Detection and characterisation of focal liver lesions in colorectal carcinoma patients: comparison of diffusion-weighted and Gd-EOB-DTPA enhanced MR imaging

Löwenthal, David; Zeile, Martin; Lim, W. Y.; Wybranski, Christian; Fischbach, Frank; Wieners, Gero; Pech, Maciej; Kropf, Siegfried; Ricke, Jens; Dudeck, Oliver

doi:10.1007/s00330-010-1977-2

Cited by 121 publications

(98 citation statements)

References 25 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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“…Parallel techniques reduce artifacts, such as "blurring" or magnetic susceptibility artifacts, increasing the signal-to-noise ratio (SNR) [10,11] ; moreover, respiratory-triggered sequences offer a better possibility of SNR compared to breath-hold techniques [12] . Many studies have recently started to compare DWI to T1-weighted acquisition in the detection and characterization of liver lesions [13][14][15] . In diffusion imaging of the liver, the first difficulty concerns the choice of the appropriate b-value, which means the degree of weighting in diffusion.…”

Section: Introductionmentioning

confidence: 99%

“…�igh b-values cannot be used because of the low SNR they determine: for these reasons, in this study we retrospectively evaluin this study we retrospectively evaluated the ability to detect lesions using relatively low b-value DWI (b-values extended from b = 0-10 to b = 0-500) in a routine liver MRI protocol. The characterization of FLLs was not considered in our work, because the role of DWI in this regard has already been widely debated in previous studies [5,15] , and seems to be limited by overlapping [16] . In the detection of FLLs, diffusion weighted sequences were compared to fat suppressed fast spin-echo (fs-FSE) T2-weighted sequences, steady state free-precession (SSFP) sequences and dynamic triphasic gadoliniumenhanced acquisition, acquired with 3D fast spoiled gradient echo (FSPGR), emphasizing their advantages and limits.…”

Section: Introductionmentioning

confidence: 99%

Diffusion-weighted MRI in a liver protocol: Its role in focal lesion detection

Palmucci

Mauro²,

Messina³

et al. 2012

WJR

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AIM:To evaluate the role of diffusion-weighted imaging (�WI) in the detection of focal liver lesions (FLLs), using a conventional magnetic resonance imaging (MRI) protocol. METHODS:Fifty-two patients (22 males, average age 55.6 years, range: 25-82 years), studied using a 1.5 Tesla magnetic resonance scanner, were retrospectively analyzed; detection of FLLs was evaluated by considering the number of lesions observed with the following sequences: (1) respiratory-triggered diffusion-weighted single-shot echo-planar (�W SS-EP) sequences; (2) fat-suppressed fast spin-echo (fs-FSE) T2 weighted sequences; (3) steady-state free precession (SSFP) images; and (4) dynamic triphasic gadolinium-enhanced images, acquired with three-dimensional fast spoiled gradient-echo (3� FSPGR). Two radiologists independently reviewed the images: they were blinded to their respective reports. �W SS-EP sequences were compared to fs-FSE, SSFP and dynamic gadolinium-enhanced acquisitions using a t -test. Pairs were compared for the detection of: (1) all FLLs; (2) benign FLLs; (3) malignant FLLs; (4) metastases; and (5) hepatocellular carcinoma (HCC). RESULTS:Interobserver agreement was very good (weighted k = 0.926, CI = 0.880-0.971); on the consensus reading, 277 FLLs were detected. In the comparison with fs-FSE, DW SS-EP sequences had a significantly higher score in the detection of all FLLs, benign FLLs, malignant FLLs and metastases; no statistical difference was observed in the detection of hepatocellular carcinoma (HCCs). In the comparison with SSFP sequences, DW SS-EP had significantly higher scores (P < 0.05) in the detection of all lesions, benign lesions, malignant lesions, metastases and HCC. All FLLs were better detected by dynamic 3� FSGR enhanced acquisition, with P = 0.0023 for reader 1 and P = 0.0086 for reader 2 in the comparison with �W SS-EP sequences; with reference to benign FLLs, �W SS-EP showed lower values than 3� FSPGR enhanced acquisition (P < 0.05). No statistical differences were observed in the detection of malignant lesions and metastases; considering HCCs, a very slight difference was reported by reader 1 (P = 0.049), whereas no difference was found by reader 2 (P = 0.06). CONCLUSION:In lesion detection, �WI had higher scores than T2 sequences; considering malignant FLLs, no statistical difference was observed between �WI and dynamic gadolinium images.

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“…Therefore, high-quality imaging of the liver and abdomen is needed shortly before surgery to avoid false-negative results. High-quality imaging means contrast-enhanced dynamic scanning using CT and/or MRI and, in the case of MRI, DWI besides the standard sequences [34,35]. For both CT and MRI these prerequisites for liver imaging are compatible with pancreatic imaging optimized for resectability assessment.…”

Section: Livermentioning

confidence: 99%

Radiologic Resectability Assessment in Pancreatic Cancer

Denecke

Grieser

Bahra

2013

Fortschr Röntgenstr

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Complete tumor resection is still the only potentially curative therapy option for patients with ductal adenocarcinoma of the pancreas. Surgical exploration is the gold standard for the determination of tumor resectability. Radiological resectability assessment is of great importance because many clearly unresectable cases can be identified preoperatively and it became essential for surgical planning. The evolving surgical and radiological techniques demand a continuous reappraisal of radiological criteria in resectability assessment. In the following, the criteria for resection planning are described along with surgical management and the role of radiology in some innovative surgical concepts is explained. Citation Format:

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Detection and characterisation of focal liver lesions in colorectal carcinoma patients: comparison of diffusion-weighted and Gd-EOB-DTPA enhanced MR imaging

Abstract: Late-phase Gd-EOB-DTPA-enhanced images were superior for the detection of FLLs, while DWIs were most valuable for the identification of particularly small metastases. Combined interpretation of unenhanced images resulted in precise characterisation of FLLs.

Cited by 121 publications

References 25 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

Diffusion-weighted MRI in a liver protocol: Its role in focal lesion detection

Radiologic Resectability Assessment in Pancreatic Cancer

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