Combining diffusion-weighted MRI with Gd-EOB-DTPA-enhanced MRI improves the detection of colorectal liver metastases

Koh, Dow‐Mu; Collins, David J.; Wallace, Toni; Chau, Ian; Riddell, Angela M.

doi:10.1259/bjr/91771639

Cited by 87 publications

(60 citation statements)

References 23 publications

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“…7), was noteworthy. Previous studies have suggested that the combination of DWI with hepatospecific contrast-enhanced sequences may improve our ability to detect colorectal liver metastases [13][14][15][16][17][18]. However, these data were obtained in small, heterogenous series.…”

Section: Discussionmentioning

confidence: 97%

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Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy

et al. 2012

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Objectives To compare the diagnostic accuracy and sensitivity of Gd-EOB-DTPA MRI and diffusion-weighted (DWI) imaging alone and in combination for detecting colorectal liver metastases in patients who had undergone preoperative chemotherapy. Methods Thirty-two consecutive patients with a total of 166 liver lesions were retrospectively enrolled. Of the lesions, 144 (86.8 %) were metastatic at pathology. Three image sets (1, Gd-EOB-DTPA; 2, DWI; 3, combined Gd-EOB-DTPA and DWI) were independently reviewed by two observers. Statistical analysis was performed on a per-lesion basis. Results Evaluation of image set 1 correctly identified 127/ 166 lesions (accuracy 76.5 %; 95 % CI 69.3-82.7) and 106/ 144 metastases (sensitivity 73.6 %, 95 % CI 65.6-80.6). Evaluation of image set 2 correctly identified 108/166 (accuracy 65.1 %, 95 % CI 57.3-72.3) and 87/144 metastases (sensitivity of 60.4 %, 95 % CI 51.9-68.5). Evaluation of image set 3 correctly identified 148/166 (accuracy 89.2 %, 95 % CI 83.4-93.4) and 131/144 metastases (sensitivity 91 %, 95 % CI 85.1-95.1). Differences were statistically significant (P<0.001). Notably, similar results were obtained analysing only small lesions (<1 cm). Conclusions The combination of DWI with Gd-EOB-DTPAenhanced MRI imaging significantly increases the diagnostic accuracy and sensitivity in patients with colorectal liver metastases treated with preoperative chemotherapy, and it is particularly effective in the detection of small lesions. Key Points • Accurate detection of colorectal liver metastases is essential to determine resectability.• Almost 80 % of patients are candidates for neoadjuvant chemotherapic treatment at diagnosis. After chemotherapy, metastases usually decrease, and drug-induced liver steatosis may be present.• The sensitivity of imaging is significantly inferior to that in chemotherapy-naïve patients.• DWI combined with Gd-EOB-DTPA increases sensitivity in detecting small metastases after chemotherapy.

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Section: Discussionmentioning

confidence: 97%

“…one-or two-stage hepatectomy). In recent years, however, the efficacy of the newer cytotoxic agents has expanded the use of systemic chemotherapy in the preoperative setting before liver resection in both unresectable and resectable patients [14][15][16]. As a consequence, post-chemotherapy evaluation has become a routine challenge.…”

Section: Discussionmentioning

confidence: 99%

Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy

et al. 2012

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“…(21) However, there is mounting evidence in the literature of the superior sensitivity of MR imaging in detecting and characterising liver lesions compared with CT, particularly when combined with the use of a specific hepatobiliary contrast agent and DWI. (22) While most of the data relates to colorectal cancer liver metastasis, MR imaging has been shown to be equally useful with other malignancies. (18) This study supports the findings from previous studies that suggested increased detection of liver metastases in patients with pancreatic cancer on MR imaging.…”

Section: Discussionmentioning

confidence: 99%

The value of liver magnetic resonance imaging in patients with findings of resectable pancreatic cancer on computed tomography

