Neoadjuvant chemotherapy affects staging of colorectal liver metastasis—a comparison of PET, CT and intraoperative ultrasound

Abstract

Staging accuracy of colorectal liver metastasis is influenced by neoadjuvant chemotherapy. For PET, decreased tumour metabolism rather than downsizing may account for a drop in sensitivity after neoadjuvant chemotherapy. IUS is critical to avoid incomplete resections.

Gadoxetic acid-enhanced MRI and diffusion-weighted imaging for the detection of colorectal liver metastases after neoadjuvant chemotherapy

“…It is well known that chemotherapy-related changes result in a significant decline in the diagnostic performance of postchemotherapy imaging, especially for CT and PET [12,13,28]. Similarly, we originally expected that the diagnostic performance of gadoxetic acid-enhanced MRI would decline somewhat following chemotherapy, since sinusoidal injury may impair the detection of small focal liver lesions on MRI by hiding the lesion or leading to a false-positive lesion as a result of the typical diffuse reticular hypointensity seen on the HBP image [27].…”

“…This has also been shown to have a clear influence on the staging accuracy of preoperative imaging modalities for CRLMs [11][12][13][14]. In a recent metaanalysis study by van Kessel et al [15], CT, FDG-PET and FDG-PET/CT showed lower diagnostic performances for the evaluation of CRLMs in patients treated with chemotherapy compared to chemonaive patients, whereas MRI showed a high pooled sensitivity of 85.7 % in patients who underwent chemotherapy.…”

Response assessment of colorectal liver metastases with contrast enhanced CT/18F-FDG PET

“…Furthermore, the use of chemotherapy less than 1 month before the scan can result in high false negative results [10,11]. In these cases, ceCT has been demonstrated to be superior to the PET to correctly evaluate liver metastases after neadjuvant chemotherapy [12].…”

New perspectives of PET/CT in oncology

“…Furthermore, the use of chemotherapy less than 1 month before the scan can result in high false negative results [12]. In these cases, ceCT has been demonstrated to be superior to the PET to correctly evaluate liver metastases after neadjuvant chemotherapy [13].…”