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Strange CD, Strange TA, Erasmus LT, Patel S, Ahuja J, Shroff GS, Agrawal R, Truong MT. Imaging in Lung Cancer Staging. Clin Chest Med 2024; 45:295-305. [PMID: 38816089 DOI: 10.1016/j.ccm.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Lung cancer remains one of the leading causes of mortality worldwide, as well as in the United States. Clinical staging, primarily with imaging, is integral to stratify patients into groups that determine treatment options and predict survival. The eighth edition of the tumor, node, metastasis (TNM-8) staging system proposed in 2016 by the International Association for the Study of Lung Cancer remains the current standard for lung cancer staging. The system is used for all subtypes of lung cancer, including non-small cell lung cancer, small cell lung cancer, and bronchopulmonary carcinoid tumors.
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Affiliation(s)
- Chad D Strange
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA.
| | - Taylor A Strange
- Department of Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Lauren T Erasmus
- Department of Anatomy and Cell Biology, Faculty of Sciences, McGill University, Montreal, QC H3A 0G4, Canada
| | - Smita Patel
- Department of Radiology, University of Michigan at Ann Arbor, 1500 E Medical Center Drive, SPC 5868, Ann Arbor, MI 48109, USA
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Rishi Agrawal
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
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Boraschi P, Moretto R, Donati F, Borelli B, Mercogliano G, Giugliano L, Boccaccino A, Della Pina MC, Colombatto P, Signori S, Masi G, Cremolini C, Urbani L. Exploring the Outcome of Disappearance or Small Remnants of Colorectal Liver Metastases during First-Line Chemotherapy on Hepatobiliary Contrast-Enhanced and Diffusion-Weighted MR Imaging. Cancers (Basel) 2023; 15:cancers15082200. [PMID: 37190129 DOI: 10.3390/cancers15082200] [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: 03/18/2023] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
We aimed to evaluate the outcome of the disappearance or small remnants of colorectal liver metastases during first-line chemotherapy assessed by hepatobiliary contrast-enhanced and diffusion-weighted MR imaging (DW-MRI). Consecutive patients with at least one disappearing liver metastasis (DLM) or small residual liver metastases (≤10 mm) assessed by hepatobiliary contrast-enhanced and DW-MRI during first-line chemotherapy were included. Liver lesions were categorized into three groups: DLM; residual tiny liver metastases (RTLM) when ≤5 mm; small residual liver metastases (SRLM) when >5mm and ≤10 mm. The outcome of resected liver metastases was assessed in terms of pathological response, whereas lesions left in situ were evaluated in terms of local relapse or progression. Fifty-two outpatients with 265 liver lesions were radiologically reviewed; 185 metastases fulfilled the inclusion criteria: 40 DLM, 82 RTLM and 60 SRLM. We observed a pCR rate of 75% (3/4) in resected DLM and 33% (12/36) of local relapse for DLM left in situ. We observed a risk of relapse of 29% and 57% for RTLM and SRLM left in situ, respectively, and a pCR rate of about 40% overall for resected lesions. DLM assessed via hepatobiliary contrast-enhanced and DW-MRI very probably indicates a complete response. The surgical removal of small remnants of liver metastases should always be advocated whenever technically possible.
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Affiliation(s)
- Piero Boraschi
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Francescamaria Donati
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Beatrice Borelli
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy
| | - Giuseppe Mercogliano
- Department of Radiology, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Luigi Giugliano
- Department of Radiology, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Alessandra Boccaccino
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy
| | - Maria Clotilde Della Pina
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Piero Colombatto
- Hepatology Unit, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Stefano Signori
- General Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy
| | - Lucio Urbani
- General Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
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Kitasaki N, Abe T, Inoue M, Kohata A, Toyota K. Pathological complete response of multiple liver metastases from colon cancer successfully treated with conversion surgery: A case report. Int J Surg Case Rep 2023; 104:107935. [PMID: 36801767 PMCID: PMC9969276 DOI: 10.1016/j.ijscr.2023.107935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Recently, the successful long-term survival of patients with unresectable distant metastases from colorectal cancer, who underwent conversion surgery after systemic chemotherapy, have been documented. Herein, we present a patient afflicted with ascending colon cancer and multiple unresectable liver metastases, who underwent conversion surgery, resulting in the complete disappearance of the pathological liver metastases. PRESENTATION OF CASE A 70-year-old woman visited our hospital with a chief complaint of weight loss. A diagnosis of ascending colon cancer (cT4aN2aM1a [H3]: TNM classification 8th edition) stage IVa with RAS/BRAF wild-type mutation was made (four liver metastases up to 60 mm in diameter were observed in both lobes). After 2 years and 3 months of systemic chemotherapy (capecitabine, oxaliplatin, and bevacizumab), the tumor marker levels had decreased to normal ranges and all liver metastases showed partial responses with remarkable shrinkage. After confirmation of a liver function and a preserved future liver remnant volume, the patient finally underwent hepatectomy, involving partial resection of S4 and subsegmentectomy of S8, along with a right hemicolectomy. Histopathologic examination revealed that all liver metastases had completely disappeared, while regional lymph node metastases had changed into scar tissue. However, the primary tumor failed to respond to chemotherapy, resulting in ypT3N0M0 ypStage IIA. The patient was discharged from the hospital on the 8th postoperative day without any postoperative complications. She is currently on the 6th month of follow-up without any recurring metastasis. CLINICAL DISCUSSION Curative surgery is recommended for resectable liver metastases of colorectal cancer (CRLM), be it synchronous or heterochronous. Up until now, the efficacy of perioperative chemotherapy for CRLM is limited. Chemotherapy has a double-edged aspect, where some cases have shown successful improvement in the treatment stage. CONCLUSION To obtain the maximum benefit from conversion surgery, it is critical to incorporate the appropriate surgical technique, at the correct stage, in order avoid the progression to chemotherapy-associated steatohepatitis (CASH) in the patient.
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Affiliation(s)
- Nao Kitasaki
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan.
| | - Tomoyuki Abe
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan.
| | - Masashi Inoue
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan.
| | - Akihiro Kohata
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan.
| | - Kazuhiro Toyota
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan.
