1
|
Dejima A, Seyama Y, Nakano D, Takao M, Natsume S, Takao M, Nakamori S, Kanai T, Horiguchi S, Kawai K. A rare case of localized peliosis hepatis during adjuvant chemotherapy including oxaliplatin mimicking a liver metastasis of colon cancer. Surg Case Rep 2023; 9:198. [PMID: 37966558 PMCID: PMC10651565 DOI: 10.1186/s40792-023-01774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/29/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Oxaliplatin-based regimens are commonly used as adjuvant chemotherapy following surgery for colorectal cancer. Adverse events associated with oxaliplatin include blue liver, which is caused by sinusoidal dilation and diffuse peliosis hepatis. We report herein a case of localized peliosis hepatis closely resembling a metastatic liver tumor. CASE PRESENTATION The patient, a 50-year-old male, underwent a robotically assisted colectomy for rectosigmoid colon cancer, which was discovered when hematochezia occurred. The patient received a diagnosis of pStage IIIb and was treated with four courses of CAPOX as adjuvant chemotherapy starting at postoperative month 1. At postoperative month 4, contrast-enhanced computed tomography (CT) of the abdomen revealed a 20-mm, low-density area with heterogeneous internal structure in S6/7 of the liver. Abdominal ultrasound and gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) findings led to a diagnosis of metastatic liver tumor, for which a laparoscopic partial hepatectomy was performed. The resected lesion was a dark reddish-brown nodule with indistinct margins that appeared to be continuous with the surrounding area. Histopathological analysis revealed severe, localized dilatation of the sinusoids and congestion consistent with the gross nodule. Based on these findings, localized peliosis hepatis associated with oxaliplatin-induced sinusoidal damage was diagnosed. CONCLUSIONS Localized peliosis hepatis associated with oxaliplatin use can be difficult to distinguish from a metastatic liver tumor on imaging studies.
Collapse
Affiliation(s)
- Akira Dejima
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunyo-Ku, Tokyo, 113-0021, Japan.
| | - Yasuji Seyama
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunyo-Ku, Tokyo, 113-0021, Japan
| | - Daisuke Nakano
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunyo-Ku, Tokyo, 113-0021, Japan
| | - Misato Takao
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunyo-Ku, Tokyo, 113-0021, Japan
| | - Soichiro Natsume
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunyo-Ku, Tokyo, 113-0021, Japan
| | - Mikiya Takao
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunyo-Ku, Tokyo, 113-0021, Japan
| | - Sakiko Nakamori
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunyo-Ku, Tokyo, 113-0021, Japan
| | - Tatsuya Kanai
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunyo-Ku, Tokyo, 113-0021, Japan
| | - Shinichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunyo-Ku, Tokyo, 113-0021, Japan
| | - Kazushige Kawai
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunyo-Ku, Tokyo, 113-0021, Japan
| |
Collapse
|
2
|
Konishi T, Shimada Y, Hsu M, Wei IH, Pappou E, Smith JJ, Nash GM, Guillem JG, Paty PB, Garcia-Aguilar J, Cercek A, Yaeger R, Stadler ZK, Segal NH, Varghese A, Saltz LB, Shia J, Vakiani E, Gönen M, Weiser MR. Contemporary Validation of a Nomogram Predicting Colon Cancer Recurrence, Revealing All-Stage Improved Outcomes. JNCI Cancer Spectr 2019; 3:pkz015. [PMID: 31119207 PMCID: PMC6512350 DOI: 10.1093/jncics/pkz015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/28/2019] [Accepted: 03/21/2019] [Indexed: 12/23/2022] Open
Abstract
Background The Memorial Sloan Kettering Cancer Center (MSK) colon cancer recurrence nomogram is a risk calculator that provides patients and clinicians with individualized prediction of recurrence following curative resection of colon cancer. Although validated on multiple separate cohorts, the nomogram requires periodic updating as patient care changes over time. The aim of this study was to evaluate the nomogram’s accuracy in a contemporary cohort and modify the tool to reflect improvements in outcome related to advances in colon cancer therapy. Methods A contemporary patient cohort was compiled, including consecutive colon cancer patients undergoing curative resection for stage I–III colon adenocarcinoma at MSK from 2007 to 2014. The nomogram’s predictive accuracy was assessed by concordance index and calibration plots of predicted vs actual freedom from recurrence at 5 years after surgery. Results Data from a total of 999 eligible patients with complete records were used for validation. Median follow-up among survivors was 37 months. The concordance index was 0.756 (95% confidence interval = 0.707 to 0.805), indicating continued discriminating power, but the calibration plot revealed that the nomogram overestimated recurrence risk. Recalibration of the nomogram by estimating a new baseline freedom-from-recurrence function restored the nomogram’s accuracy. Conclusion The updated nomogram retains the original nomogram’s variables but includes a lower baseline estimation of recurrence risk, reflecting improvements in outcomes for all stages of colon cancer, likely resulting from advances in imaging and integration of multiple treatment modalities.
Collapse
Affiliation(s)
- Tsuyoshi Konishi
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshifumi Shimada
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY.,Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Iris H Wei
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emmanouil Pappou
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Joshua Smith
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Garrett M Nash
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | - José G Guillem
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | - Philip B Paty
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zsofia K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anna Varghese
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leonard B Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Martin R Weiser
- Department of Surgery , Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
3
|
Chiorean L, Cantisani V, Jenssen C, Sidhu P, Baum U, Dietrich C. Focal masses in a non-cirrhotic liver: The additional benefit of CEUS over baseline imaging. Eur J Radiol 2015; 84:1636-43. [PMID: 26049958 DOI: 10.1016/j.ejrad.2015.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/16/2015] [Accepted: 05/02/2015] [Indexed: 02/07/2023]
|
4
|
Mainenti PP, Romano F, Pizzuti L, Segreto S, Storto G, Mannelli L, Imbriaco M, Camera L, Maurea S. Non-invasive diagnostic imaging of colorectal liver metastases. World J Radiol 2015; 7:157-169. [PMID: 26217455 PMCID: PMC4506934 DOI: 10.4329/wjr.v7.i7.157] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/10/2015] [Accepted: 06/02/2015] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the few malignant tumors in which synchronous or metachronous liver metastases [colorectal liver metastases (CRLMs)] may be treated with surgery. It has been demonstrated that resection of CRLMs improves the long-term prognosis. On the other hand, patients with un-resectable CRLMs may benefit from chemotherapy alone or in addition to liver-directed therapies. The choice of the most appropriate therapeutic management of CRLMs depends mostly on the diagnostic imaging. Nowadays, multiple non-invasive imaging modalities are available and those have a pivotal role in the workup of patients with CRLMs. Although extensive research has been performed with regards to the diagnostic performance of ultrasonography, computed tomography, positron emission tomography and magnetic resonance for the detection of CRLMs, the optimal imaging strategies for staging and follow up are still to be established. This largely due to the progressive technological and pharmacological advances which are constantly improving the accuracy of each imaging modality. This review describes the non-invasive imaging approaches of CRLMs reporting the technical features, the clinical indications, the advantages and the potential limitations of each modality, as well as including some information on the development of new imaging modalities, the role of new contrast media and the feasibility of using parametric image analysis as diagnostic marker of presence of CRLMs.
