Differentiating metastatic mucinous colorectal adenocarcinomas from simple cysts of the liver using contrast-enhanced and diffusion-weighted MRI

Lee, Ji Eun; Kim, Seong Hyun; Lee, Sun Young; Choi, Sung Yong; Hwang, Jeong Ah; Woo, Sook‐Young

doi:10.1259/bjr.20180303

Cited by 7 publications

(10 citation statements)

References 23 publications

(36 reference statements)

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“…Indeed, the combination of these signs has been shown to be 95% specific for the diagnosis of mucinous metastases [47]. Moreover, the ADC values of mucinous metastases tend to be lower, with higher signal intensity on hepatobiliary phase images compared to cysts [47]. These features are consistent with the presence of fibrotic tissue surrounding the extracellular mucin pools.…”

Section: Ct and Mrimentioning

confidence: 83%

“…Peripheral rim or subtle inner enhancement can help exclude simple benign hepatic cysts. Indeed, the combination of these signs has been shown to be 95% specific for the diagnosis of mucinous metastases [47]. Moreover, the ADC values of mucinous metastases tend to be lower, with higher signal intensity on hepatobiliary phase images compared to cysts [47].…”

Section: Ct and Mrimentioning

confidence: 99%

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Colorectal liver metastases: radiopathological correlation

et al. 2020

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With the development of chemotherapy regimens, targeted therapies, and hepatic surgery, the survival of patients with colorectal liver metastases (CRLM) has dramatically improved. Imaging plays a central role for the diagnosis, staging, and treatment allocation in these patients. To interpret CRLM on imaging, radiologists must be familiar with the main imaging features of untreated tumors as well as the modifications induced by systemic therapies, and their meaning in relation to pathological tumor response and tumor biology. CRLM have the same histological features as the primary tumor. Most are "non-otherwise specified" (NOS) adenocarcinomas. The mucinous tumor is the most common of the rare subtypes. In NOS tumors, imaging usually differentiates central areas of necrosis from peripheral proliferating tumors and desmoplastic reaction. Areas of mucin mixed with fibrosis are seen in mucinous subtypes to help differentiate the metastases from other tumors cysts or hemangiomas. After treatment, the viable tumor is gradually replaced by ischemic-like necrosis and fibrosis, and remnants cells are mainly located on the periphery of tumors. Imaging can help predict the degree of tumor response, but changes can be difficult to differentiate from the pretherapeutic appearance. When chemotherapy is interrupted or in case of resistance to treatment, a peripheral infiltrating halo of tumor growth may appear. The purpose of the article is to illustrate the significance of the imaging features of colorectal liver metastases during systemic therapy, using radiopathological correlations.

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Section: Ct and Mrimentioning

confidence: 83%

Section: Ct and Mrimentioning

confidence: 99%

Colorectal liver metastases: radiopathological correlation

et al. 2020

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“…Variable. (36) Variable (27,36) Delayed enhancement, less than fibrosis (26,27,36,40) Increased ADC value (41) Fibrosis (Figures 3C,D,H) Low signal relative to liver (27) Low signal relative to liver (27,36) Late enhancement (26,42,43) Increased ADC value (44, 45) Mucin (Figures 3E, F) High signal (46) Low signal (46) No enhancement (46) Increased ADC value (46)…”

Section: T2 Signal T1 Signal Enhancement Diffusionmentioning

confidence: 99%

“…Defining the internal composition of metastases may help to categorise tumour biology and thus influence immunological and surgical strategy recently described Consensus Molecular Subtypes (CMS) of colorectal liver metastases ( 11 ), can be characterized by particular histopathological features and could be categorized by imaging. The molecular subtyping of liver metastases may be important even in patients when a resected primary tumour specimen is available, as significant discordance exists between primary and metastatic molecular subtypes ( 46 , 48 , 49 ). Within-patient heterogeneity is implicated as the root cause of a variable immunological response between primary and metastatic lesions ( 50 , 51 ).…”