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Ozaki K, Ishida S, Higuchi S, Sakai T, Kitano A, Takata K, Kinoshita K, Matta Y, Ohtani T, Kimura H, Gabata T. Diagnostic performance of abbreviated gadoxetic acid-enhanced magnetic resonance protocols with contrast-enhanced computed tomography for detection of colorectal liver metastases. World J Radiol 2022; 14:352-366. [PMID: 36340439 PMCID: PMC9630987 DOI: 10.4329/wjr.v14.i10.352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/05/2022] [Accepted: 10/06/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although contrast-enhanced magnetic resonance imaging (MRI) using gadoxetic acid has been shown to have higher accuracy, sensitivity, and specificity for the detection and characterization of hepatic metastases compared with other modalities, the long examination time would limit the broad indication. Several abbreviated enhanced MRI (Ab-MRI) protocols without dynamic phases have been proposed to achieve equivalent diagnostic performance for the detection of colorectal liver metastases. However, an optimal protocol has not been established, and no studies have assessed the diagnostic performance of Ab-MRI combined with contrast-enhanced computed tomography (CE-CT), which is the preoperative imaging of colorectal cancer staging in clinical settings, to determine the best therapeutic strategy.
AIM To compare the diagnostic performance of two kinds of Ab-MRI protocol with the standard MRI protocol and a combination of the Ab-MRI protocol and CE-CT for the detection of colorectal liver metastases.
METHODS Study participants comprised 87 patients (51 males, 36 females; mean age, 67.2 ± 10.8 years) who had undergone gadoxetic acid-enhanced MRI and CE-CT during the initial work-up for colorectal cancer from 2010 to 2021. Each exam was independently reviewed by two readers in three reading sessions: (1) Only single-shot fast spin echo (FSE) T2-weighted or fat-suppressed-FSE-T2-weighted, diffusion-weighted, and hepatobiliary-phase images (Ab-MRI protocol 1 or 2); (2) all acquired MRI sequences (standard protocol); and (3) a combination of an Ab-MRI protocol (1 or 2) and CE-CT. Diagnostic performance was then statistically analyzed.
RESULTS A total of 380 Lesions were analyzed, including 195 metastases (51.4%). Results from the two Ab-MRI protocols were similar. The sensitivity, specificity, and positive and negative predictive values from Ab-MRI were non-inferior to those from standard MRI (P > 0.05), while those from the combination of Ab-MRI protocol and CE-CT tended to be higher than those from Ab-MRI alone, although the difference was not significant (P > 0.05), and were quite similar to those from standard MRI (P > 0.05).
CONCLUSION The diagnostic performances of two Ab-MRI protocols were non-inferior to that of the standard protocol. Combining Ab-MRI with CE-CT provided better diagnostic performance than Ab-MRI alone.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, University of Fukui, Fukui 9101193, Japan
| | - Shota Ishida
- Department of Radiological Technology, Faculty of Medical Science, Kyoto College of Medical Science, Kyoto 6220041, Japan
| | - Shohei Higuchi
- Department of Radiology, University of Fukui, Fukui 9101193, Japan
| | - Toyohiko Sakai
- Department of Radiology, University of Fukui, Fukui 9101193, Japan
| | - Ayaki Kitano
- Department of Radiology, University of Fukui, Fukui 9101193, Japan
| | - Kenji Takata
- Department of Radiology, University of Fukui, Fukui 9101193, Japan
| | | | - Yuki Matta
- Department of Radiology, University of Fukui, Fukui 9101193, Japan
| | - Takashi Ohtani
- Department of Radiology, University of Fukui, Fukui 9101193, Japan
| | - Hirohiko Kimura
- Department of Radiology, University of Fukui, Fukui 9101193, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa 9208641, Japan
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5
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Moretto R, Borelli B, Boraschi P, Roffi N, Donati F, Antoniotti C, Della Pina C, Colombatto P, Balestri R, Signori S, Gigoni R, Guidoccio F, Volterrani D, Masi G, Cremolini C, Urbani L. Impact of baseline gadoxetic acid-enhanced liver magnetic resonance and diffusion-weighted imaging in resectable colorectal liver metastases: A prospective, monocentric study. Surg Oncol 2022; 44:101836. [PMID: 35998501 DOI: 10.1016/j.suronc.2022.101836] [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: 04/27/2022] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Liver magnetic resonance imaging (MRI) utilizing hepatocyte-specific contrast agent and diffusion-weighted imaging (DWI) is currently used to properly stage colorectal liver metastases (CRLM) in patients candidate to liver surgery. However, the added value of liver MRI in choosing the treatment strategy in resectable CRLM over computed tomography (CT)-scan is not clear. PATIENTS AND METHODS This is a prospective monocentric collection of consecutive cases of patients with CRLM conceived with the aim to assess the added value of liver MRI in changing the initial treatment strategy planned according to CT-scan. Potential changes in the initially planned strategy were defined as: - from upfront surgery to perioperative chemotherapy (fluoropyrimidine and oxaliplatin) - from upfront surgery to first-line systemic therapy (doublet or triplet plus a biological agent) - from perioperative chemotherapy to first-line systemic therapy. Hypothesising that MRI may induce a change in the choice of the treatment strategy in the 20% of cases (alternative hypothesis), against a null hypothesis of 5%, with one-tailed alpha and beta errors of 0.05 and 0.20 respectively, 27 patients were needed. The added value of liver MRI would have been considered clinically meaningful if at least 4 changes in the treatment strategy were observed. RESULTS Among 27 enrolled patients, upfront surgery and perioperative chemotherapy strategies were chosen in 17 (63%) and 10 (37%) cases, respectively, based on CT-scan. After liver MRI, additional liver lesions were found in 8 patients (30%) and the initial strategy was changed in 7 patients (26%) (4 initially deemed candidate to upfront surgery and 3 initially sent to perioperative chemotherapy) that were treated with first-line systemic therapy. CONCLUSIONS Our results support the indication of the current guidelines on the routine use of liver MRI in the initial workup of patients with resectable CRLM with an MRI-driven changes of initial treatment plan in a relevant percentage of cases.
