Comparative Diagnostic Performance of Multiparametric Ultrasound Versus Contrast-Enhanced Computed Tomography the Differential Diagnosis of Focal Liver Lesions in Colorectal Cancer
Vol. 71 No. 6 (2025), ORIGINAL ARTICLES. CLINICAL RESEARCH
Vol. 71 No. 6 (2025)

Comparative Diagnostic Performance of Multiparametric Ultrasound Versus Contrast-Enhanced Computed Tomography the Differential Diagnosis of Focal Liver Lesions in Colorectal Cancer

ORIGINAL ARTICLES. CLINICAL RESEARCH
https://doi.org/10.37469/0507-3758-2025-71-6-OF-2539
Published 30.12.2025
Kseniia Vyacheslavovna Kozubova
N.N. Petrov National Medicine Research Center of Oncology, St. Petersburg, the Russian Federation; St. Petersburg State University St. Petersburg, the Russian Federation
https://orcid.org/0000-0001-9611-0439
Ekaterina Aleksandrovna Busko
N.N. Petrov National Medicine Research Center of Oncology, St. Petersburg, the Russian Federation
https://orcid.org/0000-0002-0940-6491
Denis Valeryevich Nesterov
N.N. Petrov National Medicine Research Center of Oncology, St. Petersburg, the Russian Federation; North-Western State Medical University named after I.I. Mechnikov, the Russian Federation
https://orcid.org/0000-0002-8022-6864
Ilya Aleksandrovich Burovick
N.N. Petrov National Medicine Research Center of Oncology, St. Petersburg, the Russian Federation; St. Petersburg State University St. Petersburg, the Russian Federation
https://orcid.org/0000-0002-4714-1228
Sergey Sergeevich Bagnenko
N.N. Petrov National Medicine Research Center of Oncology, St. Petersburg, the Russian Federation; St. Petersburg State Pediatric Medical University, St. Petersburg, the Russian Federation
https://orcid.org/0000-0002-4131-6293
Roman Andreevich Kadyrleev
N.N. Petrov National Medicine Research Center of Oncology, St. Petersburg, the Russian Federation; St. Petersburg State University St. Petersburg, the Russian Federation
https://orcid.org/0000-0001-6576-1087
Elvira Sergeevna Filonova
N.N. Petrov National Medicine Research Center of Oncology, St. Petersburg, the Russian Federation;
https://orcid.org/0000-0002-2038-3964
Valeriia Valeryevna Nesterova
N.N. Petrov National Medicine Research Center of Oncology, St. Petersburg, the Russian Federation
https://orcid.org/0009-0003-6798-5537
Pavel Vasilievich Balahnin
N.N. Petrov National Medicine Research Center of Oncology, St. Petersburg, the Russian Federation
https://orcid.org/0000-0002-3042-6729
##article.numberofdownloads## 0
##article.numberofviews## 2
pdf (Русский)

Keywords

colorectal cancer
liver metastases
contrast-enhanced ultrasound
computed tomography
diagnostic imaging

How to Cite

Kozubova, K. V., Busko, E. A., Nesterov, D. V., Burovick, I. A., Bagnenko, S. S., Kadyrleev, R. A., Filonova, E. S., Nesterova, V. V., & Balahnin, P. V. (2025). Comparative Diagnostic Performance of Multiparametric Ultrasound Versus Contrast-Enhanced Computed Tomography the Differential Diagnosis of Focal Liver Lesions in Colorectal Cancer. Voprosy Onkologii, 71(6), OF–2539. https://doi.org/10.37469/0507-3758-2025-71-6-OF-2539
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver

Abstract

Introduction. Liver metastasis represents a critical prognostic determinant in colorectal cancer (CRC). Precise imaging characterization of focal liver lesions directly impacts staging accuracy, treatment planning, and the need for additional diagnostic procedures. While various radiological modalities yield distinct imaging patterns that enable confident lesion characterization without further studies, the effect of chemotherapy on these patterns and their diagnostic specificity remains understudied.

Aim. To compare the diagnostic yield of specific imaging features for focal liver lesions using grayscale ultrasound (US), contrast-enhanced ultrasound (CEUS), and contrast-enhanced computed tomography (CECT) in patients with CRC.

Materials and Methods. This prospective study included 35 CRC patients (12 chemotherapy-naïve, 23 post-chemotherapy). All participants underwent comprehensive imaging evaluation comprising B-mode US, CEUS, and multiphase CECT. Imaging analysis focused on lesion characterization and identification of specific enhancement patterns enabling definitive lesion classification.

Results. CEUS demonstrated superior performance in detecting specific diagnostic features compared to both grayscale US and CECT. Notably, CEUS maintained high pattern specificity in the post-chemotherapy cohort, while CECT specificity declined to 86 %.

Conclusion. CEUS provides optimal diagnostic yield for characterizing focal liver lesions while maintaining consistent performance post-chemotherapy. Standardized contrast enhancement patterns enable reliable metastasis-benign differentiation. Chemotherapy does not reduce the diagnostic effectiveness of CEUS, whereas with CT the specificity of patterns decreases. CEUS can serve as a first-line modality for lesion verification after initial US detection and as a valuable alternative to CT in cases of diagnostic uncertainty or contraindications to CT.

https://doi.org/10.37469/0507-3758-2025-71-6-OF-2539
##article.numberofdownloads## 0
##article.numberofviews## 2
pdf (Русский)

References

Horn S.R., Amini N., Monjazeb A.M., et al. Epidemiology of liver metastases. Cancer Epidemiology. 2020; 67: 101760.-DOI: https://doi.org/10.1016/j.canep.2020.101760.

