralbl.
Chir. 2008; 133 (3): 267–284.
3. Ультразвуковая диагностика в абдоминальной и сосудистой хирургии; Под ред. Кунцевич Г.И. Минск: Кавалер Паблишерс, 1999.
4. Миронова Г.Т. Ультразвуковая вычислительная томография в диагностике первичной злокачественной
опухоли и метастазов печени: Автореф. дис. …канд.
мед. наук. М., 1988.
5. Кунцевич Г.И., Гаврилин А.В., Вишневский В.А., Бурцева Е.А. Комплексная ультразвуковая диагностика
метастатического поражения печени. Ультразвук.
и функцион. диагн. 2004; 3: 13–20.
6. Вишневский В.А., Кубышкин В.А., Чжао А.В., Икрамов Р.З. Операции на печени: Руководство для хирургов. М.: Миклош, 2003.
7. Камалов Ю.Р. Абдоминальное комплексное ультразвуковое исследование при опухолевых поражениях
печени и ее трансплантации.: Дис. ... д-ра мед. наук.
М., 2001.
8. Marcus C.D., LadamMarcus V., Cucu C. Imaging techniques to evaluate the response to treatment in oncology:
Current standards and perspectives. Crit. Rev. Oncol.
Hematol. 2009; 72 (3): 217–238.
9. O’Malley M.E., Takayama Y., Sherman M. et al. Outcome
of small (10–20 mm) arterial phaseenhancing nodules
seen on triphasic liver CT in patients with cirrhosis or
chronic liver disease. Am J. Gastroenterol. 2005; 100 (7):
1523–1528.
10. Weg N., Scheer M.R., Gabor M.P. Liver lesions: improved
detection with dual-detector-array CT and routine 2.5-mm
thin collimation. Radiology 1998; 209: 417–426.
11. Kopka L., Grabbe E. Biphasische Leberdiagnostik mit der
Mehrzeilendetektor-Spiral-CT. Radiology 1999; 39:
971–978.
12. Kulinna C., Helmberger T., Kessler M., Reiser M. Verbesserung der Diagnostik von Lebermetastasen mit der MultiDetektor-CT. Radiology 2001; 41: 16–23.
13. Hale H.L., Husband J.E., Gossios K., Norman A.R.,
Cunningham D. CT of calcified liver metastases in colorectal cancer. Clin. Radiol. 1998; 53: 735–741.
14. Valls C., Andia E., Sanchez A. et al. Hepatic metastases
from colorectal cancer: preoperative detection and
assessment of resectability with helical CT. Radiology
2001; 218: 55–60.
15. Niekel M.C., Bipat S., Stoker J. Diagnostic Imaging of
Colorectal Liver Metastases with CT, MR Imaging, FDG
PET, and/or FDG PET/CT: A MetaAnalysis of
Prospective Studies including patients who have not previously undergone treatment. Radiology 2010; Published
online before print September 9, 2010, doi:
10.1148/radiol.10100729.
16. Clasen S., Boss A., Schmidt D. et al. MR-guided radiofrequency ablation in a 0.2T open MR system: technical
success and technique effectiveness in 100 liver tumors.
J. Magn. Reson. Imaging. 2007; 26 (4): 1043–1052.
17. von Falkenhausen M.M., Lutterbey G., Morakkabati-Spitz
N. et al. HighFieldStrength MR Imaging of the Liver at
3.0 T: Intraindividual Comparative Study with MR Imaging
at 1.5 T. Radiology 2006; 241: 156–166.
18. Milot L., Guindi M., Gallinger S. et al. MR Imaging Correlates of Intratumoral tissue types within Colorectal Liver
Metastases: A High-Spatial-Resolution Fresh ex Vivo
Radiologic-Pathologic Correlation Study. Radiology 2010;
254: 747–754.
19. Huppertz A., Haraida S., Kraus A. et al. Enhancement of
Focal Liver Lesions at Gadoxetic Acid–enhanced MR
Imaging: Correlation with Histopathologic Findings and
Spiral CT – Initial Observations. Radiology 2005; 234:
468–478.
20. Schima W., Függer R., Schober E. et al. Diagnosis and
staging of pancreatic cancer: comparison of mangafodipir-enhanced MRI and contrast-enhanced helical
hydro-CT. Am. J. Roentgenol. 2002; 179: 717–124.
21. Mann G.N., Mary H.F., Lai L.L. et al. Clinical and cost
effectiveness of a new hepatocellular MRI contrast agent,
mangafodipir trisodium, in the preoperative assessment
of liver respectability. Ann. Surg. Oncol. 2001; 8: 573–579.
22. Nasu K., Kuroki Y., Nawano S. et al. Hepatic Metastases:
Diffusion-weighted Sensitivity-encoding versus SPIOenhanced MR Imaging. Radiology 2006; 239: 122–130.
23. Robinson P.J. The early detection of liver metastases.
Cancer Imaging. 2002; 2: 113–115.
24. Zacherl J., Scheuba C., Imhof M. et al. Current value of
intraoperative sonography during surgery for hepatic neoplasms. Wld J. Surg. 2002; 26: 550–554.
25. Van Etten B., van der Sijp J.R.M., Kruyt R.H. et al.
Ferumoxideenhanced magnetic resonance imaging
technique in pre operative assessment for colorectal liver
metastases. Eur. J. Surg. Oncol. 2002; 28: 645–651.
26. Herbertson R.A., Lee S.T., Tebbutt N. et al. The expanding
role of PET technology in the management of patients with
colorectal cancer. Ann. Oncol. 2007; 18 (11): 1774–1781.
27. Ruers T.J., Langenhoff B.S., Neeleman N. et al. Value of
positron emission tomography with [F-18] fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study. J. Clin. Oncol. 2002; 20: 388–395.
28. Selzner M., Hany T.F., Wildbrett P. et al. Does the novel