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Affiliation(s)
- Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy.
| | - Beatrice Borelli
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126, Pisa, Italy
| | - Piero Boraschi
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Nicolò Roffi
- General Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Francescamaria Donati
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Carlotta Antoniotti
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126, Pisa, Italy
| | - Clotilde Della Pina
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Piero Colombatto
- Hepatology Unit, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Riccardo Balestri
- General Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Stefano Signori
- General Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Roberto Gigoni
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Federica Guidoccio
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Duccio Volterrani
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126, Pisa, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126, Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126, Pisa, Italy
| | - Lucio Urbani
- General Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
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6
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Wong GYM, Bhimani N, Mol B, Diakos C, de Reuver P, Molloy MP, Hugh TJ. Performance of prognostic models incorporating KRAS mutation status to predict survival after resection of colorectal liver metastases. HPB (Oxford) 2022; 24:1316-1325. [PMID: 35093297 DOI: 10.1016/j.hpb.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/02/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Genetic And Morphologic Evaluation (GAME) score and modified clinical score (m-CS) are two novel prognostic models that incorporate KRAS mutation status to predict survival after resection of colorectal liver metastases (CRLM). This retrospective cohort study evaluated the performance of these two models. METHODS A total of 103 patients who underwent resection of CRLM between 2007 and 2017 and had known KRAS mutation status were included, 39 (37.9%) of whom had KRAS mutated tumours. Complete case analysis of the patients was performed according to the Clinical Risk Score (CRS), m-CS, and GAME score. The primary outcome was overall survival stratified according to low-risk and high-risk scores. Harrell's C-index and Akaike information criterion (AIC) were used to compare the discrimination of the evaluated prognostic models. RESULTS The GAME score demonstrated the largest difference in overall survival for patients stratified according to low-risk and high-risk groups. Harrell's C-index values for the CRS, m-CS, and GAME models were 0.583, 0.600, and 0.668, respectively. AIC values for the CRS, m-CS, and GAME models were 441, 439, and 427, respectively. CONCLUSION The GAME score outperforms the CRS and m-CS in predicting overall survival after resection of CRLM in patients with known KRAS mutation status.
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Affiliation(s)
- Geoffrey Yuet Mun Wong
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
| | - Nazim Bhimani
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Barend Mol
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Connie Diakos
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Philip de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Mark P Molloy
- Bowel Cancer and Biomarker Research Laboratory, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas J Hugh
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Sanuki N, Takeda A, Tsurugai Y, Eriguchi T. Role of stereotactic body radiotherapy in multidisciplinary management of liver metastases in patients with colorectal cancer. Jpn J Radiol 2022; 40:1009-1016. [PMID: 35857212 PMCID: PMC9529716 DOI: 10.1007/s11604-022-01307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
In the treatment of colorectal cancer patients with distant metastases, the development of new anticancer agents has considerably prolonged progression-free survival. Such survival benefits attributed to chemotherapy have increased the relative significance of local therapy in patients with limited metastases. The liver is recognized as the most common site of metastasis of colorectal cancer because of the intestinal mesenteric drainage to the portal veins. Hepatic resection of isolated liver metastases of colorectal cancer is the only option for a potential cure. However, hepatic metastases are resectable in only approximately 20% of the patients. For remaining patients with high-risk resectable liver metastases or those who are unfit for surgery, less invasive, local therapies including radiation therapy (stereotactic body radiation therapy, SBRT) may have a potential role in treatment. Although the local control rate of SBRT for colorectal liver metastases has room for improvement, its less-invasive nature and broad indications deserve consideration. Future research should include SBRT dose escalation or the selection of patients who benefit from local ablative therapies. SBRT may offer an alternative, non-invasive approach for the treatment of colorectal liver metastases in a multidisciplinary treatment strategy.
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Affiliation(s)
- Naoko Sanuki
- Department of Radiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, 510-8567, Japan.
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan.
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan
| | - Yuichiro Tsurugai
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan
| | - Takahisa Eriguchi
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan
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Borrego Gómez J, Romera N, Tellado J, del Campo L, Díaz Formoso J, Fuster M, Vivas I, Ramón Botella E, Menéndez de Llano Ortega R. Recomendaciones de expertos sobre el uso de ácido gadoxético en pacientes con metástasis hepáticas en España. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Borrego Gómez J, Romera N, Tellado J, del Campo L, Díaz Formoso J, Fuster M, Vivas I, Ramón Botella E, Menéndez de Llano Ortega R. Expert recommendations about the use of gadoxetic acid in patients with liver metastases in Spain. RADIOLOGIA 2022; 64:300-309. [DOI: 10.1016/j.rxeng.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 09/03/2021] [Indexed: 10/15/2022]
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10
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Yamada S, Kishi Y, Miyake M, Nara S, Esaki M, Shimada K. Characteristics of false-positive lesions in evaluating colorectal liver metastases on gadoxetic acid-enhanced magnetic resonance imaging. Surg Today 2022; 52:1178-1184. [PMID: 35043218 DOI: 10.1007/s00595-022-02451-5] [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: 08/27/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Gadoxetic acid-enhanced MRI (Gd-EOB-MRI) shows higher sensitivity for colorectal liver metastases (CRLM) than contrast-enhanced computed tomography (CECT). However, the details of false-positive lesions for each imaging modality are unknown. METHODS Cases undergoing hepatectomy for CRLM following a preoperative evaluation with both CECT and Gd-EOB-MRI between July 2008 and December 2016 were reviewed. The false-positive and false-negative rates were assessed for each modality, and the characteristics of false-positive lesions were evaluated. RESULTS We evaluated 275 partial hepatectomies in 242 patients without preoperative chemotherapy. Among the 275 hepatectomies, 546 lesions were recognized by CECT and/or Gd-EOB-MRI. The false-positive rates for CECT and Gd-EOB-MRI were 4% (18/422) and 7% (37/536), respectively. The size of false-positive lesions was significantly smaller than that of correctly diagnosed lesions (median: 28 mm [3-120 mm] vs 7.6 mm [320 mm], P < 0.001). Compared with the 233 correctly diagnosed lesions ≤ 20 mm in diameter, false-positive lesions were more frequently located near the liver surface or vasculobiliary structures than true lesions (33/37 [89%] vs 149/233 [64%], respectively; P = 0.0021). CONCLUSION Gd-EOB-MRI had a 7% false-positive rate. A small size and tumor location near the surface or near vasculobiliary structures were associated with false positivity.
