Imaging of Colorectal Liver Metastases: New Developments and Pending Issues

Abstract

Computed tomography (CT), magnetic resonance imaging (MRI), and 18-fluorideoxyglucose positron emission tomography (18FDG-PET) are historically the most accurate imaging techniques for diagnosing liver metastases. Recently, the combination of diffusion-weighted imaging and hepatospecific contrast media, such as gadoxetic acid in MRI, have been demonstrated to have the highest diagnostic accuracy, sensitivity, and specificity for detecting liver metastases. Various recent meta-analyses have confirmed the diagnostic superiority of this combination (diffusion-weighted imaging and gadoxetic acid-enhanced MRI), especially in terms of per lesion sensitivity, as compared with CT and 18FDG-PET, even for smaller lesions (≤1 cm). However, none of the oncological guidelines have suggested the use of MRI as a first-line technique for liver metastasis detection during the staging process of oncological patients. This review analyzes the history of the principal imaging techniques for the diagnosis of liver metastases, in particular of colorectal liver metastases, focusing on the most accurate method (diffusion-weighted imaging combined with gadoxetic acid-enhanced MRI), possible reasons for the lack of its diffusion in the guidelines, and possible future scenarios.

Gastric Cancer Staging: Is It Time for Magnetic Resonance Imaging?

“…The per-lesion sensitivities of DWI alone, Gd-EOB-DTPA MRI alone, and the combined techniques were 95.5%, 90.6%, and 87.1%, respectively, with a p -value < 0.001, comparing the combined technique with the other techniques alone, and Gd-EOB-DTPA MRI alone with DWI alone. These data were subsequently confirmed by other studies that analyzed these three MRI techniques [ 14 , 43 ]. The resultant high sensitivity of MRI justifies the use of this technique in all patients with liver metastases to ensure the most accurate preoperative planning [ 14 , 43 ].…”

“…These data were subsequently confirmed by other studies that analyzed these three MRI techniques [ 14 , 43 ]. The resultant high sensitivity of MRI justifies the use of this technique in all patients with liver metastases to ensure the most accurate preoperative planning [ 14 , 43 ].…”

“…Historically, magnetic resonance imaging (MRI) had a limited role in GC evaluation due to its technical limitations, such as blurring and lower spatial resolution. In recent decades, however, much progress has been made in MRI technology, improving the diagnostic performance of this imaging technique in many areas of medicine, including oncology [ 14 ]. Furthermore, MRI presents many advantages over CT (the radiological method recommended for the staging of GC), including the ability to generate significantly greater soft-tissue contrast resolution and the ability to remove the risk of iodinated contrast-induced nephropathy or ionizing radiation [ 15 ].…”

Endorectal Ultrasound and Magnetic Resonance Imaging for Rectal Cancer Staging: A Modern Multimodality Approach

“…An additional imaging technique, such as diffusion weighted imaging (DWI), has demonstrated an important contribution in the assessment of rectal cancer. Currently, DWI is the only noninvasive method able to detect diffuse movement of water molecules in living tissues, thus assessing tissue cellularity and integrity of cell membrane [ 16 , 17 ]. This technique has shown higher abilities in distinguishing tumor boundaries and in predicting tumor invasion than conventional MRI [ 11 , 13 , 15 , 16 , 17 ].…”

“…Currently, DWI is the only noninvasive method able to detect diffuse movement of water molecules in living tissues, thus assessing tissue cellularity and integrity of cell membrane [ 16 , 17 ]. This technique has shown higher abilities in distinguishing tumor boundaries and in predicting tumor invasion than conventional MRI [ 11 , 13 , 15 , 16 , 17 ]. Endorectal ultrasonography (ERUS) is a reliable imaging method, able to evaluate rectal wall infiltration, especially for early tumors [ 4 , 18 , 19 , 20 , 21 ].…”