Chew¹,

O’Dwyer²

2015

smedj

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INTRODUCTIONPancreatic cancer has an incidence rate of 13.6 per 100,000 in the United Kingdom.(1) Most patients with pancreatic cancer have advanced disease at the time of diagnosis, and their overall fiveyear survival rate is less than 5%, although this rate is estimated to rise to 10%-20% after curative surgery.(2-7) Curative and palliative operations are associated with an average inpatient stay of two weeks, a mortality rate of up to 5% and morbidity rates of 20%-50%.(8-10) Patient recovery is often slow and accompanied by further intervention. As a result, hospital and societal costs are high. Therefore, accurate patient staging is critical in order to avoid unnecessary operations.Magnetic resonance (MR) imaging, when used with a hepatocyte-specific contrast agent, has increased sensitivity and specificity compared to computed tomography (CT).(11) Therefore, MR imaging is now routinely used for disease staging in patients with colorectal or other operable liver diseases who are suitable for liver resection. The reported sensitivity of MR imaging in detecting liver metastasis is 81%-92%, compared to 70%-87% for multidetector CT (MDCT). (12,13) No guideline exists on separate and specific staging of the liver in the setting of pancreatic cancer, although international guidelines recommend staging using contrast-enhanced MDCT while reserving MR imaging for indeterminate liver lesions encountered on CT. (14,15) The aim of this study was to prospectively assess the impact of liver MR imaging on the preoperative staging of patients with findings of resectable pancreatic cancer on CT. METHODSAll patients referred to a regional centre for evaluation and treatment of suspected pancreatic cancer between April 2012 and December 2013 were included in this study. Investigations performed included CT (performed in the portal venous phase, 64-slice MDCT) of the chest, abdomen and pelvis, and endoscopic ultrasonography (EUS) with fine-needle aspiration biopsy of the pancreatic mass and suspicious adjacent lymph nodes.The imaging, pathologic and clinical findings were discussed at weekly multidisciplinary meetings attended by consultant surgeons, radiologists, pathologists and oncologists with a special interest in pancreatic cancer. Patients with pathologically confirmed pancreatic cancer deemed resectable on CT and EUS proceeded to MR imaging of the liver prior to surgery or neoadjuvant chemotherapy. The decision on resectability was based on established criteria (American Hepato-Pancreato-Biliary Association/Society of Surgical Oncology/Society for Surgery of the Alimentary Tract).(16,17) Institutional Review Board approval was sought but not deemed necessary, as we were already routinely using MR imaging to stage patients with metastatic colorectal cancer who were being assessed for liver resection in our department. As part of the staging process, all patients undergoing operation for resectable pancreatic cancer had undergone prior laparoscopy to exclude peritoneal metastasis.Patients were examined using a Magnatom® A...

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“…While several articles and 1 meta-analysis show that combining DW-MRI with gadoxetic acid-enhanced MRI significantly improves the detection of colorectal liver metastases [43][44][45][46] , such studies are missing in NET.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Morphological and Functional Imaging for Detecting and Assessing the Resectability of Neuroendocrine Liver Metastases

Ronot

Clift²,

Baüm³

et al. 2017

Neuroendocrinology

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This review evaluates the diagnostic efficacy of different morphological and functional imaging modalities (ultrasound [US], computed tomography [CT], magnetic resonance [MR] imaging, scintigraphy, and positron emission tomography [PET]) in detecting neuroendocrine liver metastases (NELM), assessing vascular and biliary involvement, and the presence of extrahepatic disease. MR imaging is superior for depicting NELM compared to US, CT, and somatostatin receptor scintigraphy. Diffusion-weighted MR imaging is more sensitive for detecting NELM than both T2-weighted and dynamic gadolinium-enhanced MR sequences, and should be systematically performed. Similarly, gadoxetic acid-enhanced MR imaging is more sensitive for detecting liver metastases than conventional extracellular gadolinium chelate-enhanced MR sequences. Its role in detecting NELM remains investigational but appears promising. Somatostatin receptor-targeted PET/CT is a highly effective approach in assessing the resectability of well-differentiated NELM due to very high specificity (and high sensitivity) and its ability to detect small volume extrahepatic disease; this molecular imaging modality is becoming increasingly available in and outside Europe after the recent approval of ⁶⁸68-DOTATATE in the US. In addition, the information from multiphase, contrast-enhanced CT with 3D reconstruction - obtained concurrently with the information on somatostatin receptor expression of the metastases - is very helpful in planning the extent and type of resection of NELM.

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Combining diffusion-weighted MRI with Gd-EOB-DTPA-enhanced MRI improves the detection of colorectal liver metastases

Cited by 87 publications

References 23 publications

Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy

Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy

The value of liver magnetic resonance imaging in patients with findings of resectable pancreatic cancer on computed tomography

Morphological and Functional Imaging for Detecting and Assessing the Resectability of Neuroendocrine Liver Metastases

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