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Affiliation(s)
- Shuhei Yamada
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yoji Kishi
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Division of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Mototaka Miyake
- Division of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Satoshi Nara
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Minoru Esaki
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kazuaki Shimada
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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11
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Interindividual Comparison of Frequency-Selective Nonlinear Blending to Conventional CT for Detection of Focal Liver Lesions Using MRI as the Reference Standard. AJR Am J Roentgenol 2022; 218:1021-1029. [PMID: 35018796 DOI: 10.2214/ajr.21.26922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Diagnosing liver lesions is challenging. CT is used for primary diagnosis; however, its contrast resolution is limited. Investigating methods for better detection of liver lesions is important. Objective: To evaluate the effect of frequency-selective nonlinear blending (NLB) on the detectability of liver lesions on CT. Methods: Retrospective search yielded 109 patients with malignant and benign liver lesions (n = 356; 191 principally diagnosed, 165 incidental findings) underwent contrast-enhanced CT (CECT) in portal venous phase and liver MRI between January 2012 and December 2017. Nonlinear blending (NLB) was applied to CECTs, and three readers rated image quality (5-point Likert scale) in blinded, independent, and randomized fashion. Focal lesions (n = 356) were evaluated for lesion identification and categorization to assess sensitivity. For 191 lesions (primary diagnosis) two readers evaluated CECT and NLB CT to compare size and subjective measurement accuracy. A fourth reader conducted ROI measurements for calculation of contrast-to-noise ratio (CNR), and a fifth reader reviewed MRI as standard of reference. Statistics included interobserver agreement, quantitative comparisons of CNR, lesion size, and subjective image analyses of image quality and sensitivity of detecting liver lesions. Results: Three readers rated image quality of NLB CT higher than for CECT (NLB CT, 4 [10% and 90% percentile: 4, 5]; CECT, 2 [1, 3]; p < .001). CECT showed good interreader agreement (interclass coefficient [ICC], 0.81 [95% CI, 0.76¬-0.85]); NLB CT also (ICC, 0.75 [95% CI, 0.69-0.79]). Mean CNR of liver lesions was increased using NLB (CECT, 4.18 [range, 1.67-9.06]; NLB CT, 12.49 [range, 6.18-23.39]; p < .001). Bland-Altman analysis of lesion size showed reduced underestimation from 2.5 mm (SD, 9.2 [95% CI, 1.2-3.9]) in CECT to 0.1 mm (SD, 3.9 [95% CI, -0.68 to 0.46) for NLB CT (concordance correlation coefficient, 0.99). Sensitivity for detecting liver lesions was increased to 86% for NLB CT (CECT, 76%). Conclusion: Frequency-selective NLB of CECT allows increased image quality and CNR, more precise size measurement, and higher sensitivity for detecting liver lesions. Clinical Impact: NLB CT improves liver lesion detection and increases the accuracy of lesion size measurement, which is important when considering local ablation or liver transplant.
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12
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Early Diagnosis of Liver Metastases from Colorectal Cancer through CT Radiomics and Formal Methods: A Pilot Study. J Clin Med 2021; 11:jcm11010031. [PMID: 35011771 PMCID: PMC8745238 DOI: 10.3390/jcm11010031] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver metastases are a leading cause of cancer-associated deaths in patients affected by colorectal cancer (CRC). The multidisciplinary strategy to treat CRC is more effective when the radiological diagnosis is accurate and early. Despite the evolving technologies in radiological accuracy, the radiological diagnosis of Colorectal Cancer Liver Metastases (CRCLM) is still a key point. The aim of our study was to define a new patient representation different by Artificial Intelligence models, using Formal Methods (FMs), to help clinicians to predict the presence of liver metastasis when still undetectable using the standard protocols. METHODS We retrospectively reviewed from 2013 to 2020 the CT scan of nine patients affected by CRC who would develop liver lesions within 4 months and 8 years. Seven patients developed liver metastases after primary staging before any liver surgery, and two patients were enrolled after R0 liver resection. Twenty-one patients were enrolled as the case control group (CCG). Regions of Interest (ROIs) were identified through manual segmentation on the medical images including only liver parenchyma and eventual benign lesions, avoiding major vessels and biliary ducts. Our predictive model was built based on formally verified radiomic features. RESULTS The precision of our methods is 100%, scheduling patients as positive only if they will be affected by CRCLM, showing a 93.3% overall accuracy. Recall was 77.8%. CONCLUSION FMs can provide an effective early detection of CRCLM before clinical diagnosis only through non-invasive radiomic features even in very heterogeneous and small clinical samples.
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13
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Stavrou GA, Stang A, Raptis DA, Schadde E, Zeile M, Brüning R, Wagner KC, Huber TM, Oldhafer KJ. Intraoperative (Contrast-Enhanced) Ultrasound Has the Highest Diagnostic Accuracy of Any Imaging Modality in Resection of Colorectal Liver Metastases. J Gastrointest Surg 2021; 25:3160-3169. [PMID: 34159555 DOI: 10.1007/s11605-021-04925-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
AIM Defining sensitivity, specificity, diagnostic accuracy for detection of colorectal liver metastases in imaging compared to intraoperative assessment. Defining a cutoff, where accuracy of detection is impaired. METHODS Prospective single-institution clinical trial (clinicaltrials.gov: NCT01522209). Patients underwent CEUS, MDCT, and 3 Tesla EOB-MRI within 2 weeks preoperatively. Intraoperative palpation, IOUS, and CEIOUS were performed. A patient and lesion-based database was analyzed for accuracy of detection of CEUS, CT, MRI, and Palp/IOUS/CEIOUS combined read. Histology was standard of reference. RESULTS Forty-seven high tumor load (mean 5, 4 lesions) patients were analyzed. Histopathology confirmed 264 lesions (245 malignant: 19 benign). Accuracy for detection of all lesions: CEUS 63%, CT 71%, MRI 92%, and PALP/IOUS/CEIOUS 98%. ROC analysis for lesion size showed severe impairment of accuracy in lesion detection smaller than 5mm. Intraoperative imaging was not impaired by lesion size. Patient-based analysis revealed a change of resection plan after IOUS/CEIOUS in 35% of patients. CONCLUSION At 5-mm lesion size, preoperative imaging shows a drop in accuracy of detection. In patients with multiple lesions, addition of MRI to MDCT seems useful. Accuracy of intraoperative ultrasound is not impacted by lesion size and should be mandatory. CEIOUS can improve intraoperative decision-making. TRIAL REGISTRATION Study registered with clinicaltrials.gov : NCT01522209.
