Current Status of Imaging and Emerging Techniques to Evaluate Liver Metastases From Colorectal Carcinoma

Abstract

Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. Liver is a common site of tumor spread and in approximately 30% of the cases; synchronous liver disease is present at the time of diagnosis. Early detection of liver metastases is crucial to appropriately select patients who may benefit from hepatic resection among those needing chemotherapy, to improve 5-year survival. Advances in imaging techniques have contributed greatly to the management of these patients. Multidetector computed tomography is the most useful test for initial staging and in posttreatment surveillance settings. Magnetic resonance imaging is considered superior to multidetector computed tomography and positron emission tomography for the detection and characterization of small lesions and for liver evaluation in the presence of background fatty liver changes. Positron emission tomography-computed tomography has a problem-solving role in the detection of distant metastasis and in posttreatment evaluation. The advanced imaging methods also serve a role in selecting appropriate patients for radiologically targeted therapies and in monitoring response to conventional and novel therapies.

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

“…A role [12]: A, recommendation based on consistent and good-quality patient-oriented evidence; B, recommendation based on inconsistent or limited-quality patient-oriented evidence; C, recommendation based on consensus, usual practice, opinion, disease-oriented evidence or case series for studies of diagnosis, treatment, prevention or screening. for PET-CT has been suggested for detecting distant metastases [28,29]. Contrast-enhanced intraoperative ultrasound has been shown to improve both the sensitivity of intraoperative ultrasonography to detect LM and the rate of complete resection of hepatic metastases in patients undergoing surgery for CRCLM after chemotherapy [30].…”

Image-guided Treatment in the Hepatobiliary System: Role of Imaging in Treatment Planning and Posttreatment Evaluation

“…PET/CT also improves disease staging and enables treatment selection in patients with thyroid, melanoma, or carcinoid tumors. However, PET/CT has a limited role in evaluation of small liver lesions, particularly liver metastases from colorectal cancer, and pancreatic cancers smaller than 1 cm (57). Dynamic contrast-enhanced MR imaging, with extracellular contrast agents or gadoxetate disodium, is superior to PET/CT for detection of subcentimeter hepatic lesions.…”

Complex Surgical Strategies to Improve Resectability in Borderline-Resectable Disease

“…Although bias exists in the choice of tests ordered in the workup of CRLM, modern imaging techniques such as multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) (with or without hepatobiliary contrast agents), and fluorodeoxyglucose positron emission tomography (FDGPET) are all frequently utilized in the radiologic assessment of metastatic CRC. Overall, the difference in accuracy between MDCT, MRI, and FDG-PET in detecting CRLM ranges from 72 to 98 % in the literature for tumors larger than 1 cm [13••].…”