Collapse
|
5
|
Cantisani V, Grazhdani H, Fioravanti C, Rosignuolo M, Calliada F, Messineo D, Bernieri MG, Redler A, Catalano C, D’Ambrosio F. Liver metastases: Contrast-enhanced ultrasound compared with computed tomography and magnetic resonance. World J Gastroenterol 2014; 20:9998-10007. [PMID: 25110428 PMCID: PMC4123379 DOI: 10.3748/wjg.v20.i29.9998] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/23/2013] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound (US) for several applications, especially for the detection of metastases. In particular, contrast enhanced ultrasonography (CEUS) allows the display of the parenchymal microvasculature, enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases, which is similar to contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging. Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US. Furthermore, studies have shown that CEUS yields sensitivities comparable to CT. In this review, we describe the state of the art of CEUS for detecting colorectal liver metastases, the imaging features, the literature reports of metastases in CEUS as well as its technique, its clinical role and its potential applications. Additionally, the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.
Collapse
|
6
|
Lee KH, Lee JM, Park JH, Kim JH, Park HS, Yu MH, Yoon JH, Han JK, Choi BI. MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent gadoxetic acid. Korean J Radiol 2013; 14:894-904. [PMID: 24265564 PMCID: PMC3835636 DOI: 10.3348/kjr.2013.14.6.894] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/04/2013] [Indexed: 12/16/2022] Open
Abstract
Objective To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance (MR) imaging with that of triple-phase multidetector-row computed tomography (MDCT) in the detection of liver metastasis. Materials and Methods Our institutional review board approved this retrospective study and waived informed consent. The study population consisted of 51 patients with hepatic metastases and 62 patients with benign hepatic lesions, who underwent triple-phase MDCT and gadoxetic acid-enhanced MRI within one month. Two radiologists independently and randomly reviewed MDCT and MRI images regarding the presence and probability of liver metastasis. In order to determine additional value of hepatobiliary-phase (HBP), the dynamic-MRI set alone and combined dynamic-and-HBP set were evaluated, respectively. The standard of reference was a combination of pathology diagnosis and follow-up imaging. For each reader, diagnostic accuracy was compared using the jackknife alternative free-response receiver-operating-characteristic (JAFROC). Results For both readers, average JAFROC figure-of-merit (FOM) was significantly higher on the MR image sets than on the MDCT images: average FOM was 0.582 on the MDCT, 0.788 on the dynamic-MRI set and 0.847 on the combined HBP set, respectively (p < 0.0001). The differences were more prominent for small (≤ 1 cm) lesions: average FOM values were 0.433 on MDCT, 0.711 on the dynamic-MRI set and 0.828 on the combined HBP set, respectively (p < 0.0001). Sensitivity increased significantly with the addition of HBP in gadoxetic acid-enhanced MR imaging (p < 0.0001). Conclusion Gadoxetic acid-enhanced MRI shows a better performance than triple-phase MDCT for the detection of hepatic metastasis, especially for small (≤ 1 cm) lesions.
Collapse
Affiliation(s)
- Kyung Hee Lee
- Division of Abdominal Imaging, Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Arakawa Y, Shimada M, Utsunomya T, Imura S, Morine Y, Ikemoto T, Hanaoka J, Sugimoto K, Bando Y. Oxaliplatin-related sinusoidal obstruction syndrome mimicking metastatic liver tumors. Hepatol Res 2013; 43:685-9. [PMID: 23730707 DOI: 10.1111/j.1872-034x.2012.01114.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 09/06/2012] [Accepted: 10/04/2012] [Indexed: 12/11/2022]
Abstract
A 40-year-old woman who had undergone a curative low anterior resection for advanced rectal cancer was admitted to our hospital. She had been administrated oxaliplatin-based chemotherapy as postoperative adjuvant chemotherapy. The contrast-enhanced computed tomography revealed three hypovascular tumors, 3.0, 1.5 and 1.0 cm in diameter, located in the right hepatic lobe. The hepatocyte phase of the gadoxetic acid-enhanced magnetic resonance imaging demonstrated these lesions as hypointense tumors relative to the surrounding hepatic parenchyma. All these findings of the preoperative imaging modalities were compatible to metastatic liver tumors from the rectal cancer, and right hepatic lobectomy was successfully performed. Histopathologically, the tumors revealed sinusoidal dilation and severe congestion outlined by atrophic hepatocyte trabeculae, which was known as peliosis hepatis. The perisinusoidal space of Disse was extensively dilated and contained many erythrocytes. Taking these findings into account, the hepatic tumors were considered to be the space-occupying lesions resulting from the sinusoidal obstruction syndrome. We herein report the first case of focal sinusoidal obstruction syndrome mimicking metastatic liver tumors.
Collapse
Affiliation(s)
- Yusuke Arakawa
- Department of Surgery, Institute of Health Biosciences, University of Tokushima
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Kim YK, Park G, Kim CS, Yu HC, Han YM. Diagnostic efficacy of gadoxetic acid-enhanced MRI for the detection and characterisation of liver metastases: comparison with multidetector-row CT. Br J Radiol 2012; 85:539-47. [PMID: 22556405 DOI: 10.1259/bjr/25139667] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We compared the diagnostic performance of gadoxetic acid-enhanced MRI and 16-slice multidetector CT (MDCT) with respect to their abilities to detect hepatic metastases and differentiate hepatic metastases from hepatic cysts and haemangiomas. METHODS 67 patients with 110 liver metastases (size 0.3-2.5 cm), 33 haemangiomas (size 0.5-1.5 cm) and 17 cysts (size 0.3-1.0 cm) underwent 4-phase MDCT and gadoxetic acid-enhanced MRI, including early dynamic phases, post-contrast T(2) weighted turbo spin echo sequences and 20 min hepatocyte-selective phases. Two observers independently analysed each image in random order. Sensitivity and diagnostic accuracy for lesion detection and differentiation for MDCT and gadoxetic acid-enhanced MRI were calculated using receiver operating characteristic analysis. RESULTS For both observers, the Az values of gadoxetic acid-enhanced MRI (mean, 0.982 and 0.981) were significantly higher than the Az values of MDCT (mean, 0.839 and 0.892) (p<0.05) for the detection of metastases and for the differentiation of metastases from haemangiomas and cysts. Sensitivities of gadoxetic acid-enhanced MRI with regard to the detection and characterisation of liver metastases (mean, 96.9% and 96.0%) were significantly higher than those of MDCT (mean, 78.7% and 75.0%) (p<0.05). CONCLUSION Gadoxetic acid-enhanced MRI showed higher diagnostic accuracy and sensitivity than did MDCT for the detection of hepatic metastases and for the differentiation between hepatic metastases and hepatic haemangiomas or cysts.
Collapse
Affiliation(s)
- Y K Kim
- Department of Diagnostic Radiology and Research Institute of Clinical Medicine, Chonbuk National University Hospital and Medical School, Seoul, Republic of Korea.
| | | | | | | | | |
Collapse
|
9
|
Xu LH, Cai SJ, Cai GX, Peng WJ. Imaging diagnosis of colorectal liver metastases. World J Gastroenterol 2011; 17:4654-9. [PMID: 22180707 PMCID: PMC3237298 DOI: 10.3748/wjg.v17.i42.4654] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 06/15/2011] [Accepted: 06/22/2011] [Indexed: 02/06/2023] Open
Abstract
Rapid advances in imaging technology have improved the detection, characterization and staging of colorectal liver metastases. Multi-modality imaging approach is usually the more useful in diagnosis colorectal liver metastases. It is well established that hepatic resection improves the long-term prognosis of many patients with liver metastases. However, incomplete resection does not prolong survival, so knowledge of the exact extent of intra-hepatic disease is crucially important in determining patient management and outcome. The diagnosis of liver metastases relies first and totally on imaging to decide which patients may be surgical candidates. This review will discuss the imaging options and their appropriate indications. Imaging and evaluating of colorectal liver metastases (CRLM) have been performed with contrast-enhanced ultrasound, multi-detector computed tomography, magnetic resonance imaging (MRI) with extra-cellular contrast media and liver-specific contrast media MRI, and positron emission tomography/computed tomography. This review will concentrate on the imaging approach of CRLM, and also discuss certain characteristics of some liver lesions. We aim to highlight the advantages of each imaging technique, as well as underscoring potential pitfalls and limitations.
