Liver Cancer pp 355-367 | Cite as

Liver Metastases from Colorectal Cancer: Ultrasound Imaging

  • Søren R. Rafaelsen
Part of the Methods of Cancer Diagnosis, Therapy and Prognosis book series (HAYAT, volume 5)

Colorectal cancer is the second largest cause of cancer-related deaths in the United States.

Approximately 15–20% of the patients with cancer of the colon and rectum have liver metastases at the time of primary surgery (Faivre et al., 2003). Assessment of liver metastases is essential for the appropriate management of colorectal cancer. Surgical resection is an effective treatment for hepatic metastases of colorectal cancer. However, this option is available only to a small group of patients. Preoperative portal vein embolization for hypertrophy of future hepatic resection and other pioneering multidisciplinary modalities and the aggressive surgical approach has been adopted to extend the frontiers of surgical therapy (Khatri et al., 2005). For the majo-rity of patients surgery is not a curative option, and only palliative therapy is available resulting in no long-term survivors. If left untreated the median survival is 6 months, but with modern combination chemothe-rapy a median survival of 24 month is possible. In a French study (Guyot et al., 2005) the proportion of patients with liver metastases resected with curative intent increased over time from 6% (1976–1984) to 30% (1994–2003).


Colorectal Cancer Liver Metastasis Hepatic Metastasis Colorectal Liver Metastasis Doppler Signal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Adam, R., Avisar, E., Ariche, A., Giachetti, S., Azoulay, D., Castaing, D., Kunstlinger, F., Levi, F., and Bismuth, F. 2001. Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal cancer. Ann. Surg. Oncol. 8:347–353.PubMedCrossRefGoogle Scholar
  2. Bang, N., Nielsen, M.B., Rasmussen, A.N., Osterhammel, P.A., and Pedersen, J.F. 2001. Hepatic vein transit time of an ultrasound contrast agent: simplified procedure using pulse inversion imaging. Br. J. Radiol. 74:752–755.PubMedGoogle Scholar
  3. Bernatik, T., Becker, D., Neureiter, D., Hansler, J.H., Frieser, M., Schaber, S., Wein, A., Hahn, E.G., and Strobel, D. 2004. Hepatic transit time of an echo enhancer: an indicator of meta-static spread to the liver. Eur. J. Gastroenterol. Hepatol. 16:313–317.PubMedCrossRefGoogle Scholar
  4. Brannigan, M., Burns, P.N., and Wilson, S.R. 2004. Blood flow patterns in focal liver lesions at microbubble-enhanced US. Radiographics 24:921–935.PubMedCrossRefGoogle Scholar
  5. Bruneton, J.N., Raffaelli, C., Balu-Maestro, C., Padovan I, B., Chevallier, P., and Mourou, M.Y. 1996. Sonographic diagnosis of solid liver nodules in cancer patients. Eur. Radiol. 6:439–442.PubMedGoogle Scholar
  6. Choudhry, S., Gorman, B., Charboneau, J.W., Tradup, D.J., Beck, R.J., Kofler, J.M., and Groth, D.S. 2000. Comparison of tissue harmonic imaging with conventional US in abdominal disease. Radiographics 20:1127–1135.PubMedGoogle Scholar
  7. Cosgrove, D., and Blomley, M. 2004. Liver tumors. Abdom. Imaging 29:446–454PubMedCrossRefGoogle Scholar
