Preoperative CT versus diffusion weighted magnetic resonance imaging of the liver in patients with rectal cancer; a prospective randomized trial

Achiam, Michael Patrick; Løgager, Vibeke; Skjoldbye, Bjørn; Møller, Jakob M.; Lorenzen, Torben; Rasmussen, Vera L.; Thomsen, Henrik S.; Mollerup, Talie; Okholm, Cecilie; Rosenberg, Jacob

doi:10.7717/peerj.1532

Cited by 13 publications

(26 citation statements)

References 24 publications

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“…Regarding DW‐MRI, an RCT demonstrated that DW‐MRI is superior to CT in terms of diagnosis of liver metastases 50 . Therefore, when contrast material cannot be used for some reason, such as allergy, DW‐MRI can be a useful substitution for EOB‐MRI for the diagnosis of liver metastases when operative resection is planned.…”

Section: Resultsmentioning

confidence: 99%

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Yamamoto

Yoshida

Furuse

et al. 2020

J Hepato Biliary Pancreat

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Background Hepatectomy is standard treatment for colorectal liver metastases; however, it is unclear whether liver metastases from other primary cancers should be resected or not. The Japanese Society of Hepato‐Biliary‐Pancreatic Surgery therefore created clinical practice guidelines for the management of metastatic liver tumors. Methods Eight primary diseases were selected based on the number of hepatectomies performed for each malignancy per year. Clinical questions were structured in the population, intervention, comparison, and outcomes (PICO) format. Systematic reviews were performed, and the strength of recommendations and the level of quality of evidence for each clinical question were discussed and determined. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations. Results The eight primary sites were grouped into five categories based on suggested indications for hepatectomy and consensus of the guidelines committee. Fourteen clinical questions were devised, covering five topics: (1) diagnosis, (2) operative treatment, (3) ablation therapy, (4) the eight primary diseases, and (5) systemic therapies. The grade of recommendation was strong for one clinical question and weak for the other 13 clinical questions. The quality of the evidence was moderate for two questions, low for 10, and very low for two. A flowchart was made to summarize the outcomes of the guidelines for the indications of hepatectomy and systemic therapy. Conclusions These guidelines were developed to provide useful information based on evidence in the published literature for the clinical management of liver metastases, and they could be helpful for conducting future clinical trials to provide higher‐quality evidence.

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Section: Resultsmentioning

confidence: 99%

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Yamamoto

Yoshida

Furuse

et al. 2020

J Hepato Biliary Pancreat

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“…Accurate detection of CRLM is vital for CRC patients due to the predictive significance for treatment and survival 33 . The prognosis of CRLM is largely dependent on the resectability of hepatic metastases 34 .…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis of CRLM is largely dependent on the resectability of hepatic metastases 34 . Although preoperative CT scan is the first-line imaging modality for metastatic liver lesions, this modality could result in either missed metastases or unnecessary operations 33 . MRI is becoming the current standard in liver metastasis detection since it displayed superior sensitivity to CT with no potential radiation hazard [35][36][37][38] .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of magnetic resonance imaging for colorectal liver metastasis: A systematic review and meta-analysis