Collapse
|
10
|
Small colorectal cystic metastases to the liver: still a diagnostic dilemma? A report of a case and a review of the literature. Updates Surg 2011; 64:297-300. [PMID: 21987005 DOI: 10.1007/s13304-011-0115-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 09/26/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Although cystic colorectal metastases are rare (1.8%), they are still a crucial challenge for the surgeon especially in terms of detection and differential diagnosis. Since prognosis after resection is very good (40% 5-year survival), early diagnosis is essential. CASE REPORT A 55-year-old man was admitted to our hospital with a suspected diagnosis of multiple small liver metastases. He had previously undergone left sided-cholectomy followed by chemotherapy for colonic carcinoma. Computed tomography (CT) revealed multiple small (<15 mm) intrahepatic biliary cysts, suspected for cystic colorectal liver metastases. CONCLUSION The diagnosis of cystic colorectal liver metastases is quite difficult and it is mostly based on the last-generation magnetic resonance (MR). In spite of this, we must often rely on histological results for a definitive diagnosis.
Collapse
|
11
|
Muhi A, Ichikawa T, Motosugi U, Sou H, Nakajima H, Sano K, Sano M, Kato S, Kitamura T, Fatima Z, Fukushima K, Iino H, Mori Y, Fujii H, Araki T. Diagnosis of colorectal hepatic metastases: Comparison of contrast-enhanced CT, contrast-enhanced US, superparamagnetic iron oxide-enhanced MRI, and gadoxetic acid-enhanced MRI. J Magn Reson Imaging 2011; 34:326-35. [DOI: 10.1002/jmri.22613] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
12
|
Koelblinger C, Ba-Ssalamah A, Goetzinger P, Puchner S, Weber M, Sahora K, Scharitzer M, Plank C, Schima W. Gadobenate dimeglumine-enhanced 3.0-T MR imaging versus multiphasic 64-detector row CT: prospective evaluation in patients suspected of having pancreatic cancer. Radiology 2011; 259:757-66. [PMID: 21436084 DOI: 10.1148/radiol.11101189] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare the diagnostic performance (detection, local staging) of multiphasic 64-detector row computed tomography (CT) with that of gadobenate dimeglumine-enhanced 3.0-T magnetic resonance (MR) imaging in patients suspected of having pancreatic cancer. MATERIALS AND METHODS The institutional review board approved this prospective study, and all patients provided written informed consent. Multidetector CT and MR imaging were performed in 89 patients (48 women aged 46-89 years [mean, 65.6 years] and 41 men aged 46-86 years [mean, 65.3 years]) suspected of having pancreatic cancer on the basis of findings from clinical examination or previous imaging studies. Two readers independently assessed the images to characterize lesions and determine the presence of focal masses, vascular invasion, distant metastases, and resectability. Findings from surgery, biopsy, endosonography, or follow-up imaging were used as the standard of reference. Logistic regression, the McNemar test, and κ values were used for statistical analysis. RESULTS Focal pancreatic masses were present in 63 patients; 43 patients had adenocarcinoma. For reader 1, the sensitivities and specificities in the detection of pancreatic adenocarcinoma were 98% (42 of 43 patients) and 96% (44 of 46 patients), respectively, for CT and 98% (42 of 43 patients) and 96% (44 of 46 patients) for MR imaging. For reader 2, the sensitivities and specificities were 93% (40 of 43 patients) and 96% (44 of 46 patients), respectively, for CT and 95% (41 of 43 patients) and 96% (44 of 46 patients) for MR imaging. Vessel infiltration was determined in 22 patients who underwent surgery, and reader 1 obtained sensitivities and specificities of 90% (nine of 10 vessels) and 98% (119 of 122 vessels), respectively, for CT and 80% (eight of 10 vessels) and 96% (117 of 122 vessels) for MR imaging; for reader 2, those values were 70% (seven of 10 vessels) and 98% (120 of 122 vessels) for CT and 50% (five of 10 vessels) and 98% (120 of 122 vessels) for MR imaging. Both readers correctly assessed resectability in 87% (13 of 15 patients) of cases with CT and 93% (14 of 15 patients) of cases with MR imaging. Nonresectability was assessed correctly with CT in 75% (six of eight patients) of cases by reader 1 and 63% (five of eight patients) of cases by reader 2; nonresectability was correctly assessed with MR imaging in 75% (six of eight patients) of cases by reader 1 and 50% (four of eight patients) of cases by reader 2. None of the differences between modalities and readers were statistically significant (P > .05). CONCLUSION Both CT and MR imaging are equally suited for detecting and staging pancreatic cancer. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101189/-/DC1.
Collapse
Affiliation(s)
- Claus Koelblinger
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Cabassa P, Bipat S, Longaretti L, Morone M, Maroldi R. Liver metastases: Sulphur hexafluoride-enhanced ultrasonography for lesion detection: a systematic review. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1561-1567. [PMID: 20800958 DOI: 10.1016/j.ultrasmedbio.2010.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 05/11/2010] [Accepted: 06/11/2010] [Indexed: 05/29/2023]
Abstract
This is a systematic review to evaluate the accuracy of contrast-enhanced ultrasonography (CEUS) performed with "SonoVue" (sulphur hexafluoride) in the detection of hepatic metastases. The MEDLINE, EMBASE and COCHRANE Databases were searched, regardless of language, for relevant articles published before December 2009. Two reviewers independently assessed study eligibility using a standardized form and methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS) Checklist. Sensitivity estimates were calculated on a per-patient and/or per-lesion basis. The search for published articles yielded 718 potentially relevant abstracts. Of these, 14 papers were eligible but only three articles fulfilled the inclusion criteria, which comprised a total of 450 patients (patient sample number: range 12 to 365; cancer prevalence: 14.8 to 71.2%). Estimated per-patient sensitivity ranged from 79-100%. Although the quality assessment of diagnostic accuracy studies checklist showed the papers were of good quality, a meta-analysis was not applicable because of the lack of eligible studies. In conclusion, CEUS seems to be promising in the detection of liver metastases; however, there have not been enough studies to conduct meta-analysis. Further studies are required before this promising method can be widely used.
Collapse
Affiliation(s)
- Paolo Cabassa
- Department of Radiology, University of Brescia, Brescia, Italy.
| | | | | | | | | |
Collapse
|
14
|
Assessment of liver metastases from colorectal adenocarcinoma following chemotherapy: SPIO-MRI versus FDG-PET/CT. Radiol Med 2010; 115:1087-100. [PMID: 20574703 DOI: 10.1007/s11547-010-0560-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 11/27/2009] [Indexed: 01/06/2023]
Abstract
PURPOSE This study compared superparamagnetic iron-oxide-enhanced magnetic resonance imaging (SPIO-MRI) and combined fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) in evaluating liver metastases from colorectal adenocarcinoma following chemotherapy. MATERIALS AND METHODS Nineteen patients were included in this retrospective study. SPIO-MRI and PET/CT results were compared with surgery, intraoperative ultrasound and pathology results in 11 patients and with the follow-up in eight patients. RESULTS SPIO-MRI and PET/CT identified 125 and 71 metastases, respectively. False negative lesions were 11 for SPIO-MRI and 65 for PET/CT. In the whole study population, the per-lesion analysis of SPIO-MRI and PET/CT showed a sensitivity of 92% and 52% (p<0.001) and the per-segment analysis a sensitivity of 99% and 79% (p<0.001), respectively. In patients who underwent surgery, the per-lesion analysis of SPIO-MRI and PET/CT showed a sensitivity of 85% and 58% (p<0.05) and the per-segment analysis a sensitivity of 97% and 63% (p<0.05), respectively. In patients who underwent follow-up, the per-lesion analysis of SPIO-MRI and PET/CT showed a sensitivity of 97% and 47% (p<0.001) and the per-segment analysis a sensitivity of 100% and 63% (p<0.007), respectively. For lesions ≥15 and <30 mm and for lesions <15 mm, SPIO-MRI demonstrated a higher sensitivity than PET/CT (p<0.001). CONCLUSIONS SPIO-MRI appears superior to PET/CT in evaluating liver metastases from colorectal adenocarcinoma following chemotherapy.
