THE USE OF DOPPLER PERFUSION INDEX IN THE DETECTION OF COLORECTAL CANCER HEPATIC METASTASES

Year 2021, Volume: 16 Issue: 1, 12 - 18, 08.02.2021

Kamil Doğan Bilgin Kadri Arıbaş

https://doi.org/10.17517/ksutfd.824106

Abstract

ABSTRACT
Objective
Colon cancer, which is the most common type of cancer in the gastrointestinal system, is a major cause of morbidity and mortality. It usually spreads over the liver. During the detection of the diseases, the existence of metastases in the liver cannot be overlooked. Additional liver metastases can also be observed in the monitoring period. Early diagnosis of liver metastases in colon cancer bears utmost importance. The use of perfusion changes in liver during the early diagnosis has been a popular research topic. Doppler Perfusion Index can be defined as a term which occurs as a result of increasing hepatic arterial blood flow or decreasing portal venous blood flow and denotes the ratio of hepatic arterial blood flow to total liver blood flow. In this respect, the present study aims to detect the existence of micrometastasis using DPI in patients suffering from colon cancer and displaying no signs of visible liver metastasis.
Material and method
We measured DPI index in 79 patients suffering from colon cancer and displaying no signs of visible liver metastasis and monitored them in terms of prospectively visible metastasis development.
Findings
During the monitoring process, 2 patients developed exitus and 9 patients developed metastasis. Thus, it can be stated that DPI values obtained from our patient group overlapped with the findings in the existing literature in terms of the early diagnosis of metastasis.
Conclusion
Offering an inexpensive and non-invasive method for direct measurement, Duplex RDUS method can be used in the early diagnosis of hepatic metastasis in patients with colorectal cancer.

Keywords

Colon cancer, Liver metastases, Doppler Perfusion Index

Kolorektal Kanser Hepatik Metastazlarının Saptanmasında Doppler Perfüzyon İndeksi

Abstract

Amaç
Kolon kanseri gastrointestinal sistemin en sık görülen kanseri olup önemli bir morbidite ve mortalite sebebidir. En sık yayılım gösterdiği organ karaciğerdir. Hastalığın tanısı anında karaciğerde metastaz varlığı azımsanamayacak derecededir. Takip sürecinde de ayrıca karaciğer metastazları gelişmektedir. Kolon kanserinin karaciğer metastazlarının erken tanısı önemlidir. Erken tanıda karaciğer perfüzyon değişikliklerinin kullanılabileceği ötedenberi çalışma konusu olmuştur. Hepatik arteryel kan akımında artış yada portal venöz kan akımında azalma ile ortaya çıkan ve hepatik arteryel kan akımının total karaciğer kan akımına oranını ifade eden Doppler Perfüzyon İndeksi olarak tanımlanmış bir kavram bulunmaktadır. Biz de karaciğerde görünür metastazı bulunmayan kolon kanserli hastalarda DPİ ile mikrometastaz varlığını tesbit etmeyi amaçladık.
Gereç ve yöntemler
Kolon kanseri tanılı ve karaciğerinde görünür metastazı bulunmayan 79 hastanın DPİ ölçümlerini yapıp prospektif olarak görünür metastaz gelişimi yönünden takip ettik.
Bulgular
Takibimiz esnasında 2 hastada exitus ve 9 hastada görünür metastaz gelişmiş olup hasta grubumuzda elde ettiğimiz DPİ değerleri metastaz varlığını erken tesbit etmede literatürle uyumlu olarak değerlendirilmiştir.
Sonuç
Ucuz, noninvazif ve doğrudan ölçüm yapılabilen dupleks RDUS yöntemiyle, kolorektal kanserli hastaların hepatik metastazlarının erken aşamada tesbit edilebileceğini düşünüyoruz.