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Affiliation(s)
- Gregor A Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbruecken General Hospital, Saarbruecken, Germany. .,Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.
| | - Axel Stang
- Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.,Department of Medical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Dimitri A Raptis
- Department of Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Erik Schadde
- Department of Surgery, Division of Surgical Oncology and Division of Transplant Surgery, Rush University Medical Center, Chicago, IL, USA.,Institute of Physiology, University of Zürich Campus Irchel, Zürich, Switzerland.,Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Martin Zeile
- Department of Radiology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Roland Brüning
- Department of Radiology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Kim C Wagner
- Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Tessa M Huber
- Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Karl J Oldhafer
- Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.,Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
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14
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Zhou N, Meng X, Zhang Y, Yu B, Yuan J, Yu J, Zhu H, Yang Z. Diagnostic Value of Delayed PET/MR in Liver Metastasis in Comparison With PET/CT. Front Oncol 2021; 11:717687. [PMID: 34527587 PMCID: PMC8435726 DOI: 10.3389/fonc.2021.717687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/10/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives The aim of this study was to evaluate the value of a delayed positron emission tomography/magnetic resonance (PET/MR) scan relative to a single positron emission tomography/computed tomography (PET/CT) scan for liver metastasis detection. Methods In this study, 70 patients with solid malignancies and suspicious liver lesions undergoing 2-deoxy-2-[18F]fluoro-D-glucose [(18F)FDG] PET/CT and subsequent delayed liver PET/MR scans were analyzed. The histopathological analysis and/or imaging follow-up were performed as the standard of reference. Lesion maximum standardized uptake value (SUVmax), diameter, and tumor to nontumor ratio (T/N) were measured. Lesion detection sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both examinations. Results (1) The standard of reference revealed 208 liver lesions in 70 patients (metastasis in 56 patients with 196 lesions; benign in 14 patients with 12 lesions). Compared with PET/CT, PET/MR had higher accuracy (98.6% vs. 78.6%), sensitivity (98.2% vs. 76.8%), and specificity (100.0% vs. 85.7%) (2). The therapeutic strategies of 29 patients (41.4%) needed reconsideration after the additional PET/MR, including new metastases detected (13/70), new affected lobes identified (14/70), and false-positive corrected (2/70) (3). PET/MR detected significantly more metastases than PET/CT did, especially with small lesions. The SUVmax of the same lesion correlated well between the two acquisitions, while the delayed PET showed a higher T/N ratio. Conclusions In liver metastasis detection, the diagnostic value of the delayed PET/MR is validated to be superior to that of PET/CT, which may aid the clinical decision-making.
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Affiliation(s)
- Nina Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangxi Meng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Boqi Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jianmin Yuan
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Jiangyuan Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hua Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhi Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital & Institute, Beijing, China
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15
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Shimada H, Fukagawa T, Haga Y, Okazumi S, Oba K. Clinical TNM staging for esophageal, gastric, and colorectal cancers in the era of neoadjuvant therapy: A systematic review of the literature. Ann Gastroenterol Surg 2021; 5:404-418. [PMID: 34337289 PMCID: PMC8316742 DOI: 10.1002/ags3.12444] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
AIM Clinical staging is vital for selecting appropriate candidates and designing neoadjuvant treatment strategies for advanced tumors. The aim of this review was to evaluate diagnostic abilities of clinical TNM staging for gastrointestinal, gastrointestinal cancers. METHODS We conducted a systematic review of recent publications to evaluate the accuracy of diagnostic modalities on gastrointestinal cancers. A systematic literature search was performed in PubMed/MEDLINE using the keywords "TNM staging," "T4 staging," "distant metastases," "esophageal cancer," "gastric cancer," and "colorectal cancer," and the search terms used in Cochrane Reviews between January 2005 to July 2020. Articles focusing on preoperative diagnosis of: (a) depth of invasion; (b) lymph node metastases; and (c) distant metastases were selected. RESULTS After a full-text search, a final set of 55 studies (17 esophageal cancer studies, 26 gastric cancer studies, and 12 colorectal cancer studies) were used to evaluate the accuracy of clinical TNM staging. Positron emission tomography-computed tomography (PET-CT) and/or magnetic resonance imaging (MRI) were the best modalities to assess distant metastases. Fat and fiber mode of CT may be useful for T4 staging of esophageal cancer, CT was a partially reliable modality for lymph node staging in gastric cancer, and CT combined with MRI was the most reliable modality for liver metastases from colorectal cancer. CONCLUSION The most reliable diagnostic modality differed among gastrointestinal cancers depending on the type of cancer. Therefore, we propose diagnostic algorithms for clinical staging for each type of cancer.