Collapse
|
15
|
Sofue K, Tsurusaki M, Miyake M, Sakurada A, Arai Y, Sugimura K. Detection of hepatic metastases by superparamagnetic iron oxide-enhanced MR imaging: prospective comparison between 1.5-T and 3.0-T images in the same patients. Eur Radiol 2010; 20:2265-73. [PMID: 20428875 DOI: 10.1007/s00330-010-1798-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 03/03/2010] [Accepted: 03/04/2010] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To prospectively compare the diagnostic performance of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging at 3.0 T and 1.5 T for detection of hepatic metastases. METHODS A total of 28 patients (18 men, 10 women; mean age, 61 years) with 80 hepatic metastases were prospectively examined by SPIO-enhanced MR imaging at 3.0 T and 1.5 T. T1-weighted gradient-recalled-echo (GRE) images, T2*-weighted GRE images and T2-weighted fast spin-echo (SE) images were acquired. The tumour-to-liver contrast-to-noise ratio (CNR) of the lesions was calculated. Three observers independently reviewed each image. Image artefacts and overall image quality were analysed, sensitivity and positive predictive value for the detection of hepatic metastases were calculated, and diagnostic accuracy using the receiver-operating characteristics (ROC) method was evaluated. RESULTS The tumour-to-liver CNRs were significantly higher at 3.0 T. Chemical shift and motion artefact were more severe, and overall image quality was worse on T2-weighted fast SE images at 3.0 T. Overall image quality of the two systems was similar on T1-weighted GRE images and T2*-weighted GRE images. Sensitivity and area under the ROC curve for the 3.0-T image sets were significantly higher. CONCLUSION SPIO-enhanced MR imaging at 3.0 T provided better diagnostic performance for detection of hepatic metastases than 1.5 T.
Collapse
Affiliation(s)
- Keitaro Sofue
- Department of Radiology, National Cancer Center, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
16
|
Donati OF, Hany TF, Reiner CS, von Schulthess GK, Marincek B, Seifert B, Weishaupt D. Value of retrospective fusion of PET and MR images in detection of hepatic metastases: comparison with 18F-FDG PET/CT and Gd-EOB-DTPA-enhanced MRI. J Nucl Med 2010; 51:692-9. [PMID: 20395324 DOI: 10.2967/jnumed.109.068510] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED The purpose of this study was to compare the accuracy of lesion detection and diagnostic confidence between (18)F-FDG PET/CT, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, and retrospectively fused PET and MRI (PET/MRI). METHODS Thirty-seven patients (mean age +/- SD, 60.2 +/- 12 y) with suspected liver metastases underwent PET/CT and Gd-EOB-DTPA-enhanced MRI within 0-30 d (mean, 11.9 +/- 9 d). PET and Gd-EOB-DTPA-enhanced MR image data were retrospectively fused. Images were reviewed independently by 2 readers who identified and characterized liver lesions using PET/CT, Gd-EOB-DTPA-enhanced MRI, and PET/MRI. Each liver lesion was graded on a 5-point confidence scale ranging from definitely benign (grade of 1) to definitely malignant (grade of 5). The accuracy of each technique was determined by receiver-operating-characteristic analysis. Histopathology served as the standard of reference for all patients with malignant lesions. RESULTS A total of 85 liver lesions (55 liver metastases [65%] and 30 benign lesions [35%]) were present in 29 (78%) of the 37 patients. Twenty-four (65%) of the 37 patients had liver metastases. The detection rate of liver lesions was significantly lower for PET/CT than for Gd-EOB-DTPA-enhanced MRI (64% and 85%; P = 0.002). Sensitivity in the detection and characterization of liver metastases for PET/CT, Gd-EOB-DTPA-enhanced MRI, PET/MRI in reader 1, and PET/MRI in reader 2 was 76%, 91%, 93%, and 93%, respectively; the respective specificity values were 90%, 100%, 87%, and 97%. The difference in sensitivity between PET/CT and PET/MRI was significant (P = 0.023). The level of confidence regarding liver lesions larger than 1 cm in diameter was significantly higher in PET/MRI than in PET/CT (P = 0.046). Accuracy values (area under the receiver-operating-characteristic curve) for PET/CT, Gd-EOB-DTPA-enhanced MRI, PET/MRI in reader 1, and PET/MRI in reader 2 were 0.85, 0.94, 0.92, and 0.96, respectively. CONCLUSION The sensitivity of Gd-EOB-DTPA-enhanced MRI and PET/MRI in the detection of liver metastases is higher than that of PET/CT. Diagnostic confidence was significantly better with PET/MRI than with PET/CT regarding lesions larger than 1 cm in diameter. Compared with Gd-EOB-DTPA-enhanced MRI, PET/MRI resulted in a nonsignificant increase in sensitivity and diagnostic confidence.
Collapse
Affiliation(s)
- Olivio F Donati
- Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
17
|
Floriani I, Torri V, Rulli E, Garavaglia D, Compagnoni A, Salvolini L, Giovagnoni A. Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: a systematic review and meta-analysis. J Magn Reson Imaging 2010; 31:19-31. [PMID: 20027569 DOI: 10.1002/jmri.22010] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Surgery of liver metastases can be effective, and the appropriate selection of surgical candidates relies first on imaging. Different techniques are available, but information on their relative performance is unclear. The aim of this overview is to assess the imaging modality performance in the diagnosis of colorectal cancer (CRC) liver metastases. MEDLINE and EMBASE were searched for articles published from January 2000 to August 2008. Eligible trials had to be conducted on patients with diagnosis/suspicion of CRC liver metastases, comparing more than two modalities among MRI, computed tomography (CT), positron emission tomography using fluoro-18-deoxyglucose (FDG-PET), ultrasonography (US). Pooled estimates of sensitivity, specificity were calculated and pair-wise comparisons were performed. Of 6030 screened articles, 25 were eligible. Sensitivity and specificity on a per-patient basis for US, CT, MRI, and FDG-PET were 63.0% and 97.6%, 74.8% and 95.6%, 81.1% and 97.2, and 93.8% and 98.7%, respectively. On a per-lesion basis, sensitivity was 86.3%, 82.6%, 86.3%, and 86.0%, respectively. Specificity was reported in few studies. MRI showed a better sensitivity than CT in per-patient (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.47-0.99; P = 0.05) and in per-lesion analysis (OR: 0.66; 95% CI: 0.55-0.80; P < 0.0001). In per-lesion analysis, the difference was higher when liver-specific contrast agents were administered. Available evidence supports the MRI use for the detection of CRC liver metastases.
