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Тазовая хирургия и онкология

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ОСОБЕННОСТИ СОВРЕМЕННОЙ ДИАГНОСТИКИ МЕТАСТАЗОВ КОЛОРЕКТАЛЬНОГО РАКА В ПЕЧЕНЬ

https://doi.org/10.17650/2220-3478-2013-0-4-23-30

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Аннотация

Разработка оптимального алгоритма лучевых диагностических обследований в случае метастатического поражения печени при колоректальном раке (КРР) является крайне актуальной. В статье дан обзор литературы по диагностике метастазов КРР в печень. Диагностика метастазов в печень основана на методах визуализации, позволяющих оценить состояние печени, количество и размер очагов и ряд параметров, по которым пациент подходит для радикального хирургического лечения. Описана ультразвуковая, рентгенологическая и магнитно-резонансная семиотика метастазов в печень, а также отражены дополнительные сведения, которые можно получить с помощью лучевых методов исследования, что имеет огромное значение в определении резектабельности и предоперационном планировании хирургического вмешательства. Рассмотрена дифференциальная диагностика с доброкачественными образованиями печени. Вопрос о ценности и приоритете таких методов лучевой диагностики, как ультразвуковое исследование с контрастированием, рентгеновская компьютерная томография и магнитно-резонансная томография с контрастными веществами, широко обсуждается среди специалистов. 

Об авторах

Т. Ю. Данзанова
НИИ клинической онкологии ФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, Москва
Россия
Отделение ультразвуковой диагностики отдела лучевой диагностики и интервенционной радиологии


Г. Т. Синюкова
НИИ клинической онкологии ФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, Москва
Россия
Отделение ультразвуковой диагностики отдела лучевой диагностики и интервенционной радиологии


П. И. Лепэдату
НИИ клинической онкологии ФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, Москва
Россия
Отделение ультразвуковой диагностики отдела лучевой диагностики и интервенционной радиологии


Список литературы

1. Комов Д.В. Первичные и метастатиче-ские опухоли печени. Автореф. дисс. ... д-ра мед. наук. М., 1984. С. 1–2, 29–51.

2. Трапезников Н.Н., Поддубная И.В. Справочник по онкологии. М.: Каппа, 1996. С. 294–303.

3. Подлужный Д.В. Хирургическое лечение больных с метастазами неколоректальных опухолей в печень. Автореф. дисс. ... канд. мед. наук. М., 2001. С. 1–2, 5–23.

4. Комаров И.Г., Комов Д.В. Метастазы злокачественных опухолей без выявленного первичного очага. М.: Триада Х, 2002. С. 63–105.

5. Комов Д.В., Израелашвили М.Ш. Хирургическое лечение вторичных злокачественных опухолей печени. Хирургия 1989, с. 76–79.

6. Пинчук В.Г., Балицкий К.П. Комплексный подход к изучению проблемы метастазирования. Экспер онкол 1991;5:14–17, 50, 53, 115.

7. Elias D., Cavalcanti de Albuquerque A., Eggenspieler P. et al. Resection of liver metastases from a noncolorectal primary: indications and results based on 147 monocentric patients. J Am Coll Surg 1998;187(5):487–93.

8. Baker M.E., Pelley R. Hepatic metastases: basic principles and implications for radiologists. Radiology 1995;197:329–37.

9. Патютко Ю.И. Хирургическое лечение злокачественных опухолей печени. М.: Практическая медицина, 2005. С. 69–82.

10. Broelsch C.E., Knoefel W.T., Gundlach M. et al. Chirurgische Therapie primarer und sekundarer Lebertumoren. Schweiz Rundsch Med Prax 1997;86(4):91–3.

11. Schima W., Kulinna C., Langenberger H., Ba-Ssalamah A. Liver metastases of colorectal cancer: US, CT or MR? Cancer Imaging 2005;5 Spec No A:S149–56.

12. Jemal A., Siegel R., Ward E. et al. Cancer statistics, 2006. CA Cancer J Clin 2003;56:106–30.

13. Bipat S., van Leeuwen M.S., Comans E.F. et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis – meta-analysis. Radiology 2005;237:123–31.

14. Simmonds P.C., Primrose J.N., Colquitt J.L. et al. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 2006;94:982–99.

15. Патютко Ю.И., Поляков А.Н., Сагайдак И.В., Котельников А.Г. Комбинированное лечение больных колоректальным раком с метастатическим поражением печени. Журнал им. Н.И. Пирогова 2008;7:20–3.

16. Статистика злокачественных новообразований в России и странах СНГ в 2007 г. Под ред. М.И. Давыдова, Е.М. Аксель. Вестник РОНЦ им. Н.Н. Блохина РАМН 2009;20(3):12–64.