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Affiliation(s)
- Hideaki Shimada
- Department of Gastroenterological SurgeryToho University Graduate School of MedicineTokyoJapan
| | - Takeo Fukagawa
- Department of SurgeryTeikyo University School of MedicineTokyoJapan
| | - Yoshio Haga
- Department of SurgeryJapan Community Healthcare Organization Amakusa Central General HospitalAmakusaJapan
| | - Shin‐ichi Okazumi
- Department of Gastroenterological SurgeryToho University Graduate School of MedicineTokyoJapan
- Department of SurgeryToho University Sakura Medical CenterSakuraJapan
| | - Koji Oba
- Department of BiostatisticsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
- Interfaculty Initiative in Information StudiesGraduate School of Interdisciplinary Information StudiesThe University of TokyoTokyoJapan
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16
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Pilot study of gadoxetate disodium-enhanced mri for localized and metastatic prostate cancers. Sci Rep 2021; 11:5662. [PMID: 33707581 PMCID: PMC7952731 DOI: 10.1038/s41598-021-84960-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
OATP1B3 is expressed de novo in primary prostate cancer tissue and to a greater degree in prostate cancer metastases. Gadoxetate disodium is a substrate of OATP1B3, and its uptake has been shown to correlate with OATP1B3 expression in other cancers. We aimed to evaluate use of gadoxetate disodium to image prostate cancer and to track its utility as a biomarker. A single center open-label non-randomized pilot study recruited men with (1) localized, and (2) metastatic castration resistant prostate cancer (mCRPC). Gadoxetate disodium-enhanced MRI was performed at four timepoints post-injection. The Wilcoxon signed rank test was used to compare MRI contrast enhancement ratio (CER) pre-injection and post-injection. OATP1B3 expression was evaluated via immunohistochemistry (IHC) and a pharmacogenomic analysis of OATP1B3, NCTP and OATP1B1 was conducted. The mCRPC subgroup (n = 9) demonstrated significant enhancement compared to pre-contrast images at 20-, 40- and 60-min timepoints (p < 0.0078). The localized cancer subgroup (n = 11) demonstrated earlier enhancement compared to the mCRPC group, but no retention over time (p > 0.05). OATP1B3 expression on IHC trended higher contrast enhancement between 20–40 min (p ≤ 0.064) and was associated with contrast enhancement at 60 min (p = 0.0422). OATP1B1 haplotype, with N130D and V174A substitutions, impacted enhancement at 40–60 min (p ≤ 0.038). mCRPC lesions demonstrate enhancement after injection of gadoxetate disodium on MRI and retention over 60 min. As inter-individual variability in OATP1B3 expression and function has both predictive and prognostic significance, gadoxetate disodium has potential as a biomarker in prostate cancer.
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Nagino M, Hirano S, Yoshitomi H, Aoki T, Uesaka K, Unno M, Ebata T, Konishi M, Sano K, Shimada K, Shimizu H, Higuchi R, Wakai T, Isayama H, Okusaka T, Tsuyuguchi T, Hirooka Y, Furuse J, Maguchi H, Suzuki K, Yamazaki H, Kijima H, Yanagisawa A, Yoshida M, Yokoyama Y, Mizuno T, Endo I. Clinical practice guidelines for the management of biliary tract cancers 2019: The 3rd English edition. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:26-54. [PMID: 33259690 DOI: 10.1002/jhbp.870] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. METHODS In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as Grade 1 (strong) or Grade 2 (weak) according to the concepts of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS The 31 CQs covered the six topics: (a) prophylactic treatment, (b) diagnosis, (c) biliary drainage, (d) surgical treatment, (e) chemotherapy, and (f) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. CONCLUSIONS This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.
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Affiliation(s)
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideyuki Yoshitomi
- Department of Surgery, Saitama Medical Center, Dokkyo Medical University, Koshigaya, Japan
| | - Taku Aoki
- Second Department of Surgery, Dokkyo Medical University, Mibu, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomoki Ebata
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaru Konishi
- Department of Hepatobiliary Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuaki Shimada
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Shimizu
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Toshio Tsuyuguchi
- Department of Gastroenterology, Chiba Prefectural Sawara Hospital, Sawara, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Gastroenterological Oncology, Fujita Health University, Toyoake, Japan
| | - Junji Furuse
- Department of Medical Oncology, Faculty of Medicine, Kyorin University, Mitaka, Japan
| | - Hiroyuki Maguchi
- Education and Research Center, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, Nagakute, Japan
| | - Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroshi Kijima
- Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akio Yanagisawa
- Department of Pathology, Japanese Red Cross Kyoto Diichi Hospital, Kyoto, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic & Gastrointestinal Surgery, International University of Health and Welfare, Ichikawa, Japan
| | - Yukihiro Yokoyama
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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18
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Beer L, Jajodia A, Prosch H. Pearls and pitfalls in lung cancer staging. BJR Open 2020; 2:20200019. [PMID: 33178978 PMCID: PMC7594898 DOI: 10.1259/bjro.20200019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022] Open
Abstract
Lung cancer is the third most common cancer in the UK and is the leading cause of death. Radiology plays a central role in the diagnostic work-up of patients with suspected and known lung cancer. Tumour assessment includes both local staging, as well as distant staging. Local staging objectives include the assessment of technical resectability with regard to the evaluation of tumour size and invasion of surrounding structures. Distant staging objectives aim to identify distant metastasis in lymphatic and extra lymphatic tissues. CT, positron emission tomography/CT, MRI, and ultrasound are routinely used imaging techniques for staging in patients with lung cancer. In this review, we will consider the pitfalls of these examinations that radiologists potentially face during the work-up of patients with lung cancer.
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Affiliation(s)
| | - Ankush Jajodia
- Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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19
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Barimani D, Kauppila JH, Sturesson C, Sparrelid E. Imaging in disappearing colorectal liver metastases and their accuracy: a systematic review. World J Surg Oncol 2020; 18:264. [PMID: 33032620 PMCID: PMC7545848 DOI: 10.1186/s12957-020-02037-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/25/2020] [Indexed: 12/14/2022] Open
Abstract
Background Approximately 30% of patients with colorectal cancer develop colorectal liver metastases (CRLM). CRLM that become undetectable by imaging after chemotherapy are called disappearing liver metastases (DLM). But a DLM is not necessarily equal to cure. An increasing incidence of patients with DLM provides surgeons with a difficult dilemma: to resect or to not resect the original sites of DLM? The aim of this review was to investigate to what extent a DLM equates a complete response (CR) and to compare outcomes. Methods This review was conducted in accordance with the PRISMA guidelines and registered in Prospero (registration number CRD42017070441). Literature search was made in the PubMed and Embase databases. During the process of writing, PubMed was repeatedly searched and reference lists of included studies were screened for additional studies of interest for this review. Results were independently screened by two authors with the Covidence platform. Studies eligible for inclusion were those reporting outcomes of DLM in adult patients undergoing surgery following chemotherapy. Results Fifteen studies were included with a total of 2955 patients with CRLM. They had 4742 CRLM altogether. Post-chemotherapy, patients presented with 1561 DLM. Patients with one or more DLM ranged from 7 to 48% (median 19%). Median DLM per patient was 3.4 (range 0.4–5.6). Patients were predominantly evaluated by contrast-enhanced computed tomography (CE-CT) before and after chemotherapy, with some exceptions and with addition of magnetic resonance imaging (MRI) in some studies. Intraoperative ultrasound (IOUS) was universally performed in all but two studies. If a DLM remained undetectable by IOUS, this DLM represented a CR in 24–96% (median 77.5%). Further, if a DLM on preoperative CE-CT remained undetectable by additional workup with MRI and CE-IOUS, this DLM was equal to a CR in 75–94% (median 89%). Patients with resected DLM had a longer disease-free survival compared to patients with DLM left in situ but statistically significant differences in overall survival could not be found. Conclusion Combination of CE-CT, MRI, and IOUS showed promising results in accurately identifying DLM with CR. This suggests that leaving DLM in situ could be an alternative to surgical resection when a DLM remains undetectable by MRI and IOUS.