  8. Courreges, F., Vieyres, P., Istepanian, R.S., Arbeille, P., and Bru C. 2005. Clinical trials and evaluation of a mobile, robotic tele-ultrasound system. J. Telemed. Telecare 11 Suppl 1:46–49.PubMedCrossRefGoogle Scholar
  9. Diaz-Rubio, E., and Schmoll, H.J. 2005. The future development of bevacizumab in colorectal cancer. Oncology 69 Suppl 3:34–45.PubMedCrossRefGoogle Scholar
  10. Du, W.H., Yang, W.X., Xiong, X.Q., Wang, X., Zhou, Y., and Wang H. 2005. Contrast-enhanced ultrasonographic imaging diagnosis on assessment of vascularity in liver metastatic lesions. World J. Gastroentol. 11:3610–3613.Google Scholar
  11. Easson, A.M., Barron, P.T., Cripps, C., Hill, G., Guindi, M., and Michaud, C. 1996. Calcification in colorectal hepatic metastases correlates with longer survival. J. Surg. Oncol. 63:221–225.PubMedCrossRefGoogle Scholar
  12. Eberhardt, S.C., Choi, P.H., Bach, A.M., Funt, S.A., Felderman, H.E., and Hann, L.E. 2003. Utility of sonography for small hepatic lesions found on computed tomography in patients with cancer. J. Ultrasound Med. 22:335–343.PubMedGoogle Scholar
  13. Faivre, J., Manfredi, S., and Bouvier, A.M. 2003. Epidemiology of colorectal cancer liver metas-tases. Bull. Acad. Nath. Med. 187:815–823.Google Scholar
  14. Figueredo, A., Rumble, R.B., Maroun, J., Earle, C.C., Cummings, B., McLeod, R., Zuraw, L., and Zwaal, C. Gastrointestinal Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care. 2003. Follow-up of patients with curatively resected colorectal cancer: a practice guideline. Bio. Med. Central. Cancer 6;3:26Google Scholar
  15. Forsberg, F., Piccoli, C.W., Liu, J.B., Rawool, N.M., Merton, D.A., Mitchell, D.G., and Goldberg, B.B. 2002a. Hepatic tumor detection: MR imaging and conventional US versus pulse-inversion harmonic US of NC100100 during its reticu-loendothelial system-specific phase. Radiology 222:824–829.CrossRefGoogle Scholar
  16. Forsberg, F., Rawool, N.M., Merton, D.A., Liu, J.B., and Goldberg, B.B. 2002b. Contrast enhanced vascular three-dimensional ultrasound imaging. Ultrasonics 40:117–122.CrossRefGoogle Scholar
  17. Furudoi, A., Tanaka, S., Haruma, K., Kitadai, Y., Yoshihara, M., Chayama, K., and Shimamoto, F. 2002. Clinical significance of vascular endo-thelial growth factor C and angiogenesis at the deepest invasive site of advanced colorectal carcinoma. Oncology 62:157–166.PubMedCrossRefGoogle Scholar
  18. Gillams, A.R. 2005. The use of radiofrequency in cancer. Br. J. Cancer 92:1825–1829.PubMedCrossRefGoogle Scholar
  19. de Goede, E., Filez, L., Janssens, J., and Van Cutsem, E. 1998. Follow-up of colon cancer: detection of liver metastases: benefit and periodicity. Acta Gastroenterol. Belg. 61:8–10.PubMedGoogle Scholar
  20. Goldberg, B.B., Merton, D.A., Forsberg, F., Liu, J.B., and Rawool, N. 1996. Color Amplitude Imaging: Preliminary results using vascular sonographic contrast agents. J. Ultrasound Med. 15:127–134.PubMedGoogle Scholar
  21. Gordon, M.S., and Cunningham, D. Managing patients treated with bevacizumab combination therapy. 2005. Oncology 69 Suppl 3:25–33.PubMedCrossRefGoogle Scholar