Section: Radiopathological Features Of Crlmmentioning

confidence: 99%

Comprehensive Imaging Characterization of Colorectal Liver Metastases

et al. 2021

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Colorectal liver metastases (CRLM) have heterogenous histopathological and immunohistochemical phenotypes, which are associated with variable responses to treatment and outcomes. However, this information is usually only available after resection, and therefore of limited value in treatment planning. Improved techniques for in vivo disease assessment, which can characterise the variable tumour biology, would support further personalization of management strategies. Advanced imaging of CRLM including multiparametric MRI and functional imaging techniques have the potential to provide clinically-actionable phenotypic characterisation. This includes assessment of the tumour-liver interface, internal tumour components and treatment response. Advanced analysis techniques, including radiomics and machine learning now have a growing role in assessment of imaging, providing high-dimensional imaging feature extraction which can be linked to clinical relevant tumour phenotypes, such as a the Consensus Molecular Subtypes (CMS). In this review, we outline how imaging techniques could reproducibly characterize the histopathological features of CRLM, with several matched imaging and histology examples to illustrate these features, and discuss the oncological relevance of these features. Finally, we discuss the future challenges and opportunities of CRLM imaging, with a focus on the potential value of advanced analytics including radiomics and artificial intelligence, to help inform future research in this rapidly moving field.

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“…There has been some discussion regarding the ability of preoperative imaging techniques such as positron emission tomography (PET) and magnetic resonance imaging (MRI) to determine whether or not a CRCLM contains mucin ( 21 , 22 ). Several features on MRI such as high signal intensity on T2 weighted imaging and rim enhancement can be helpful in identifying mucinous CRCLM, however, not all cases can be identified by these features ( 23 , 24 ). The relevance in determining whether a CRCLM contains mucin or not is unknown and in some cases metastatic lesions may have a mucin component which is due to preoperative treatment response.…”

Section: Introductionmentioning

confidence: 99%

An Analysis of Clinicopathological Outcomes and the Utility of Preoperative MRI for Patients Undergoing Resection of Mucinous and Non-Mucinous Colorectal Cancer Liver Metastases

et al. 2022

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Background and AimsMucinous colorectal cancer has traditionally been associated with high rates of recurrence and poor long-term survival. There is limited published data on outcomes for patients undergoing liver resection for metastatic mucinous colorectal cancer. The aim of this study was to compare the clinicopathological outcomes for patients with mucinous colorectal cancer liver metastases (CRCLM) undergoing liver resection to a matched group of patients with adenocarcinoma not otherwise specified (NOS) and to evaluate the accurary of preoperative magnetic resonance imaging (MRI) at detecting the presence of mucin in liver metastases.Materials and MethodsPatients with mucinous CRCLM undergoing liver resection were matched 1:3 to patients with adenocarcinoma NOS CRCLM. Clinicopathological data from the primary tumour and metastatic lesion were collected and compared between the groups. Hepatic recurrence-free, disease-free and overall survival were compared between the groups. The ability of preoperative MRI to detect mucin in CRCLM was also evaluated.ResultsA total of 25 patients with mucinous CRCLM underwent surgery over the 12-year period and were matched to 75 patients with adenocarcinoma NOS. Clinicopathological findings were similar between the groups. Resection of mucinous CRCLM was feasible and safe with similar levels of morbidity to adenocarcinoma NOS. There were no differences identified in hepatic recurrence-free (p=0.85), disease-free (p=0.25) and overall survival (p=0.98) between the groups. MRI had a sensitivity of 31.3% in detecting the presence of mucin in CRCLM.ConclusionPatients with mucinous CRCLM in this study had similar outcomes to patients with adenocarcinoma NOS. Based on our findings, histological subtype should not be taken into account when deciding on resectability of CRCLM.

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Differentiating metastatic mucinous colorectal adenocarcinomas from simple cysts of the liver using contrast-enhanced and diffusion-weighted MRI

Abstract: On contrast-enhanced and DW MRI, rim and intracystic enhancement can be helpful for differentiating metastatic mucinous colorectal adenocarcinomas from simple cysts of the liver.

Cited by 7 publications

References 23 publications

Colorectal liver metastases: radiopathological correlation

Colorectal liver metastases: radiopathological correlation

Comprehensive Imaging Characterization of Colorectal Liver Metastases

An Analysis of Clinicopathological Outcomes and the Utility of Preoperative MRI for Patients Undergoing Resection of Mucinous and Non-Mucinous Colorectal Cancer Liver Metastases

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