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Affiliation(s)
- Darius Barimani
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
| | - Joonas H Kauppila
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.,Surgery Research Unit, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
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20
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Alizadeh A, Mansour-Ghanaei F, Bagheri FB, Froutan H, Froutan Y, Joukar F, Atrkar-Roushan Z, Chavoshi SA, Hassanipour S. Imaging Accuracy in Diagnosis of Different Focal Liver Lesions: A Retrospective Study in North of Iran. J Gastrointest Cancer 2020; 52:970-975. [PMID: 32929681 DOI: 10.1007/s12029-020-00510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Focal liver lesions (FLLs) are incidentally detected masses found in daily abdominal imaging which are necessary to be characterized, because of the potential of being malignant. There are several imaging methods, such as ultrasonography (US), computed tomography (CT scan), and contrast enhanced magnetic resonance imaging (MRI). Here, we evaluate and compare the diagnostic accuracy (i.e., sensitivity and specificity) of these imaging methods for the diagnosis of FLLs. MATERIAL AND METHODS In this retrospective study, patients with focal liver lesions included and based on the gastroenterologist decision, in 79 patients different imaging methods were used to determine the nature of FLLs: the US, CT scan, and MRI. At the next step, fine-needle aspiration biopsy (FNA) was performed in all cases, and the results about the true nature of FLLs compared with different imaging results. The chi-square test and McNemar test were used. RESULTS Ultrasound diagnosis of benign and malignant was obtained with 82% diagnosis accuracy, 100% sensitivity, 71.4% specificity, 100% negative predictive value, and 69.2% positive predictive value (PPV) compared with the biopsy. Also, the results of benign and malignant masses in CT scan were obtained with diagnostic accuracy of 95%, 100% sensitivity, 80% specificity, 93.9% positive predictive value, and 100% negative predictive value. MRI performed only in 2 cases with similar results to pathology. CONCLUSION It seems that CT scan is more appropriate and useful in the diagnosis of hepatic masses due to its higher diagnostic accuracy than the ultrasound.
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Affiliation(s)
- Ahmad Alizadeh
- Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
| | - Faezeh Berengi Bagheri
- Department of Radiology, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Hossein Froutan
- Emam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Froutan
- Department of Pathology, Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Seyed Ali Chavoshi
- Department of Radiology, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Soheil Hassanipour
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Hepatobiliary phase enhancement of liver metastases on gadoxetic acid MRI: assessment of frequency and patterns. Eur Radiol 2020; 31:1359-1366. [PMID: 32886204 DOI: 10.1007/s00330-020-07228-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/13/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess for and characterize patterns of hepatobiliary phase (HBP) enhancement in hepatic metastases of various malignancies on gadoxetic acid-enhanced MRI. METHODS Eighty gadoxetic acid-enhanced MRI studies performed between July 2012 and November 2019 in patients with hepatic metastases from 13 different primary malignancies were assessed. Most (n = 60) were from colorectal cancer (CRC), pancreatic ductal adenocarcinoma (PDAC), or neuroendocrine tumor (NET) primaries. Two radiologists quantitatively evaluated the dominant lesion on each MRI. A lesion was considered enhancing when HBP enhancement relative to muscle exceeded 20%. Lesions were classified by pattern of enhancement. Quantitative enhancement metrics and patterns of enhancement were compared between CRC, PDAC, and NET using non-parametric statistical tests. RESULTS Most dominant metastatic lesions > 1 cm (77%, 54/70) demonstrated HBP enhancement. HBP enhancement was identified in hepatic metastases from 10 different primary malignancies, including CRC, PDAC, and NET. PDAC metastases demonstrated a lower degree of HBP enhancement (26%) than CRC (44%, padj = 0.04) and NET (51%, padj = 0.01) metastases. Three discrete enhancement patterns were identified: peripheral, central (target), and diffuse heterogeneous. Patterns of HBP enhancement varied between CRC, PDAC, and NET, with secondary analysis demonstrating that PDAC had the highest proportion of peripheral pattern (73%, padj < 0.001), CRC the highest proportion of diffuse heterogeneous pattern (32%, padj < 0.01), and NET the highest proportion of central pattern (89%, padj < 0.001). CONCLUSION Liver metastases from several primary malignancies, including PDAC, demonstrate mild HBP enhancement in variable patterns. Correlation with OATP1B3 expression and prognosis is required. KEY POINTS • Hepatobiliary phase (HBP) enhancement was identified in 77% of hepatic metastases in several different primary malignancies. • Discrete patterns of HBP enhancement exist (peripheral, central, diffuse heterogeneous) and varied between CRC, PDAC, and NET. CRC and PDAC metastases demonstrated mostly non-central patterns (diffuse and peripheral), and NET mostly a central pattern. • Relationship between HBP enhancement, enhancement pattern, OATP1B3 expression, and prognosis requires further dedicated exploration for each malignancy.
