Contrast-enhanced ultrasound after devascularisation of neuroendocrine liver metastases: functional and morphological evaluation
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To evaluate morphological and perfusion changes in liver metastases of neuroendocrine tumours by contrast-enhanced ultrasound (CEUS) after transarterial embolisation with bead block (TAE) or trans-arterial chemoembolisation with doxorubicin-eluting beads (DEB-TACE).
In this retrospective study, seven patients underwent TAE, and ten underwent DEB-TACE using beads of the same size. At 1 day before embolisation, 2 days, 1 month and 3 months after the procedure, a destruction-replenishment study using CEUS was performed with a microbubble-enhancing contrast material on a reference tumour. Relative blood flow (rBF) and relative blood volume (rBV) were obtained from the ratio of values obtained in the tumour and in adjacent liver parenchyma. Morphological parameters such as the tumour’s major diameter and the viable tumour’s major diameter were also measured. A parameter combining functional and morphological data, the tumour vitality index (TVI), was studied. The Wilcoxon rank-sum test and Fisher’s test were used to compare treatment groups.
At 3 months rBF, rBV and TVI were significantly lower (P = 0.005, P = 0.04 and P = 0.03) for the group with doxorubicin. No difference in morphological parameters was found throughout the follow-up.
One parameter, TVI, could evaluate the morphological and functional response to treatments.
• Contrast-enhanced ultrasound provides morphological and functional information about neuroendocrine hepatic metastases
• CEUS can evaluate changes after transarterial chemoembolisation, transarterial-embolisation and transarterial radioembolisation
• Functional (but not morphological) imaging reveals differences between TAE and DEB-TACE therapy
• To combine morphological and functional parameters, a tumour vitality index is proposed
• TVI can be used to monitor treatments acting on tumour vascularisation
KeywordsTransarterial chemoembolization Doxorubicin drug-eluting beads (DEB) Contrast-enhanced ultrasound Perfusion imaging Tumour vitality index
contrast harmonic imaging
relative blood flow
relative blood volume
response evaluation criteria in solid tumours
region of interest
tumour vitality index
tumour’s major diameter
viable tumour’s major diameter
well-differentiated endocrine carcinoma
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