17. Xu L.H., Cai S.J., Cai G.X. et al. Imaging diagnosis of colorectal liver metastases. World J Gastroenterol 2011 Nov 14;17(42):4654–9.

18. Кунцевич Г.И., Гаврилин А.В., Вишневский В.А., Бурцева Е.А. Комплексная ультразвуковая диагностика метастатического поражения печени. Ультразвуковая и функциональная диагностика 2004;3:13–20.

19. Миронова Г.Т. Ультразвуковая вычислительная томография в диагностике первичной злокачественной опухоли и метастазов печени. Автореф. дисс. ... канд. мед. наук. М., 1988. 162 с.

20. Van Erkel A.R., Pijl M.E., van den Berg Huysmans A.A. et al. Hepatic metastases in patients with colorectal cancer: relationship between size of metastases, standard of reference, and detection rates. Radiology 2002;224(2):404–9.

21. Стрыгина Е.А. Ультразвуковая томография в оценке эффективности цитостатической терапии метастазов в печень опухолей желудочно-кишечного тракта. Автореф. дисс. ... канд. мед. наук. М., 2002. С. 24.

22. Ernst H., Hahn E.G., Balzer T. et al. Color doppler ultrasound of liver lesions: signal enchancement after intravenous injection of ultrasound contrast agent. Levovist. J Clin Ultrasound 1996;24:31–5.

23. Hosten N., Steger W., Bechstein W.O. et al. Vaskularizationsmuster in fokalen Leberlesionen: Vergleich der nativen und signalverstarkten amplitudenmodulierten Farbduplexsonographie. Rofo 1997;166:507–13.

24. Bernatik T., Strobel D., Hahn E.G. et al. Detection of liver metastases: comparison of contrast-enhanced wide-band harmonic imaging with conventional ultrasonography. J Ultrasound Med 2001;20:509–15.

25. Mita K., Kim S.R., Kudo M. et al. Diagnostic sensitivity of imaging modalitiesfor hepatocellular carcinoma smaller than 2 cm. World J Gastroenterol 2010 Sep 7;16(33):4187–92.

26. Kamel I.R., Georgiades C., Fishman E.K. Incremental value of advanced image processing of multislice computed tomography data in the evaluation of hypervascular liver lesions. J Comput Assist Tomogr 2003;27:652–6.

27. Sahani D., Mehta A., Blake M. et al. Preoperative hepatic vascular evaluation with CT and MR angiography: implications for surgery. Radiographics 2004;24:1367–80.

28. Yim P.J., Vora A.V., Raghavan D. et al. Volumetric analysis of liver metastases in computed tomography with the fuzzy C-means algorithm. J Comput Assist Tomogr 2006;30:212–20.

29. Miles K.A., Hayball M.P., Dixon A.K. Functional images of hepatic perfusion obtained with dynamic CT. Radiology 1993;188:405–11.

30. Ch'en I.Y., Katz D.S., Jeffrey R.B. Jr et al. Do arterial phase helical CT images improve detection or characterization of colorectal liver metastases? J Comput Assist Tomogr 1997;21:391–7.

31. Wicherts D.A., de Haas R.J., van Kessel C.S. et al. Incremental value of arterial and equilibrium phase compared to hepatic venous phase CT in the preoperative staging of colorectal liver metastases: an evaluation with different reference standards.Eur J Radiol 2011;77:305–11.

32. 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;209:417–26.

33. Kopka L., Grabbe E. Biphasic liver diagnosis with multiplanar-detector spiral CT. Radiologe 1999;39:971–8.

34. Hale H.L., Husband J.E., Gossios K. et al. CT of calcified liver metastases in colorectal carcinoma. Clin Radiol 1998;53:735–41.

35. 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.

36. Kirchin M.A., Pirovano G.P., Spinazzi A. Gadobenate dimeglumine (Gd-BOPTA). An overview. Invest Radiol 1998;33:798–809.

37. Hamm B., Staks T., Mühler A. et al. Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging. Radiology 1995;195:785–92.

38. Ward J., Robinson P.J., Guthrie J.A. et al. Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology 2005;237:170–80.

39. Kim M.J., Kim J.H., Chung J.J. et al. Focal hepatic lesions: detection and characterization with combination gadolinium- and superparamagnetic iron oxide-enhanced MR imaging. Radiology 2003;228:719–26.

40. Soyer P., Poccard M., Boudiaf M. et al. Detection of hypovascular hepatic metastases at triple-phase helical CT: sensitivity of phases and comparison with surgical and histopathologic findings. Radiology 2004;231:413–20.

41. Kim Y.K., Lee J.M., Kim C.S. et al. Detection of liver metastases: gadobenate dimeglumine-enhanced three-dimensional dynamic phases and one-hour delayed phase MR imaging versus superparamagnetic iron oxide-enhanced MR imaging. Eur Radiol 2005;15:220–8.