  22. Graham, K.C., Wirtzfeld, L.A., MacKenzie, L.T., Postenka, C.O., Groom, A.C., MacDonald, I.C., Fenster, A., Lacefield, J.C., and Chambers, A.F. 2005. Three-dimensional high-frequency ultrasound imaging for longitudinal evaluation of liver metastases in preclinical models. Cancer Res. 65:5231–5237.PubMedCrossRefGoogle Scholar
  23. Green, B., Bree, R.L., Goldstein, H.M., and Stanley, C. 1977. Gray scale ultrasound evaluation of hepatic neoplasms: patterns and correlations. Radiology 124:203–208.PubMedGoogle Scholar
  24. Gruenberger, T., Zhao, J., King, J., Chung, T, Clingan P.R., and Morris, D.L. 2002. Echogenicity of liver metastases from colorectal carcinoma is an independent prognostic factor in patients treated with regional chemotherapy. Cancer 94:1753–1759.PubMedCrossRefGoogle Scholar
  25. Gunven, P., Makuuchi, M., Takayasu, K., Moriyama, N., Yamasaki, S., and Hasegawa, H. 1985. Preoperative imaging of liver metastases. Comparison of angiography, CT scan, and ultra-sonography. Ann. Surg. 202:573–579.PubMedCrossRefGoogle Scholar
  26. Guyot, F., Faivre, J., Manfredi, S., Meny, B., Bonithon-Kopp, C., and Bouvier, A,M. 2005. Time trends in the treatment and survival of recurrences from colorectal cancer. Ann. Oncol. 16:756–761.PubMedCrossRefGoogle Scholar
  27. Hosten, N., Puls, R., Lemke, A.J., Steger, W., Zendel, W., Zwicker, C., and Felix, R. 1999. Contrast-enhanced power Doppler sonography: improved detection of characteristic flow patterns in focal liver lesions. J. Clin. Ultrasound 27:107–115.PubMedCrossRefGoogle Scholar
  28. Jenkins, L.T., Millikan, K.W., Bines, S.D., Staren, E.D., and Doolas, A. 1997. Hepatic resections for metastatic colorectal cancer. Am. Surg. 63:605–610.PubMedGoogle Scholar
  29. Jensen, J.A., Holm, O., Jensen, L.J., Bendsen, H., Nikolov, S.I., Tomov, B.G., Munk, P., Hansen, M., Salomonsen, K., Hansen, J., Gormsen, K., Pedersen, H.M., and Gammelmark, K.L. 2005. Ultrasound research scanner for real-time synthetic aperture data acquisition. IEEE. Trans. Ultrason. Ferroelectr. Freq. Control 52:881–891.PubMedCrossRefGoogle Scholar
  30. Jones, O.M., Rees, M., John, T.G., Bygrave, S., and Plant, G. 2005. Biopsy of resectable colorectal liver metastases causes tumour dissemination and adversely affects survival after liver resection. Br. J. Surg. 92:1165–1168.PubMedCrossRefGoogle Scholar
  31. Jorgensen, T., and Rafaelsen, S. 1992. Gallstones and colorectal cancer – there is a relationship, but it is hardly due to cholecystectomy. Dis. Colon Rectum 35:24–28.PubMedCrossRefGoogle Scholar
  32. Khatri, V.P., Petrelli, N.J., and Belghiti, J. 2005. Extending the frontiers of surgical therapy for hepatic colorectal metastases: is there a limit? J. Clin. Oncol. 23:8490–8499.PubMedCrossRefGoogle Scholar
  33. Kruskal, J.B., Thomas, P., Nasser, I., Cay, O., and Kane, RA. 2000. Hepatic colon cancer in mice: Dynamic in vivo correlation with hypoechoic rims visible at US. Radiology 215:852–857.PubMedGoogle Scholar
  34. Lassau, N., Koscielny, S., Opolon, P., De Baere, T., Peronneau, P., Leclere, J., and Roche, A. 2001. Evaluation of contrast-enhanced color Doppler ultrasound for the quantification of angiogenesis in vivo. Invest. Radiol. 36:50–55.PubMedCrossRefGoogle Scholar