Mao

Chen

Wang

et al. 2020

Sci Rep

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the prognosis of colorectal cancer (cRc) is largely dependent on the early detection of hepatic metastases. With the advantages of nonradioactivity and the availability of multiple scanning sequences, the efficacy of magnetic resonance imaging (MRI) in the detection of colorectal liver metastases (cRLM) is not yet clear. We performed this meta-analysis to address this issue. pubMed, embase, and the cochrane Library were searched for studies reporting diagnostic performance of MRi for cRLM. Descriptive and quantitative data were extracted. The study quality was evaluated for the identified studies and a random effects model was used to determine the integrated diagnosis estimation. Metaregression and subgroup analyses were implemented to investigate the potential contributors to heterogeneity. As a result, seventeen studies were included for analysis (from the year 1996 to 2018), comprising 1121 patients with a total of 3279 liver lesions. The pooled sensitivity, specificity, and diagnostic odds ratio were 0.90 (95% confidence intervals (CI): 0.81-0.95), 0.88 (0.80-0.92), and 62.19 (23.71-163.13), respectively. The overall weighted area under the curve was 0.94 (0.92-0.96). Using two or more imaging planes and a quantitative/semiquantitative interpretation method showed higher diagnostic performance, although only the latter demonstrated statistical significance (P < 0.05). Advanced scanning sequences with DWI and liver-specific contrast media tended to increase the sensitivity for cRLM detection. We therefore concluded that contemporary MRi has high sensitivity and specificity for screening CRLM, especially for those with advanced scanning sequences. Using two or more imaging planes and adopting a quantitative/semiquantitative imaging interpretation may further improve diagnosis. However, the MRi results should be interpreted with caution because of substantial heterogeneity among studies. Colorectal cancer (CRC) is one of the most common malignancies in the world. In recent decades, the mortality rate of CRC has decreased due to the development of diagnostic techniques and optimization of treatment strategies, including surgery, chemotherapy and palliative therapies 1. However, the incidence of CRC is increasing in the general population, especially in those younger than 40 years old 2. The prognosis of CRC patients is largely dependent on local tumor staging and the presence of distant metastasis. In those metastatic cases, the liver is the most frequently involved organ, followed by the lung 3,4. Almost one out of five patients present with liver metastases (LM) at the diagnosis of CRC 5 , and up to 50% of patients manifests LM at some time during the disease course 6 .

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“…reported that 121 equivocal hepatic lesions were detected on preoperative abdominal CT in 65 out of 494 patients (13.2%) who were diagnosed with colorectal cancer, and 11 lesions were classified as definitive metastatic lesion based on subsequent liver MRI. A prospective randomized trial [14] reported that 35 patients who were diagnosed with rectal cancer were divided into two groups, abdominal CT group (15 patients) and diffusion weighted liver MRI group (DWMR; 20 patients). The per-patient sensitivity/ specificity was 50%/100% for CT, and 100%/94% and 100%/100% for reader 1 and 2 for DWMR.…”

Section: Discussionmentioning

confidence: 99%

Suspicious T1 colon cancer with synchronous liver metastasis not detected by preoperative imaging study

Park

Moon

Lee

et al. 2019

Korean J Clin Oncol

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Colorectal carcinoma invading the submucosa but not the muscularis propria (pT1) represents the earliest form of clinically relevant colorectal cancer in most patients. T1 colorectal cancer with synchronous liver metastasis is considered to be rare. We report a rare case of T1 colon cancer with synchronous liver metastasis not detected by preoperative imaging study. A 54-year-old male patient presented to our department for treatment of sigmoid colon cancer following an endoscopic submucosal dissection. Histopathological examination revealed the pedunculated mass was moderately differentiated adenocarcinoma without lymphovascular invasion and the depth of submucosal invasion was 2,000 μm, the resection margin was not involved. We performed a laparoscopic anterior resection with lymph node dissection. After the 3 months, the patient's carcinoembryonic antigen level elevated from 1.4 to 7.26 ng/mL (normal level: <1.5 ng/mL) and the abdominal computed tomography and FDG-PET/CT (positron emission tomography-computed tomography) showed multiple hepatic metastases in both hepatic lobes (SUVmax: 5.6) without evidence of local recurrence or lymphadenopathy. We strongly suspected a synchronous liver metastasis not detected by imaging study as opposed to a systemic recurrence. Therefore, evaluation and follow-up protocol of T1 colorectal cancer should be changed for discovery and prediction of synchronous liver metastasis; because we cannot exclude the possibility of synchronous liver metastasis.

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Preoperative CT versus diffusion weighted magnetic resonance imaging of the liver in patients with rectal cancer; a prospective randomized trial

Cited by 13 publications

References 24 publications

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021

Diagnostic performance of magnetic resonance imaging for colorectal liver metastasis: A systematic review and meta-analysis

Suspicious T1 colon cancer with synchronous liver metastasis not detected by preoperative imaging study

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