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DOI: 10.1055/s-2000-7984
Hepatischer Doppler Perfusionsindex - eine geeignete Screeningmethode zur Erkennung von Lebermetastasen?
Publikationsverlauf
Publikationsdatum:
10. November 2003 (online)
Zusammenfassung
Die sonographische Messung des Doppler-Perfusionsindex (DPI) - das Verhältnis des Flusses in der A. hepatica zum Gesamtblutfluss der Leber - ist nach Literaturangaben ein sensitives Früherkennungsinstrumentarium zur Erkennung von Lebermetastasen. Studienziel: Evaluierung der DPI-Messung bei unseren Patienten mit Lebermetastasen kolorektaler Karzinome, Magen- und Bronchialkarzinome. Methode: 36 Patienten mit Lebermetastasen wurden mit 21 Kontrollpersonen verglichen. Die Blutflussvolumina der A. hepatica und der V. portae wurden als Produkt der mittleren Strömungsgeschwindigkeit und des Gefäßquerschnitts berechnet. Jede Messung wurde dreimal von zwei unabhängigen Untersuchern durchgeführt. Ergebnisse: Patienten mit Metastasen hatten im Vergleich zur Kontrollgruppe einen signifikant höheren Fluss in der A. hepatica sowie einen signifikant höheren DPI (p = 0,0004, MW ± SD 0,23 ± 0,11 versus 0,14 ± 0,06). Im Untersuchervergleich lagen die Abweichungen der DPI-Werte bei 25,98 % ± 23,20. Schlussfolgerungen: Der DPI ist bei Patienten mit Lebermetastasen signifikant höher als bei Gesunden aufgrund eines erhöhten Hepaticaflusses. Aufgrund des breiten Überlappungsbereichs des DPI war eine sichere Zuordnung zu einer der beiden Gruppen jedoch nicht möglich. Die Inter-Untersuchervariabilität liegt in einem akzeptablen Bereich.
Hepatic Doppler Perfusion Index - a Sensitive Tool for Detection of Liver Metastases?
The sonographic measurement of the Doppler perfusion index (DPI) - the ratio of blood flow in the hepatic artery to total liver blood flow - has been suggested to represent a method of detecting even small liver metastases. Aim: To evaluate the DPI measurement in our patients with liver metastases of colorectal cancer, gastric and bronchial carcinoma. Method: 36 patients with liver metastases were compared to 21 control subjects. The hepatic arterial and portal venous blood flows were calculated from the product of the average velocity of flow and the cross-sectional lumen of the vessel. Each measurement was performed three times by two independent examiners. Results: Patients with metastases had a significantly higher hepatic blood flow and a significantly higher DPI (p = 0.0004; M ± SD 0.23 ± 0.11; r 0.06 - 0.52) compared with controls (M ± SD 0.14 ± 0,06, r. 0.05 - 0.26). No significant difference was seen in the portal vein blood flow. The DPI-values measured by the two examiners differed by 25.98 % ± 23.20. Conclusion: DPI values in patients with liver metastases differ from those in control subjects due to an increased hepatic arterial blood flow. No clear separation of the two groups was possible because DPI values overlapped. The inter observer agreement in DPI seems clinically acceptable.
Schlüsselwörter:
Doppler - DPI - Lebermetastasen - Leberdurchblutung
Key words:
Doppler - DPI - Liver metastases - Liver perfusion
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Dr. med. Susanne Krüger
Krankenhaus München Neuperlach
Oskar-Maria-Graf-Ring 51
81737 München
eMail: DrSusanneKrueger@aol.com