  35. Leen, E., Angerson, W.J., Warren, H.W., O'Gorman, P., Moule, B., Carter, E.C., and Mc Ardel, C.S. 1994. Increased sensitivity of color Doppler flow imaging of colorectal hepatic metastases using galactose microparticles: a preliminary report. Br. J. Surg. 8:252–254.CrossRefGoogle Scholar
  36. Leen, E., Goldberg, J.A., Robertson, J., Angerson, W.J., Sutherland, G.R., Cooke, T.G., and McArdle, C.S. 1993. Early detection of occult colorectal hepatic metastases using duplex colour Doppler sonography. Br. J. Surg. 80:1249–1251.PubMedCrossRefGoogle Scholar
  37. Lucidarme, O., Nguyen, T., Kono, Y., Corbeil, J., Choi, SH., Varner, J., and Mattrey, R.F. 2004. Angiogenesis model for ultrasound contrast research. Acad. Radiol. 11:4–12.PubMedCrossRefGoogle Scholar
  38. Lundstedt, C., Ekberg, H., Hederstrom, E., Stridbeck, H., Torfason, B., and Transberg, K.G. 1987. Radiologic diagnosis of liver metastases in colo-rectal carcinoma. Prospective evaluation of the accuracy of angiography, ultrasonography, computed tomography and computed tomo-graphic angiography. Acta Radiol. 28:431–438.PubMedCrossRefGoogle Scholar
  39. Marchal, G.J., Plyser, K., Tshibwabwa-Tumba, E.A., Verbeken, E.K., Oyen, R.H., Baert, A.L., and Lauweryns, J.M. 1985. Anechoic halo in solid liver tumors. Radiology 156:479–483.PubMedGoogle Scholar
  40. Maruyama, H., Matsutani, S., Saisho, H., Mine, Y., Kamiyama, N., Hirata, T., and Sasamata, M. 2005. Real-time blood-pool images of contrast enhanced ultrasound with Definity in the detection of tumour nodules in the liver. Br. J. Radiol. 78:512–518.PubMedCrossRefGoogle Scholar
  41. Milsom, J.W., Jerby, B.L., Kessler, H., Hale, J.C., Herts, B.R., and O'Malley, C.M. 2000. Prospective, blinded comparison of laparoscopic ultrasonography vs. contrast-enhanced computerized tomography for liver assessment in patients undergoing colorectal carcinoma surgery. Dis. Colon Rectum 43:44–49.PubMedCrossRefGoogle Scholar
  42. Mitragotri, S. 2005. Healing sound: the use of ultrasound in drug delivery and other therapeutic applications. Nat. Rev. Drug Discov. 4:255–260.PubMedCrossRefGoogle Scholar
  43. Miyake, K., Hayakawa, K., Nishino, M., Morimoto, T., and Mukaihara, S. 2005. Effects of oral 5-fluorouracil drugs on hepatic fat content in patients with colon cancer. Acad. Radiol. 12:722–727.PubMedCrossRefGoogle Scholar
  44. Nies, C., Leppek, R., Sitter, H., Klotter, H.J., Riera, J., Klose, K.J., Schwerk, W.B., and Rothmund, M. 1996. Prospective evaluation of different diagnostic techniques for the detection of liver metas-tases at the time of primary resection of colorectal carcinoma. Eur. J. Surg. 162:811–816.PubMedGoogle Scholar
  45. Oldenburg, A., Hohmann, J., Foert, E., Skrok, J., Hoffmann, C.W., Frericks, B., Wolf, K.J., and Albrecht, T. 2005. Detection of hepatic metastases with low MI real time contrast enhanced sonogra-phy and SonoVue. Ultraschall Med. 26:277–284.PubMedCrossRefGoogle Scholar
  46. Pollard, R.E., Sadlowski, A.R., Bloch, S.H., Murray, L., Wisner, E.R., Griffey, S., and Ferrara, K.W. 2002. Contrast-assisted destruction-replenishment ultrasound for the assessment of tumor microvas-culature in a rat model. Technol. Cancer Treat. 1:459–470.Google Scholar