42. Mainenti P.P., Mancini M., Mainolfi C. et al. Detection of colo-rectal liver metastases: prospective comparison of contrast enhanced US, multidetector CT, PET/CT, and 1.5 Tesla MR with extracellular and reticulo-endothelial cell specific contrast agents. Abdom Imaging 2010;35:511–21.

43. Kim Y.K., Ko S.W., Hwang S.B. et al. Detection and characterization of liver metastases: 16-slice multidetector computed tomography versus superparamagnetic iron oxide-enhanced magnetic resonance imaging. Eur Radiol 2006;16:1337–45.

44. Rappeport E.D., Loft A., Berthelsen A.K. et al. Contrast-enhanced FDG-PET/CT vs. SPIO-enhanced MRI vs. FDG-PET vs. CT in patients with liver metastases from colorectal cancer: a prospective study with intraoperative confirmation. Acta Radiol 2007;48:369–78.

45. Zech C.J., Herrmann K.A., Reiser M.F. et al. MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA. Magn Reson Med Sci 2007;6:43–52.

46. Blyth S., Blakeborough A., Peterson M. et al. Sensitivity of magnetic resonance imaging in the detection of colorectal liver metastases. Ann R Coll Surg Engl 2008;90:25–8.

47. Karhunen P.J. Benign hepatic tumours and tumour like conditions in men. J Clin Pathol 1986;39:183–8.

48. Jones E.C., Chezmar J.L., Nelson R.C. et al. The frequency and significance of small (less than or equal to 15 mm) hepatic lesions detected by CT. AJR Am J Roentgenol 1992;158:535–9.

49. Konopke R., Kersting S., Saeger H.D. et al. Detection of liver lesions by contrast-enhanced ultrasound – comparison to intraoperative findings. Ultraschall Med 2005;26:107–13.

50. Hatanaka K., Kudo M., Minami Y. et al. Differential diagnosis of hepatic tumors: value of contrast-enhanced harmonic sonography using the newly developed contrast agent, Sonazoid. Intervirology 2008;51 Suppl 1:61–9.

51. Ward J., Naik K.S., Guthrie J.A. et al. Hepatic lesion detection: comparison of MR imaging after the administration of superparamagnetic iron oxide with dual-phase CT by using alternative-free response receiver operating characteristic analysis. Radiology 1999;210:459–66.

52. Dietrich C.F. Characterisation of benign liver lesions with contrast-enhanced ultrasound. In: R. Lencioni et al., eds. Enhancing the role of ultrasound with ultrasound contrast agents. Pisa: Springer, 2006. Pp. 3–14.

53. Terayama N., Matsui O., Ueda K. et al. Peritumoral rim enhancement of liver metastasis: hemodynamics observed on single-level dynamic CT during hepatic arteriography and histopathologic correlation. J Comput Assist Tomogr 2002;26:975–80.

54. Paulson E.K., McDermott V.G., Keogan M.T. et al. Carcinoid metastases to the liver: role of triple-phase helical CT. Radiology 1998;206:143–50.

55. Miller D.L., Simmons J.T., Chang R. et al. Hepatic metastasis detection: comparison of three CT contrast enhancement methods. Radiology 1987;165:785–90.

56. Soyer P., Levesque M., Elias D. et al. Detection of liver metastases from colorectal cancer: comparison of intraoperative US and CT during arterial portography. Radiology 1992;183:541–4.

57. Beavers K.L., Semelka R.C. MRI evaluation of the liver. Semin Liver Dis 2001;21:161–77.

58. Nasu K., Kuroki Y., Nawano S. et al. Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR imaging. Radiology 2006;239:122–30.

59. Glockner J.F. Hepatobiliary MRI: current concepts and controversies. J Magn Reson Imaging 2007;25:681–95.

60. Vogl T.J., Schwarz W., Blume S. et al. Preoperative evaluation of malignant liver tumors: comparison of unenhanced and SPIO (Resovist)-enhanced MR imaging with biphasic CTAP and intraoperative US. Eur Radiol 2003;13:262–72.

61. Hekimoglu K., Ustundag Y., Dusak A. et al. Small colorectal liver metastases: detection with SPIO-enhanced MRI in comparison with gadobenate dimeglumine-enhanced MRI and CT imaging. Eur J Radiol 2011;77:468–72.

62. Hagspiel K.D., Neidl K.F., Eichenberger A.C. et al. Detection of liver metastases: comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5 T with dynamic CT, intraoperative US, and percutaneous US. Radiology 1995;196:471–8.

63. Senéterre E., Taourel P., Bouvier Y. et al. Detection of hepatic metastases: ferumoxides-enhanced MR imaging versus unenhanced MR imaging and CT during arterial portography. Radiology 1996;200:785–92.

64. Ward J., Guthrie J.A., Wilson D. et al. Colorectal hepatic metastases: detection with SPIO-enhanced breath-hold MR imaging – comparison of optimized sequences. Radiology 2003;228:709–18.