Collapse
Affiliation(s)
- Irene Floriani
- Department of Oncology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | | | | | | | | | | | | |
Collapse
|
18
|
Bellomi M, Travaini LL. Imaging as a surveillance tool in rectal cancer. Expert Rev Med Devices 2010; 7:99-112. [PMID: 20021242 DOI: 10.1586/erd.09.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Despite advances in diagnosis and treatment, half of patients with treated rectal cancer will die owing to recurrent disease. There is no evidence of benefit on survival from an intensive surveillance program, even if presymptomatic recurrent disease is detected. The aim of this article is to review the results described for the different imaging techniques in diagnosing rectal cancer recurrence in different sites and to discuss their relative clinical impact. The sensitivity of imaging techniques is related to the performance of the machines and the site being examined. Computed tomography is the most used technique owing to its availability, speed, panoramic images and ease of use, while MRI of the pelvis and the liver produces the highest resolution, sensitivity and specificity in these anatomical areas. Owing to its high cost, [(18)F] fluorodeoxyglucose-PET should be used as a third-level examination, a 'problem-solving' method when the site of recurrence is unknown or to rule out other possible sites of recurrence before a second surgery, and, finally, because it offers the possibility to investigate the whole body. The follow-up must be designed for individual patients, taking into account a number of factors. In the near future, whole-body imaging, probably by MRI, that is free from radiation will become the method of choice for screening for recurrent disease.
Collapse
Affiliation(s)
- Massimo Bellomi
- Department of Radiology and School of Medicine, University of Milano, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | | |
Collapse
|
19
|
Choi JY, Choi JS, Kim MJ, Lim JS, Park MS, Kim JH, Chung YE. Detection of hepatic hypovascular metastases: 3D gradient echo MRI using a hepatobiliary contrast agent. J Magn Reson Imaging 2010; 31:571-8. [DOI: 10.1002/jmri.22076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
20
|
Larsen LPS. Role of contrast enhanced ultrasonography in the assessment of hepatic metastases: A review. World J Hepatol 2010; 2:8-15. [PMID: 21160951 PMCID: PMC2998950 DOI: 10.4254/wjh.v2.i1.8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 09/17/2009] [Accepted: 09/24/2009] [Indexed: 02/06/2023] Open
Abstract
Contrast enhanced ultrasonography (CEUS) has improved both the detection and characterization of focal liver lesions. It is now possible to evaluate in real time the perfusion of focal liver lesions in the arterial, portal and late contrast phases, and thus to characterize focal liver lesions with high diagnostic accuracy. As a result, CEUS has taken a central diagnostic role in the evaluation of focal liver lesions that are indeterminate upon computed tomography (CT) and magnetic resonance imaging. The combined use of second generation contrast agents and low mechanical index techniques is essential for the detection of liver metastases, and it now allows the examination of the entire liver in both the portal and late phases. Several studies have shown that using CEUS instead of conventional ultrasonography without contrast agents significantly improves sensitivity in detection of liver metastases. Furthermore, the detection rate with CEUS seems to be similar to that of CT. This review describes the clinical role of CEUS in detecting liver metastases, including details about examination techniques, features of metastases observed with CEUS, and clinical results and guidelines.
Collapse
Affiliation(s)
- Lars Peter Skovgaard Larsen
- Lars Peter Skovgaard Larsen, Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, Aarhus 8000 C, Denmark
| |
Collapse
|
21
|
Hekimoglu K, Ustundag Y, Dusak A, Kalaycioglu B, Besir H, Engin H, Erdem O. Small colorectal liver metastases: detection with SPIO-enhanced MRI in comparison with gadobenate dimeglumine-enhanced MRI and CT imaging. Eur J Radiol 2009; 77:468-72. [PMID: 19781882 DOI: 10.1016/j.ejrad.2009.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 09/02/2009] [Indexed: 02/06/2023]
Abstract
The aim of this prospective study was to compare the diagnostic role of superparamagnetic iron oxide (SPIO)-enhanced liver magnetic resonance imaging (MRI) versus gadobenate dimeglumine (GbD)-enhanced MRI and computed tomography (CT) investigations for detection of small (less than 1cm) colorectal liver metastases (LMs) of colorectal cancer. Seventy-eight LMs in 16 patients were evaluated with dynamic CT imaging, GbD-enhanced dynamic MR imaging and SPIO-enhanced MR imaging. Two radiologists were reviewed the LMs separately. Agreement between the readers and three algorithms was analyzed. Differences between the lesion detection ratios of the methods were analyzed by two proportion z test. Sensitivity values of each modality were also calculated. Interobserver agreement values with kappa analysis were found to be the best for three modalities and kappa values were 0.866, 0.843, and 1.0 respectively. For all 78 LMs, SPIO-enhanced MRI detected all lesions (100% sensitivity). This sensitivity value was higher than GbD-enhanced MRI, and there was a significant difference (p < 0.05). GbD-enhanced MRI depicted 71 lesions and this modality could not detected 7 lesions (91% sensitivity). This modality had moderate sensitivity, and this value is greater than CT imaging, so there was a significant difference also (p < 0.05). Dynamic triphasic CT imaging detected 64 (R1) and 65 (R2) LMs. This modality had the lowest sensitivity (R1: 0.82, R2: 0.83 respectively). Only SPIO-enhanced MRI was able to detect all LMs less than 1cm. LMs were the best detected with SPIO-enhanced MRI. We recommend SPIO-enhanced MRI to be the primary alternative modality especially for diagnosis of small colorectal LMs.
Collapse
Affiliation(s)
- Koray Hekimoglu
- Department of Radiology, Baskent University, School of Medicine, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
22
|
Mainenti PP, Mancini M, Mainolfi C, Camera L, Maurea S, Manchia A, Tanga M, Persico F, Addeo P, D'Antonio D, Speranza A, Bucci L, Persico G, Pace L, Salvatore M. Detection of colo-rectal liver metastases: prospective comparison of contrast enhanced US, multidetector CT, PET/CT, and 1.5 Tesla MR with extracellular and reticulo-endothelial cell specific contrast agents. ACTA ACUST UNITED AC 2009; 35:511-21. [PMID: 19562412 DOI: 10.1007/s00261-009-9555-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 06/11/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND To compare contrast-enhanced US (CE-US), multidetector-CT (MDCT), 1.5 Tesla MR with extra-cellular (Gd-enhanced) and intracellular (SPIO-enhanced) contrast agents and PET/CT, in the detection of hepatic metastases from colorectal cancer. MATERIALS AND METHODS A total of 34 patients with colo-rectal adenocarcinoma underwent preoperatively CE-US, MDCT, Gd- and SPIO-enhanced MR imaging (MRI), and PET/CT. Each set of images was reviewed independently by two blinded observers. The ROC method was used to analyze the results, which were correlated with surgical findings, intraoperative US, histopathology, and MDCT follow-up. RESULTS A total of 57 hepatic lesions were identified: 11 hemangiomas, 29 cysts, 1 focal fatty liver, 16 metastases (dimensional distribution: 5/16 < 5 mm; 3/16 between 5 mm and <10 mm; 8/16 ≥ 10 mm). Six of 34 patients were classified as positive for the presence of at least one metastasis. Considering all the metastases and those ≥ 10 mm, ROC areas showed no significant differences between Gd- and SPIO-enhanced MRI, which performed significantly better than the other modalities (P < 0.05). Considering the lesions <10 mm, ROC areas showed no significant differences between all modalities; however MRI presented a trend to perform better than the other techniques. Considering the patients, ROC areas showed no significant differences between all the modalities; however PET/CT seemed to perform better than the others. CONCLUSIONS Gd- and SPIO-enhanced MRI seem to be the most accurate modality in the identification of liver metastases from colo-rectal carcinoma. PET/CT shows a trend to perform better than the other modalities in the identification of patients with liver metastases.
