The Effect of Anti-Angiogenic Agent on Metastatic Liver Tumor as Evaluated by Contrast Enhanced Ultrasonography: Preliminary Report

  • Dr Hiroshi Kitamura, National Hospital Organization, Matsumoto Medical Center, Japan
  • Dr Kan Nakagawa, National Hospital Organization, Matsumoto Medical Center, Japan
  • Dr Kazuhiko Nomura, National Hospital Organization, Matsumoto Medical Center, Japan
  • Dr Masayuki Arai, National Hospital Organization, Matsumoto Medical Center, Japan
  • Dr Shoichiro Koike, National Hospital Organization, Matsumoto Medical Center, Japan
  • Dr Yuji Uchikawa, Shinshu University School of Medicine, Department of Surgery, Japan
  • Dr Shiro Miwa, Shinshu University School of Medicine, Department of Surgery
  • Dr Shinichi Miyagawa, Shinshu University School of Medicine, Department of Surgery

    • Introduction: In three patients, the effect of an anti-angiogenic drug (bevacizmab) on tumor vessels of liver metastasis from colon cancer was evaluated by contrast enhanced ultrasonography (CEUS) .
    Methods: Three patients with liver metastasis from colon cancer underwent contrast enhanced ultrasonography (CEUS) with Sonazoid. The mean tumor size was 32 mm in diameter. Tumor blood flow was serially evaluated before and after four courses of a 5FU and Oxaliplatin-based systemic chemotherapy including bevacizumab. In a supine position, the late phase of contrast enhanced tumor image was obtained with a commercial ultrasound system (Logiq 7; GE). During the Kupffer phase, the mechanical index was temporarily increased to 1.0 causing a burst of static bubbles in the liver (manual burst). The image of moving bubbles after manual burst in the tumor was considered to correspond with tumor vessels.
    Results: In all cases, tumor vessels were clearly visualized before treatment regardless of tumor location. Tumor size at the time of repeated CEUS was decreased in one case and not changed in two cases. The tumor vessels were subjectively judged to have decreased in two cases and not changed in one case.
    Conclusions: On CEUS, tumor vessels in liver metastasis from colon cancer were more clearly visualized than on other modalities such as color Doppler and contrast CT or MRI. Therefore, further investigation of CEUS as a predictor of the effectiveness of anti-angiogenic agent is warranted.