Väyrynen V., Wirta E.-V., Seppälä T., et al. Incidence and management of patients with colorectal cancer and synchronous and metachronous colorectal metastases: a population-based study. BJS Open. 2020; 4(4): 685–692.-DOI: https://doi.org/10.1002/bjs5.50299.

Engstrand J., Nilsson H., Strömberg C., et al. Colorectal cancer liver metastases: a population-based study on incidence, management and survival. BMC Cancer. 2018; 18: 78.-DOI: https://doi.org/10.1186/s12885-017-3925-x.

Martin J., Gholami S., Bachellier P., et al. Colorectal liver metastases: current management and future perspectives. World J Clin Oncol. 2020; 11(10): 761–808.-DOI: https://doi.org/10.5306/wjco.v11.i10.761.

Reboux N., Jooste V., Goungounga J., et al. Incidence and survival in synchronous and metachronous liver metastases from colorectal cancer. JAMA Network Open. 2022; 5(10): e2236666.-DOI: https://doi.org/10.1001/jamanetworkopen.2022.36666.

Dietrich C.F., Averkiou M., Barr R.G., et al. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the liver — update 2020. Ultrasound Med Biol. 2020; 46(10): 2579–2604.-DOI: https://doi.org/10.1016/j.ultrasmedbio.2020.04.030.

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(1): 123–131.-DOI: https://doi.org/10.1148/radiol.2371042060.

Tsili A.C., Alexiou G., Naka C., et al. Imaging of colorectal cancer liver metastases using CEUS, multidetector CT, MRI, and FDG PET/CT: a meta-analysis. Acta Radiologica. 2021; 62(3): 302–312.-DOI: https://doi.org/10.1177/0284185120925481.

Xu L.-H., Cai S.-J., Cai G.-X., Peng W.-J. Imaging diagnosis of colorectal liver metastases. World J Gastroenterol. 2011; 17(42): 4654–4659.-DOI: https://doi.org/10.3748/wjg.v17.i42.4654.

Viganò L., Sollini M., Ieva F., et al. Chemotherapy-associated liver injuries: unmet needs and new insights for surgical oncologists. Ann Surg Oncol. 2021; 28(8): 4074–4079.-DOI: https://doi.org/10.1245/s10434-021-10069-z.

Sun L., Yin S., Xing B., et al. Contrast-enhanced ultrasound with sonovue and sonazoid for the diagnosis of colorectal liver metastasis after chemotherapy. J Ultrasound Med. 2023; 42(2): 355–362.-DOI: https://doi.org/10.1002/jum.16042.

Freitas P.S., Mamoni R.L., Ferreira M.C., et al. Imaging evaluation of the liver in oncology patients: a comparison of techniques. World J Hepatol. 2021; 13(12): 1936–1955.-DOI: https://doi.org/10.4254/wjh.v13.i12.1936.

Paulatto L., Donadon M., Fard N., et al. Colorectal liver metastases: radiopathological correlation. Insights into Imaging. 2020; 11: 110.-DOI: https://doi.org/10.1186/s13244-020-00904-4.

Busko E.A., Bagnenko S.S., Kozubova K.V., et al. Comparative assessment of CT and CEUS in colorectal cancer liver metastases diagnosis. Annals of HPB Surgery. 2022; 27(1): 22–32.-DOI: https://doi.org/10.16931/1995-5464.2022-1-22-32.

Murphy-Lavallee J., Kavanagh R., Mawdsley C., et al. Are metastases really hypovascular in the arterial phase? J Ultrasound Med. 2007; 26(11): 1545–1556.-DOI: https://doi.org/10.7863/jum.2007.26.11.1545.

Liu W., Li J., Zhang X., et al. Contrast-enhanced intraoperative ultrasound improved sensitivity and PPV in colorectal liver metastasis: a systematic review and meta-analysis. Ann Surg Oncol. 2021; 28(7): 3763–3773.-DOI: https://doi.org/10.1245/s10434-020-09365-x.

Lund M., Bjerre T.A., Grønbæk H., et al. CEUS compared with CECT, MRI, and FDG-PET/CT for diagnosing CRC liver metastases: a diagnostic test accuracy systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol. 2024; 18(9): 541–549.-DOI: https://doi.org/10.1080/17474124.2024.2407973.

Sawatzki M., Güller U., Güsewell S., et al. Contrast-enhanced ultrasound can guide the therapeutic strategy by improving the detection of colorectal liver metastases. J Hepatol. 2021; 74(2): 419–427.-DOI: https://doi.org/10.1016/j.jhep.2020.09.036.

Stavrou G.A., Bala A., Kakar S., et al. Intraoperative (contrast-enhanced) ultrasound has the highest diagnostic accuracy in resection of colorectal liver metastases. J Gastrointest Surg. 2021; 25(12): 3160–3169.-DOI: https://doi.org/10.1007/s11605-021-04925-2.

Zhang L., Zhang L., Wang H., et al. Diagnostic performance of CEUS and MRI for detecting colorectal liver metastases: a systematic review and meta-analysis. Dig Liver Dis. 2019; 51(9): 1241–1248.-DOI: https://doi.org/10.1016/j.dld.2019.06.004.

Konopke R., Bunk A., Kersting S., et al. Contrast-enhanced ultrasonography in patients with colorectal liver metastases after chemotherapy. Ultraschall in der Medizin. 2008; 29: 203–209.-DOI: https://doi.org/10.1055/s-2008-1027795.

Robinson P.J.A. The effects of cancer chemotherapy on liver imaging. Eur Radiol. 2009; 19(7): 1752–1762.-DOI: https://doi.org/10.1007/s00330-009-1333-6.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

© АННМО «Вопросы онкологии», Copyright (c) 2025

Most read articles by the same author(s)