PET/CT imaging modality impact on the treatment of
patients with metastatic colorectal cancer of the liver?
Ann. Surg. 2004; 240: 1027–1034.
29. Votrubova J., Belohlavek O., Jaruskova M. et al. The role
of FDGPET/CT in the detection of recurrent colorectal
cancer. Eur. J. Nucl. Med. Mol. Imaging 2006; 33:
779–784.
30. Kinkel K., Lu Y., Both M. et al. Detection of hepatic metastases from cancers of the gastrointestinal tract by using
noninvasive imaging methods (US, CT, MR imaging, PET):
a metaanalysis. Radiology 2002; 224: 748–756.
31. Park I.J., Kim H.C., Yu C.S. et al. Efficacy of PET/CT in the
accurate evaluation of primary colorectal carcinoma. Eur.
J. Surg. Oncol. 2006; 32: 941–947.
32. Furukawa H., Ikuma H., Seki A. et al. Positron emission
tomography scanning is not superior to whole body multidetector helical computed tomography in the preoperative
staging of colorectal cancer. Gut. 2006; 55: 1007–1011.
33. Klessen C., Rogalla P., Taupitz M. Local staging of rectal
cancer: the current role of MR. Eur. Radiol. 2007; 17:
379–389.
34. Gearhart S.L., Frassica D., Rosen R. et al. Improved staging with pretreatment positron emission tomography/
computed tomography in low rectal cancer. Ann. Surg.
Oncol. 2006; 13: 397–404.
35. Parker D.W., Zagoria R.J., Morton K.A. et al. Evaluation of
liver metastases after radiofrequency ablation: utility of
18FFDG PET and PET/CT. Am. J. Roentgenol. 2005; 184
(4):1096–1102.
36. Rettenbacher T. Our experiences using contrastenhanced
ultrasound in focal liver lesions. Eur. Radiol. 2005; 15
(Suppl 5): E93–97.
37. Albrecht T., Blomley M.J., Burns P.N. et al. Improved
detection of hepatic metastases with pulse-inversion US
during the liverspesific phase of SHU 508A: multicenter
study. Radiology 2003; 227: 361–370.
38 Albrecht T., Hoffmann C.W., Schmitz S.A. et al. Detection
of liver metastases: comparison of contrast-enchanced
phase inversion ultrasound and dual phase spiral CT with
intraoperative sonographic correlation. Radiology 2000;
207 (P): 459.
39. Torzilli G., Del Fabbro D., Palmisano A. et al. Contrastenhanced intraoperative ultrasonography during hepatectomies for colorectal cancer liver metastases.
J. Gastrointest. Surg. 2005; 9 (8): 1148–1153.
40. Ding H., Wang W.P., Huang B.J. et al. Imaging of Focal
Liver Lesions. Low-Mechanical-Index Real-time Ultrasonography With SonoVue. J. Ultrasound Med. 2005; 24:
285–297.
41. Dietrich C.F., Kratzer W., Strobe D. et al. Assessment of
metastatic liver disease in patients with primary extrahepatic tumors by contrastenhanced sonography versus CT
and MRI. Wld J. Gastroenterol. 2006; 12 (11):1699–1705.
42. Quaia E., D’Onofrio M., Palumbo A. et al. Comparison of
contrast-enhanced ultrasonography versus base- line ultrasound and contrast-enhanced computed tomography in
metastatic disease of the liver: diagnostic performance and
confi-dence. Eur. Radiol. 2006; 16: 1599–1609.
43. Rettenbacher T. Our experiences using contrastenhanced ultrasound in focalliver lesions. Eur. Radiol.
2005; 15 (Suppl. 5): E93–97.
44. Tranquart F., Bleuzen A., Kissel A. Value of combined conventional and contrast sonography in the evaluation of
hepatic disoders. J. Radiol. 2004; 184: 1755–1762.
45. Leen E. The role of contrastenhanced ultrasound in the
characterization of focal liver lesions. Eur. Radiol. 2001; 11
(Suppl. 11): E27–34.

Imaging Techniques in Assessment of Liver Metastases from Colorectal Cancer

Today more than 25% of patients with colorectal cancer can be radically cured even when there is metastatic spread to the liver. The diagnosis of liver metastases relies totally on imaging to decide which patients may be surgical candi dates. The diagnostic value of ultrasound with contrast agents, multidetector CT and MR imaging with non-specific gadolinium chelates and liver-specific contrast agent is discussed. Nowadays MDCT is the mainstay of staging and follow-up of these patients, because it provides good coverage of the liver. MR imaging has been shown to be superior to helical CT in the preoperative assessment of colorectal liver metastases because of sensitivity and accuracy. There are needed new large studies to define the role of MDCT and MRI staging in patients referred for resection of liver metastases. Role of US and FDG-PET today are used in some cases to estimate treatment response after local therapy of liver metastases and monitoring during chemotherapy. US with contrast much more accurate in comparison with traditional US and going to show similar sensitivity to MDCT. Unfortunately, in our country this perspective method uses only in experimental studies.

Keywords:
colorectal cancer, liver metastases, diagnostic, sensitivity, significance, US, MDCT, MRI, FDG-PET