Collapse
|
23
|
Imaging of small hepatic metastases of colorectal carcinoma: how to use superparamagnetic iron oxide-enhanced magnetic resonance imaging in the multidetector-row computed tomography age? J Comput Assist Tomogr 2009; 33:266-72. [PMID: 19346857 DOI: 10.1097/rct.0b013e31817f5c82] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To compare the accuracy of dynamic contrast-enhanced multidetector-row computed tomography (CT) and superparamagnetic iron oxide-enhanced magnetic resonance imaging (MRI) in the evaluation of small hepatic metastases of colorectal carcinoma. MATERIALS AND METHODS Of 94 patients with colorectal carcinoma analyzed, 76 hepatic metastases (<2 cm) were diagnosed in 17 patients. Superparamagnetic iron oxide (SPIO)-magnetic resonance (precontrast and postcontrast MRI) and dynamic contrast-enhanced multidetector-row CT (dynamic CT [precontrast, arterial, portal-venous, and delayed phase]) were evaluated. The alternative free-response receiver operating characteristic analysis was performed, and the sensitivities and positive predictive values were analyzed. RESULTS The Az values and sensitivities of portal-venous phase CT, dynamic CT, and SPIO-MRI (0.62/59%, 0.69/61%, and 0.67/61%) were identical. The mean positive predictive value of dynamic CT (82%) was inferior to that of SPIO-MRI (91%). CONCLUSIONS The diagnostic ability of dynamic CT is identical to that of SPIO-MRI in Az value and sensitivity. Superparamagnetic iron oxide-MRI should be recommended only if an equivocal lesion is detected by dynamic CT.
Collapse
|
24
|
Mantatzis M, Kakolyris S, Amarantidis K, Karayiannakis A, Prassopoulos P. Treatment response classification of liver metastatic disease evaluated on imaging. Are RECIST unidimensional measurements accurate? Eur Radiol 2009; 19:1809-16. [PMID: 19238395 DOI: 10.1007/s00330-009-1327-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 12/07/2008] [Accepted: 01/05/2009] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate the accuracy of unidimensional measurements (response evaluation criteria in solid tumors, RECIST) compared with volumetric measurements in patients with liver metastases undergoing chemotherapy. Forty-four patients with newly diagnosed liver lesions underwent three MRI examinations at treatment initiation, during chemotherapy, and immediately post-treatment. Measurements based on RECIST guidelines and volume calculations were performed on the "target" lesions (TLs). The two methods were in agreement in 64/77 of patients and 253/301 of individual lesions classification in response categories ("good" agreement, Cohen kappa = 0.735 and 0.741, respectively). In 16.88% of the comparisons the two methods stratified patients to a different response category; 27.6% of TLs did not follow the response category of the patient in whom lesions were located. The actual volume of TLs differs from the calculated volume of a sphere with the same diameter. Our study supports the use of volumetric techniques that may overcome certain disadvantages of unidimensional measurements.
Collapse
Affiliation(s)
- Michael Mantatzis
- Department of Radiology, University Hospital of Alexandroupolis, Opsikiou 1, 681 00, Alexandroupolis, Greece.
| | | | | | | | | |
Collapse
|
25
|
Nishida M, Koito K, Hirokawa N, Hori M, Satoh T, Hareyama M. Does contrast-enhanced ultrasound reveal tumor angiogenesis in pancreatic ductal carcinoma? A prospective study. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:175-185. [PMID: 18845377 DOI: 10.1016/j.ultrasmedbio.2008.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Revised: 08/04/2008] [Accepted: 08/12/2008] [Indexed: 05/26/2023]
Abstract
The purpose of this study is to evaluate tumor vascularity of pancreatic carcinoma noninvasively by contrast-enhanced ultrasound (US) and clarify the diagnostic value of tumor vascularity in subjects with nonresectable advanced pancreatic carcinoma. The study was approved by our institutional review board and written informed consent was obtained from all subjects. Twenty-seven subjects with advanced pancreatic ductal carcinoma were treated by chemoradiotherapy. Contrast-enhanced US, US guided biopsies and dynamic computed tomography (CT) were performed before and after the therapy. We assigned the intratumoral enhancement pattern of US as an enhanced ultrasound (EU) score, from 1 to 4, according to the degree of enhancement area. Intratumoral microvessel density (IMD) and average vessel diameter (AVD) were calculated by means of CD 34 immunostaining. Vascular endothelial growth factor (VEGF) staining was graded on a scale of 1 to 3. EU scores before chemoradiotherapy were compared with IMD, AVD, VEGF, histological grading and hepatic metastasis. After the therapy, local treatment response was evaluated by dynamic CT calculating the maximum area of the tumor, by comparing it with its size in pre- therapy. Subjects who had at least a 50% or more decrease of tumor size lasting more than 4 wk were estimated as partial response (PR), more than a 50% of increase progressive disease (PD) and if neither PR nor PD criteria were met, they were classified as stabled disease (SD). Next, EU scores were compared with IMD, AVD, VEGF and treatment response. Statistically significant differences were evaluated by Pearson's correlation, post-hoc, Spearman's rank correlation, Wilcoxon rank sum and Student's t-test. A p < 0.05 was defined as being statistically significant. Before the therapy, the EU score and IMD were significantly correlated (r = 0.50, p < 0.02), as was VEGF (r = 0.45, p < 0.05). The EU score and AVD were negatively correlated (r = - 0.56, p < 0.02). Significant correlation was found between the EU score and histological grading (p < 0.004). The EU score was higher in subjects who had hepatic metastasis compared with subjects who had no hepatic metastasis (p < 0.05). After chemoradiotherapy, 14 subjects exhibited PR, while 13 showed SD. None of the subjects showed PD. The EU score was smaller in PR than SD (p < 0.05). The EU score significantly decreased after the therapy in PR (p < 0.01) but not in SD. IMD and AVD did not significantly decrease in either PR or SD; however, VEGF decreased significantly in PR (p < 0.01) but not in SD. Contrast-enhanced US could reveal tumor vascularity of pancreatic ductal carcinoma and could be potentially useful to evaluate treatment effect of subjects who receive chemoradiotherapy. Further investigation will be needed to prove the usefulness of contrast-enhanced US.
Collapse
Affiliation(s)
- Mutsumi Nishida
- Radiation Oncology, Imaging and Diagnosis, Sapporo Medical University Graduate School of Medicine, Sapporo, Japan.
| | | | | | | | | | | |
Collapse
|
26
|
Kim MJ. Preoperative Radiological Staging of Rectal Cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.5.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Min Ju Kim
- Department of Radiology, Korea University College of Medicine, Korea.
| |
Collapse
|
27
|
Saito K, Shindo H, Ozuki T, Ishikawa A, Kotake F, Shimazaki Y, Abe K. Detection of hepatocellular carcinoma with ferucarbotran (resovist)-enhanced breath-hold MR imaging: feasibility of 10 minute-delayed images. Magn Reson Med Sci 2008; 7:123-30. [PMID: 18827455 DOI: 10.2463/mrms.7.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We evaluated the optimal timing for breath-hold MR imaging with bolus-injectable superparamagnetic iron oxide (SPIO) for detecting hepatocellular carcinoma (HCC). MATERIALS AND METHODS Twenty patients with 62 HCCs (52 hypervascular, 10 non-hypervascular) underwent MR imaging that included unenhanced and SPIO-enhanced T1-weighted gradient echo (GRE) and T2-weighted fast spin echo (FSE) sequences, perfusion study, and SPIO-enhanced T2*-weighted GRE sequences. We obtained SPIO-enhanced T2*-weighted sequences 10 and 30 min after injecting SPIO and made 2 image sets, comprising 10- or 30-min delayed T2*-weighted images. Three observers performed alternative free response receiver operating characteristic (AFROC) analysis, and quantitative evaluation was performed. RESULTS Only Observers 2 and 3 recognized a significant difference in the area under the AFROC curve (Az) value in the 10-min delayed images; no significant difference was observed in the 30-min delayed images. There was no significant difference in the sensitivity of individual observers between 10- and 30-min delayed images. The contrast-to-noise (C/N) ratio of the 30-min delayed images was significantly higher than that of the 10-min delayed images. The C/N ratio of hypervascular HCCs in the 30-min delayed images was significantly higher than in the 10-min delayed images, but that of non-hypervascular HCCs showed no significant difference. CONCLUSION In most cases, 10-min delayed SPIO-enhanced T2*-weighted images are sufficient to detect HCCs.