  47. Rafaelsen, S.R., Kronborg, O., Larsen, C., and Fenger, C. 1995. Intraoperative ultrasonography in detection of hepatic metastases from colorec-tal cancer. Dis. Colon Rectum 38:355–360.PubMedCrossRefGoogle Scholar
  48. Rafaelsen, S.R. and Solvig, J. 2004. Ultrasound imaging of flow patterns in liver metastases from colorectal cancer. Scand. J. Gastroenterol. 39:761–765.PubMedCrossRefGoogle Scholar
  49. Roumen, R.M., Scheltinga, M.R., Slooter, G.D., and van der Linden, A.W. 2005. Doppler per-fusion index fails to predict the presence of occult hepatic colorectal metastases. Eur. J. Surg. Oncol. 31:521–527.PubMedCrossRefGoogle Scholar
  50. Smyth, M.J., Takeda, K., Haykawa, Y., Peschon, J.J., van den Brink, M.R., and Yagita, H. 2003. Nature's TRAIL – on a path to cancer immuno-therapy. Immunity 18:1–6.PubMedCrossRefGoogle Scholar
  51. Tanaka, S., Ioka, T., Oshikawa, O., Hamada, Y., and Yoshioka, F. 2001. Dynamic sonography of hepatic tumors. Am. J. Radiol. 177:799–805.Google Scholar
  52. Taylor, R.H., Gilbert, J.M., Evans, M.G., Lane, H.G., and Cassell, P.G. 1984. Prospective serial liver ultrasound scanning in resectable colorec-tal cancer treated with adjuvant razoxane. Clin. Exp. Metastasis 2:321–331.PubMedCrossRefGoogle Scholar
  53. Torzilli, G., Del Fabbro, D., Palmisano, A., Donadon, M., Bianchi, P., Roncalli, M., Balzarini, L., and Montorsi, M. 2005. Contrast-enhanced intraoperative ultrasonography during hepatec-tomies for colorectal cancer liver metastases. J. Gastrointest. Surg. 9:1148–1154.PubMedCrossRefGoogle Scholar
  54. Weller, G.E., Wong, M.K., Modzelewski, R.A., Lu, E., Klibanov, A.L., Wagner, W.R., and Villanueva, F.S. 2005. Ultrasonic imaging of tumor angiogenesis using contrast micro-bubbles targeted via the tumor-binding pep-tide arginine-arginine-leucine. Cancer Res. 65:533–539.PubMedGoogle Scholar
  55. Wernecke, K., Henke, L., Vassaloo, P., von Bassewitz, D.B., Diederich, S., Peters, P.E., and Edel, G. 1992. Pathologic explanation for hyp-oechoic halo seen on sonograms of malignant liver tumors: An in vitro correlative study. Am. J. Radiol. 159:1011–1116.Google Scholar
  56. Yoo, S.K., Kim, D.K., Jung, S.M., Kim, E.K., Lim, J.S., and Kim, J.H. 2004. Performance of a web-based, realtime, tele-ultrasound consultation system over high-speed commercial telecommunication lines. J. Telemed. Telecare 10:175–179.PubMedCrossRefGoogle Scholar
  57. Yoshida, H., Casalino, D.D., Keserci, B., Coskun, A., Ozturk, O., and Savranlar, A. 2003. Wavelet-packet-based texture analysis for differentiation between benign and malignant liver tumours in ultrasound images. Phys. Med. Biol. 48:3735–753.PubMedCrossRefGoogle Scholar
  58. Yoshida, T., Matsue, H., Suzuki, M., Okazaki, N., Yoshino, M., Moriya, Y., and Hojo, K. 1989. Preoperative ultrasonography screening for liver metastases of patients with colorectal cancer. Jpn. J. Clin. Oncol. 19:112–115.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2009

Authors and Affiliations

  • Søren R. Rafaelsen
    • 1
  1. 1.Department of RadiologyVejle HospitalVejleDenmark

Personalised recommendations