Highlights
- •CEUS detected 4% additional colorectal liver metastasis in tumor stage T3/T4.
- •This resulted in a change of the oncological strategy in 75% of these patients.
- •The number needed to screen to detect 1 additional CRLM by CEUS was 24.5.
- •CEUS correctly classified lesions of uncertain dignity (21% in CT) in 98.4%.
- •CEUS has an excellent diagnostic accuracy for these lesions (PPV: 100%; NPV: 99.6%).
Background & Aims
CT may miss up to 30% of cases of colorectal liver metastases (CRLMs). We assessed
the impact of contrast-enhanced ultrasound (CEUS) on the detection of CRLMs and on
changes to the therapeutic strategy; additionally, we assessed the accuracy of CEUS
in differentiating unclear focal liver lesions (FLLs) compared to staging-CT.
Methods
We prospectively analyzed all patients with newly diagnosed and histologically confirmed
colorectal cancer (CRC) at our tertiary gastroenterological center between December
2015 and May 2019. CEUS was performed in a total of 296 patients without CRLMs after
staging-CT using the contrast agent (SonoVue®). Standard of reference was obtained
by MRI or histology to diagnose CRLMs missed by CT. Benign FLLs were confirmed by
MRI or follow-up CT (mean follow-up interval: 18 months).
Results
Eight additional CRLMs were detected by CEUS (overall 2.7%; sensitivity 88.9%, specificity
99.0%, positive predictive value 100%, negative predictive value 99.6%). All patients
with CRLMs detected only by CEUS were in tumor stage T3/T4 (4.0% additionally detected
CRLMs). The number needed to screen to detect 1 additional CRLM by CEUS was 37 in
all patients and 24.5 in T3/T4-patients. When results were reviewed by a board-certified
radiologist and oncologist, the therapeutic strategy changed in 6 of these 8 patients.
Among the 62 patients (20.9%) with unclear FLLs after staging-CT, CEUS determined
the dignity (malignant vs. benign) of 98.4% of the FLLs.
Conclusion
Overall, CEUS detected 2.7% additional CRLMs (including 4.0% in tumor stage T3/T4)
with a significant impact on the oncological therapeutic strategy for 75% of these
patients. Patients with tumor stage T3/T4 would particularly benefit from CEUS. We
propose CEUS as the first imaging modality for CT-detected lesions of unknown dignity.
Lay summary
In patients with newly diagnosed colorectal cancer, contrast-enhanced ultrasound (CEUS)
detected additional liver metastases after computed tomography (CT). In the majority
of these patients, the oncological therapy was changed after obtaining the CEUS results.
After staging-CT, 21% of hepatic lesions remained unclear. In these cases, CEUS was
accurate to either reveal or exclude liver metastasis in nearly all patients and could
reduce costs (e.g., number of MRI scans).
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: October 13, 2020
Accepted:
September 17,
2020
Received in revised form:
September 14,
2020
Received:
April 28,
2020
Identification
Copyright
© 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