Collapse
Affiliation(s)
- Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
28
|
Rappeport ED, Loft A. Liver metastases from colorectal cancer: imaging with superparamagnetic iron oxide (SPIO)-enhanced MR imaging, computed tomography and positron emission tomography. ACTA ACUST UNITED AC 2008; 32:624-34. [PMID: 17710359 DOI: 10.1007/s00261-007-9297-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The literature about superparamagnetic iron oxide-enhanced MR imaging, computed tomography (CT) and PET (positron emission tomography using fluorine-18 labelled fluoro-deoxy-glucose) in detection of liver metastases (LM) from colorectal cancer is reviewed in this update. Special emphasis is given to studies with surgical standard of reference allowing for the lesion-by-lesion sensitivity to be determined. Based on the review, it is concluded that state-of-the-art anatomical imaging, e.g., SPIO-enhanced MR imaging and multidetector CT (MDCT), must be considered more sensitive than PET in detection of individual LM, due to technical developments in MR imaging, such as liver specific contrast agents, modern sequences and high performance gradients, and in modern MDCT have increased the performance of these modalities. MR imaging with a liver specific contrast agent is recommended for the preoperative evaluation before liver surgery for LM because of high sensitivity and better discrimination between small LM and cysts compared to MDCT. PET or PET/CT can be used for detection of extra-hepatic tumor before liver surgery.
Collapse
Affiliation(s)
- Eli D Rappeport
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | |
Collapse
|
29
|
Coenegrachts K, Orlent H, ter Beek L, Haspeslagh M, Bipat S, Stoker J, Rigauts H. Improved focal liver lesion detection: comparison of single-shot spin-echo echo-planar and superparamagnetic iron oxide (SPIO)-enhanced MRI. J Magn Reson Imaging 2008; 27:117-24. [PMID: 18050350 DOI: 10.1002/jmri.21247] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To prospectively compare single-shot spin-echo echo-planar imaging (SSSE-EPI) using b = 0, 10, 150, and 400 seconds/mm(2) with standard MRI techniques after intravenous super paramagnetic iron oxide (SPIO) in the detection and characterization of focal liver lesions with focus on small (<10 mm) focal liver lesions. MATERIALS AND METHODS A total of 25 patients suspected for colorectal liver metastases were included. Number of detected lesions was evaluated. Image quality was compared between SSSE-EPI sequence and post-SPIO (fat-suppressed T1-weighted [T1w] gradient echo [GE], T2-weighted [T2w] turbo spin echo [TSE] and T2* GE) sequences using rank order statistic (RIDIT). Lesion characterization was performed for SSSE-EPI and for all remaining sequences pre- and post-SPIO. Reference standard comprised surgery, biopsy, and/or follow-up. RESULTS Reference standard demonstrated 25 hemangiomas and 70 metastases. Best lesion detection respectively best image quality (P < 0.05) was achieved with SSSE-EPI (b = 10 seconds/mm(2)) post-SPIO T1w GE and T2w turbo spin echo. Lesion characterization using all sequences pre- and post-SPIO performed best for lesion characterization compared with SSSE-EPI. CONCLUSION This preliminary study shows the potential of SSSE-EPI as a stand-alone sequence for the detection of liver hemangiomas and metastases when compared with SPIO-enhanced imaging. Sequences pre- and post-SPIO are needed for qualitative lesion characterization.
Collapse
|
30
|
Boozari B, Lotz J, Galanski M, Gebel M. [Diagnostic imaging of liver tumours. Current status]. Internist (Berl) 2008; 48:8, 10-2, 14-6, 18-20. [PMID: 17216509 DOI: 10.1007/s00108-006-1773-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Nowadays, contrast enhanced ultrasound (CEUS) is an imaging technique equivalent to multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for the detection and characterization of focal liver lesions. These methods have comparable sensitivity and specificity in differentiating a liver lesion as "benign" or "malignant". For benign lesions, CEUS is the recommended method of the choice. In unclear cases, or if CEUS is not available, MRI or CT are the methods of the second choice. If a benign tumor remains unclear, then a needle biopsy is recommended. In the case of a malignant tumor, it is necessary to use a second imaging technique besides CEUS. In addition to the detection and characterization of a liver tumor, CT and MRI provide information on the extrahepatic spread of a tumor, particularly into the lung or retroperitoneum. The rapid development of surgical and interventional approaches requires accurate information on the character and number of malignant liver lesions. Therefore, the combined use of CEUS and MDCT or MRI currently represents the most modern and optimal standard of imaging. The standardization of CT and MRI protocols has increased the general diagnostic level of these images. Adequate training and a certificate for the use of CEUS is recommended in order to maintain the high diagnostic level of this method (EFSUMB guide lines). An optimal interdisciplinary imaging strategy for focal liver lesions minimises unnecessary invasive or potentially harmful imaging and reduces health costs.
Collapse
Affiliation(s)
- B Boozari
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, 30625, Carl-Neuberg-Str. 1, Hannover, Germany.
| | | | | | | |
Collapse
|
31
|
Can contrast-enhanced ultrasonography replace multidetector-computed tomography in the detection of liver metastases from colorectal cancer? Eur J Radiol 2007; 69:308-13. [PMID: 18068925 DOI: 10.1016/j.ejrad.2007.10.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Revised: 10/10/2007] [Accepted: 10/31/2007] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare the sensitivity and specificity of contrast-enhanced ultrasonography (CEUS) and 4-slice multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer (CRC). MATERIALS AND METHODS Candidates for this prospective study were 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital with primary or local recurrence of CRC. The patients underwent liver ultrasonography (US), CEUS, MDCT and intraoperative ultrasonography (IOUS). Fine-needle biopsy was performed on all suspicious lesions. The examinations were interpreted blindly and the combination of US, CEUS, biphasic MDCT, IOUS, follow up and biopsy was the gold standard. RESULTS Three hundred and sixty-five patients were included. All patients had undergone preoperative US, CEUS and MDCT and 65.5% had received IOUS. The gold standard found liver metastases in 54 patients (14.8%). Multidetector CT found significantly more metastases than CEUS in 15 (28%) of the patients (p=0.02). In a patient-by-patient analysis MDCT had a non-significantly higher sensitivity in the detection of liver metastases compared to CEUS (0.89 versus 0.80, p=0.06). The specificity of CEUS (0.98) was slightly better than that of MDCT (0.94) (p=0.02). CONCLUSION Multidetector CT found significant more metastases than CEUS, and MDCT had in patient-by-patient analysis a non-significant better sensitivity (p=0.06) in detecting liver metastases in patients with CRC.