65. Conlon R., Jacobs M., Dasgupta D. et al. The value of intraoperative ultrasound during hepatic resection compared with improved preoperative magnetic resonance imaging. Eur J Ultrasound 2003;16:211–6.

66. Jarnagin W.R., Bach A.M., Winston C.B. et al. What is the yield of intraoperative ultrasonography during partial hepatectomy for malignant disease? J Am Coll Surg 2001;192:577–83.

67. Cervone A., Sardi A., Conaway G.L. Intraoperative ultrasound (IOUS) is essential in the management of metastatic colorectal liver lesions. Am Surg 2000;66:611–5.

68. Schmidt J., Strotzer M., Fraunhofer S. et al. Intraoperative ultrasonography versus helical computed tomography and computed tomography with arterioportography in diagnosing colorectal liver metastases: lesion-by-lesion analysis. World J Surg 2000;24:43–7; discussion 48.

69. Ohlsson B., Tranberg K.G., Lundstedt C. et al. Detection of hepatic metastases in colorectal cancer: a prospective study of laboratory and imaging methods. Eur J Surg 1993;159:275–81.

70. Moertel C.G., Fleming T.R., Macdonald J.S. et al. An evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA 1993;270:943–7.

71. Huebner R.H., Park K.C., Shepherd J.E. et al. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 2000;41:1177–89.

72. Leen E., Angerson W.J., 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;195:113–6.

73. Carter R., Hemingway D., Cooke T.G. et al. A prospective study of six methods for detection of hepatic colorectal metastases. Ann R Coll Surg Engl 1996;78:27–30.

74. Strotzer M., Gmeinwieser J., Schmidt J. et al. Diagnosis of liver metastases from colorectal adenocarcinoma: comparison ofspiral-CTAP combined with intravenous contrast-enhanced spiral-CT and SPIO-enhanced MR combined with plain MR imaging. Acta Radiol 1997;38:986–92.

75. Abdel-Nabi H., Doerr R.J., Lamonica D.M. et al. Staging of primary colorectal carcinomas with fluorine-18 fluorodeoxyglucose whole-body PET: correlation with histopathologic and CT findings. Radiology 1998;206:755–60.

76. Whiteford M.H., Whiteford H.M., Yee L.F. et al. Usefulness of FDG-PET scan in the assessment of suspected metastatic or recurrent adenocarcinoma of the colon and rectum. Dis Colon Rectum 2000;43:759–67; discussion 767–70.

77. Chua S.C., Groves A.M., Kayani I. et al. The impact of 18F-FDG PET/CT inpatients with liver metastases. Eur J Nucl Med Mol Imaging 2007;34:1906–14.

78. Wiering B., Krabbe P.F., Jager G.J. et al. The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer 2005;104:2658–70.

79. Lubezky N., Metser U., Geva R. et al. The role and limitations of 18-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scan and computerized tomography (CT) in restaging patients with hepatic colorectal metastases following neoadjuvant chemotherapy: comparison with operative and pathological findings. J Gastrointest Surg 2007;11:472–8.

80. Sahani D.V., Kalva S.P., Fischman A.J. et al. Detection of liver metastases fromadenocarcinoma of the colon and pancreas: comparison of mangafodipir trisodium-enhanced liver MRI and whole-body FDG PET. AJR Am J Roentgenol 2005;185:239–46.

81. Soyer P., Levesque M., Caudron C. et al. MRI of liver metastases from colorectal cancer vs. CT during arterial portography. J Comput Assist Tomogr 1993;17:67–74.

82. Ong K.O., Leen E. Radiological staging of colorectal liver metastases. Surg Oncol 2007;16:7–14.

83. Kondo H., Kanematsu M., Hoshi H. et al. Preoperative detection of malignant hepatic tumors: comparison of combined methods of MR imaging with combined methods of CT. AJR Am J Roentgenol 2000;174:947–54.


Для цитирования:


Данзанова Т.Ю., Синюкова Г.Т., Лепэдату П.И. ОСОБЕННОСТИ СОВРЕМЕННОЙ ДИАГНОСТИКИ МЕТАСТАЗОВ КОЛОРЕКТАЛЬНОГО РАКА В ПЕЧЕНЬ. Тазовая хирургия и онкология. 2013;(4):23-30. https://doi.org/10.17650/2220-3478-2013-0-4-23-30

For citation:


Danzanova T.Y., Sinyukova G.T., Lepedatu P.I. SPECIFIC FEATURES OF THE CURRENT DIAGNOSIS OF COLORECTAL CANCER LIVER METASTASES. Pelvic Surgery and Oncology. 2013;(4):23-30. (In Russ.) https://doi.org/10.17650/2220-3478-2013-0-4-23-30

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