Keywords

Kolon kanseri, Karaciğer metastazı, Doppler Perfüzyon İndeksi

References

• Referans1 Dahnert W. Colorectal Carcinoma. Shaw R. Radiology Review Manual. 8 th ed. Philadephia. Williams and Wilkim. 2017; 1062.
• Referans2 Değerli Ü. Rektum Kanseri. Cerrahi Gastroenteroloji. 8. Baskı. İstanbul. Nobel Tıp Kitabevi. 2011; 299.
• Referans3 Nguyen M. Cancer of the colon and rectum. Porter RS. The Merck Manual. 20 th ed. North Wales. Elsevier. 2018.
• Referans4 Jemal A, Siegel R, Ward E, Murray T, Smigal C, Thun MJ, et al. Cancer statistic. CA Cancer J Clin 2007;57(1); 43-66.
• Referans5 Miskovitz P, Betancourt M. What to do you if you get colon cancer. New York: John Wiley & Sons. 1997; 34-43.
• Referans6 Kopljar M, Brkjacic B, Doko M, Horzic M. Nature of Doppler perfusion index changes in patients with colorectal cancer liver metastases. J Ultrasound Med 2004; 23; 1295-1300.
• Referans7 Oktar SÖ, Yücel C, Demirogulları T, Üner A, Benekli M, Erbas G ve ark. Doppler sonographic evaluation of hemodynamic changes in colorectal liver metastases relative to liver size. J Ultrasound Med 2006; 25; 575-582.
• Referans8 Leen E, Goldberg JA, Robertson J et al.The use of duplex sonography in the detection of colorectal hepatic metastases. Br J Cancer 1991; 63; 323–325.
• Referans9 Leen E, Goldberg JA, Robertson J et al. Detection of hepatic metastases using duplex/color Doppler sonography. Ann Surg. 1991; 214; 599–604.
• Referans10 Leen E, Angerson WJ, Wotherspoon H et al. Comparison of the Doppler perfusion index and intraoperative ultrasonography in diagnosing colorectal liver metastases evaluation with postoperative follow-up results. Ann Surgery. 1994; 220; 663–667.
• Referans11 Leen E, Anderson JR, Robertson J et al. Doppler index perfusion in the detection of hepatic metastases secondary to gastric carcinoma. Am J Surg. 1997; 173; 99–102.
• Referans12 Leen E, Angerson WJ, Wotherspoon H et al. Detection of colorectal liver metastases: comparison of laparotomy, CT, US, and Doppler perfusion index and evaluation of postoperative follow-up results. Radiology. 1995; 195; 113–116.
• Referans13 Leveson SH, Wiggins PA, Giles GR, Robinson PJ et al. Deranged liver blood flow in the detection of liver metastases. Br J Surg. 1985; 72; 128–130.
• Referans14 Yarmenitis SD, Kalogeropoulou CP, Hatjikondi O et al. An experimental approach of the Doppler perfusion index of the liver in detecting occult hepatic metastases: histological findings related to the hemodynamic measurements in Wistar rats. Eur Radiol. 2000; 10; 417–424.
• Referans15 Hunt TM, Flowerdew AD, Britten AJ et al. An association between parameters of liver blood flow and percentage hepatic replacement with tumour. Br J Cancer. 1989; 59; 410–414.
• Referans16 Hemingway DM, Cooke TG, Grime SJ, Nott DM, Jenkins SA. Changes in hepatic haemodynamics and hepatic perfusion index during the growth and development of hypovascular HSN sarcoma in rats. Br J Surg. 1991; 78; 326–330..
• Referans17 Carter R, Anderson JH, Cooke TG et al. Splanchnic blood flow changes in the presence of hepatic tumour: evidence of a humoral mediator. Br J Cancer. 1994; 69; 1025–1026.
• Referans18 Leen E, Angerson WJ, Cooke TG, Mc Ardle CS. Prognostic pover of Doppler perfusion index in colorectal cancer. Correlation with survival. Ann Surg. 1996; 223(2); 199-203.
• Referans19 Leen E, Goldberg JA, Angerson WJ, McArdle CS. Potential role of Doppler perfusion index in selection of patients with colorectal cancer for adjuvant chemotherapy. Lancet. 2000; 355; 34–37.
• Referans20 Roumen RM, Scheltinga MR, Slooter GD, Van der Linden AW. Doppler perfusion index fails to predict the presence of occult hepatic colorectal metastases. Eur J Surg Oncol. 2005; 31; 521–527.
• Referans21 Radmard A.R., Abrishami A, Gholamrezanezhad A. et al. Relationship between CT volumetric measurements and Doppler perfusion indices in gastrointestinal liver metastasis. Radiol med. 2015; 120; 171–179.
• Referans22 Leen E, Goldberg JA, Robertson J, et al. Early detection of occult colorectal hepatic metastases using duplex colour Doppler sonography. Br J Surg. 1993; 80; 1249–1251.
• Referans23 Guadagni S, Pizzutilli A, Mancini E, et al. Significance of duplex/colour Doppler sonography in hepatic arterial chemotherapy for patients with liver metastases from colorectal carcinoma. Eur J Surg Oncol. 2000; 26; 381–386.
• Referans24 Warren HW, Gallagher H, Hemingway DM, et al. Prospective assessment of the hepatic perfusion index in patients with colorectal cancer. Br J Surg. 1998; 85; 1708–1712.
• Referans25 Kimme-Smith C, Hussain R, Duerichz A, Tessler F and Grant E. Assurance of consistent peak-velocity measurements with a variety of duplex Doppler instruments. Radiology 1990; 177; 265-272.
• Referans26 Kakkos SK, Yarmenitis SD, Tsamandas AC, Gogos CA, Kalfarentzos F. Fatty liver in obesity: relation to Doppler perfusion index measurement of the liver. Scand J Gastroenterol. 2000; 35; 976-980.
• Referans27 Leen E, Goldberg JA, Robertson J, Angerson WJ, Sutherland GR, Cooke TG, Mc Ardle CS. Image-directed Doppler ultrasonography, A Novel technique for the diagnosis of colorectal liver metastases. J Clin Ultrasound. 1993; 21; 221-230.