Collapse
|
32
|
Piscaglia F, Corradi F, Mancini M, Giangregorio F, Tamberi S, Ugolini G, Cola B, Bazzocchi A, Righini R, Pini P, Fornari F, Bolondi L. Real time contrast enhanced ultrasonography in detection of liver metastases from gastrointestinal cancer. BMC Cancer 2007; 7:171. [PMID: 17767722 PMCID: PMC2000899 DOI: 10.1186/1471-2407-7-171] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 09/03/2007] [Indexed: 12/21/2022] Open
Abstract
Background Contrast enhanced ultrasound (CEUS) is an imaging technique which appeared on the market around the year 2000 and proposed for the detection of liver metastases in gastrointestinal cancer patients, a setting in which accurate staging plays a significant role in the choice of treatment. Methods A total of 109 patients with colorectal (n = 92) or gastric cancer prospectively underwent computed tomography (CT) scan and conventional US evaluation followed by real time CEUS. A diagnosis of metastases was made by CT or, for lesions not visibile at CT, the diagnosis was achieved by histopathology or by a malignant behavior during follow-up. Results Of 109 patients, 65 were found to have metastases at presentation. CEUS improved sensitivity in metastatic livers from 76.9% of patients (US) to 95.4% (p <0.01), while CT scan reached 90.8% (p = n.s. vs CEUS, p < 0.01 vs US). CEUS and CT were more sensitive than US also for detection of single lesions (87 with US, 122 with CEUS, 113 with CT). In 15 patients (13.8%), CEUS revealed more metastases than CT, while CT revealed more metastases than CEUS in 9 patients (8.2%) (p = n.s.). Conclusion CEUS is more sensitive than conventional US in the detection of liver metastases and could be usefully employed in the staging of patients with gastrointestinal cancer. Findings at CEUS and CT appear to be complementary in achieving maximum sensitivity.
Collapse
Affiliation(s)
- Fabio Piscaglia
- Div. Internal Medicine, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Francesco Corradi
- Div. Internal Medicine, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Mikaela Mancini
- Div. Internal Medicine, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | | | | | - Giampaolo Ugolini
- Div. Emergency Surgery, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Bruno Cola
- Div. General Surgery, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Alberto Bazzocchi
- Div. Internal Medicine, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Roberto Righini
- Div. Internal Medicine, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Patrizia Pini
- Div. Internal Medicine, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| | - Fabio Fornari
- Div. Gastroenterology, Ospedale Pietro da Saliceto, Piacenza, Italy
| | - Luigi Bolondi
- Div. Internal Medicine, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy
| |
Collapse
|
33
|
Chua SC, Groves AM, Kayani I, Menezes L, Gacinovic S, Du Y, Bomanji JB, Ell PJ. The impact of 18F-FDG PET/CT in patients with liver metastases. Eur J Nucl Med Mol Imaging 2007; 34:1906-14. [PMID: 17713766 DOI: 10.1007/s00259-007-0518-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Accepted: 06/19/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to assess the performance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) versus dedicated contrast-enhanced CT (CECT) in the detection of metastatic liver disease. METHODS All patients that presented to our Institution with suspected metastatic liver disease who underwent (18)F-FDG PET/CT and CECT within 6 weeks of each other, were retrospectively analyzed, covering a 5-year period. One hundred and thirty-one patients (67 men, 64 women; mean age 62) were identified. Seventy-five had colorectal carcinoma and 56 had other malignancies. The performance of CECT and that of (18)F-FDG-PET/CT in detecting liver metastases were compared. The ability of each to detect local recurrence, extrahepatic metastases and to alter patient management was recorded. The final diagnosis was based on histology, clinical and radiological follow-up (mean 23 months). RESULTS In detecting hepatic metastases, (18)F-FDG-PET/CT yielded 96% sensitivity and 75% specificity, whilst CECT showed 88% sensitivity and 25% specificity. (18)F-FDG-PET/CT and CECT were concordant in 102 out of 131 patients (78%). In the colorectal group (18)F-FDG-PET/CT showed 94% sensitivity and 75% specificity, whilst CECT had 91% sensitivity and 25% specificity. In the noncolorectal group (18)F-FDG-PET/CT showed 98% sensitivity and 75% specificity whilst CECT had 85% sensitivity and 25% specificity. Overall, (18)F-FDG-PET/CT altered patient management over CECT in 25% of patients. CECT did not alter patient management over (18)F-FDG-PET/CT alone in any patients. CONCLUSION (18)F-FDG-PET/CT performed better in detecting metastatic liver disease than CECT in both colorectal and noncolorectal malignancies, and frequently altered patient management. The future role of CECT in these patients may need to be re-evaluated to avoid potentially unnecessary duplication of investigation where (18)F-PET/CT is readily available.
Collapse
Affiliation(s)
- Siew C Chua
- Institute of Nuclear Medicine, UCL Hospital, University College London, 235 Euston Road, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
Metastases are the most common malignant liver lesions and the most common indication for hepatic imaging. Specific characterization of liver metastases in patients with primary non-hepatic tumors is crucial to avoid unnecessary diagnostic work-up for incidental benign liver lesions. Magnetic resonance (MR) is rapidly emerging as the imaging modality of choice for detection and characterization of liver lesions due to the high specificity resulting from optimal lesion-to-liver contrast and no radiation exposure. Improvements in breath-hold T1-weighted fast spoiled gradient echo and rapid T2-weighted single shot echo-train acquisition enable imaging of the liver in a single breath-hold with high spatial resolution. Most metastases are hypo- to isointense on T1 and iso- to hyperintense on T2-weighted images. MR contrast agents provide critical tumor characterization and can be safely used in patients with iodine contrast allergy and renal failure. Other agents, including newly developing gadolinium-chelates or iron oxide agents may provide additional benefits in selected applications. The degree and nature of tumor vascularity form the basis for liver lesion characterization based on enhancement properties. Liver metastases may be hypovascular or hypervascular. Colon, lung, breast and gastric carcinomas are the most common tumors causing hypovascular liver metastases, and typically show perilesional enhancement. Neuroendocrine tumors including carcinoid and islet cell tumors, renal cell carcinoma, breast, melanoma, and thyroid carcinoma are tumors most commonly causing hypervascular hepatic metastases, which may develop early enhancement with variable degrees of washout and peripheral rim enhancement.
Collapse
Affiliation(s)
- Saravanan Namasivayam
- Division of Abdominal Imaging, Department of Radiology, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Present address: Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit street, White 270, Boston, MA 02114, USA
| | | | - Sanjay Saini
- Division of Abdominal Imaging, Department of Radiology, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA 30322, USA; Present address: Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit street, White 270, Boston, MA 02114, USA
| |
Collapse
|
35
|
Abstract
Carcinomas of the rectum are associated with a significant local and distant recurrence rate. Not all patients are appropriate candidates for preoperative radiation therapy. Preoperative identification of those most likely to benefit from neoadjuvant therapy is important. There is no general consensus on the role of endorectal ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) in staging patients with rectal cancer. Although the tumor stage is an important prognostic factor, preoperative assessment is associated with prediction of the circumferential resection margin. Newer developments such as coils, sequences and gradients in MRI, evolution of multidetector CT and new contrast media, allow for an algorithm selection aiming at the best diagnostic options for patients. The present review will discuss the current role of the various imaging modalities in staging carcinomas of the rectum.
Collapse
Affiliation(s)
- A H Karantanas
- Department of Radiology, University of Crete, Heraklion, Greece.
| | | | | | | |
Collapse
|