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Olson MC, Vietti Violi N, Taouli B, Venkatesh SK. Abbreviated Magnetic Resonance Imaging Protocols in the Abdomen and Pelvis. Magn Reson Imaging Clin N Am 2020; 28:381-394. [PMID: 32624156 DOI: 10.1016/j.mric.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In recent decades, the clinical applications for which magnetic resonance (MR) imaging is routinely used have expanded exponentially. MR imaging protocols have become increasingly complex, adversely affecting image acquisition and interpretation times. The MR imaging workflow has become a prime target for process improvement initiatives. There has been growing interest in the cultivation of abbreviated MR imaging protocols that evaluate specific clinical questions while reducing cost and increasing access. The overarching goal is to streamline the MR imaging workflow and reduce the time needed to obtain and report examinations by eliminating duplicative or unnecessary sequences without sacrificing diagnostic accuracy.
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Affiliation(s)
- Michael C Olson
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Naïk Vietti Violi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; Department of Radiology, Lausanne University Hospital, Rue du Bugnon 46, Lausanne 1011, Switzerland
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sudhakar Kundapur Venkatesh
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Abstract
There have been significant developments in the management of advanced and recurrent colorectal cancer in recent decades. 70% of primary colorectal tumours arise in the colon and for patients with stage I-III disease, the standard of care is surgical resection followed by adjuvant therapy where appropriate. Locoregional recurrence (LR) occurs in 4-11.5% of patients following treatment of primary colon cancer with curative intent, and can be categorised as peri-anastomotic, mesenteric/paracolic (nodal), retroperitoneal and peritoneal. Of these, peritoneal recurrence is usually recognised as the most challenging type of recurrence to manage. Patients with isolated peri-anastomotic or limited nodal recurrence in the mesentery or retroperitoneum may be curable by radical salvage surgery, which often requires en bloc multi-visceral resection, while patients with low volume peritoneal metastases may be candidates for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ensuring complete resection along embryonic mesocolic planes or en bloc resection of contiguously involved structures are best strategies to reduce the likelihood of local recurrence through a R1 resection margin. The role of complete mesocolic excision (CME) with high vascular ligation has been demonstrated to increase nodal yield and improve overall survival although this is more contentious. In patients with T4a disease and serosal surface involvement, peritoneal recurrence represents the greatest threat. Efforts for early diagnosis of peritoneal recurrence in these patients or prophylactic treatment, while intuitive have not demonstrated the survival benefit that would be expected. Other than locoregional recurrence (LR), systemic recurrence may occur in up to 50% of patients who have undergone curative resection for colorectal cancer. In keeping with portal venous outflow, the most common site of systemic recurrence is the liver. Although previously thought to be a fatal condition, liver resection is now the standard of care where liver metastases can be completely resected with clear margins plus leaving an adequate liver remnant with intact vascular inflow, outflow and biliary drainage. This can usually be achieved in 26-45% of patients presenting with liver metastases. Liver surgeons at the forefront of liver resection have also developed techniques to induce liver hypertrophy so as to improve likelihood of resectability. Even where patients have non-resectable disease, ablative techniques have become increasingly common. Naturally, none of these would be possible without the advent of improved chemotherapeutic and biological options in the field of medical oncology. Pulmonary metastasectomy with curative intent may be possible in a small number (10%) of patients with lung metastases, which is associated with an overall survival of up to 40%. Unlike liver metastases, proportionally less patients with pulmonary metastases will be resectable. For these patients, several ablative options are available. For all patients with recurrent colon cancer, patient selection for radical salvage surgery and decisions surrounding treatment strategy (including use of systemic therapy or ablative procedures) should take place in a multidisciplinary team setting.
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Affiliation(s)
- Kilian G M Brown
- SOuRCe (Surgical Outcomes Research Centre), Royal Prince Alfred Hospital, Sydney, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Cherry E Koh
- SOuRCe (Surgical Outcomes Research Centre), Royal Prince Alfred Hospital, Sydney, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, Discipline of Surgery, University of Sydney, Australia
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24
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Zhang L, Zhang L, Wang H, Chen L, Sui G. Diagnostic performance of contrast-enhanced ultrasound and magnetic resonance imaging for detecting colorectal liver metastases: A systematic review and meta-analysis. Dig Liver Dis 2019; 51:1241-1248. [PMID: 31262616 DOI: 10.1016/j.dld.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the diagnostic performance of contrast-enhanced ultrasound, diffusion-weighted magnetic resonance imaging and contrast-enhanced magnetic resonance imaging for detecting colorectal liver metastases. METHODS We performed comprehensive searches of the MEDLINE, EMBASE, and Cochrane Library databases to identify studies reporting the per-lesion diagnostic accuracy of contrast-enhanced ultrasound, diffusion-weighted magnetic resonance imaging, and contrast-enhanced magnetic resonance imaging for detecting colorectal liver metastases. Studies published between January 2003 and December 2018 with reference standards, including histopathology and intraoperative observation, and/or follow-up, were included. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effects regression model was used to determine sensitivity estimates. RESULTS Overall, 47 articles were included. The sensitivity estimates for contrast-enhanced ultrasound, diffusion-weighted magnetic resonance imaging, and contrast-enhanced magnetic resonance imaging for detecting colorectal liver metastases were 85.3%, 83.0%, and 90.1%, respectively. For lesions ≥10 mm in diameter, the sensitivities were 93.1%, 92.9%, and 94.5%, respectively. In 21 articles using histopathology as the only reference standard, the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for contrast-enhanced ultrasound/contrast-enhanced magnetic resonance imaging were 86%/91%, 91%/95%, 9.2/16.6, 0.15/0.10, and 61/170, respectively. CONCLUSIONS CEUS showed a diagnostic ability comparable to that of DWI and CEMRI, particularly for lesions ≥10 mm in diameter.
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Affiliation(s)
- Luni Zhang
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Li Zhang
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Wang
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Libo Chen
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Guoqing Sui
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, China.
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25
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Vera R, González-Flores E, Rubio C, Urbano J, Valero Camps M, Ciampi-Dopazo JJ, Orcajo Rincón J, Morillo Macías V, Gomez Braco MA, Suarez-Artacho G. Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM. Clin Transl Oncol 2019; 22:647-662. [PMID: 31359336 DOI: 10.1007/s12094-019-02182-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/08/2019] [Indexed: 12/12/2022]
Abstract
Colorectal cancer (CRC) has the second-highest tumor incidence and is a leading cause of death by cancer. Nearly 20% of patients with CRC will have metastases at the time of diagnosis, and more than 50% of patients with CRC develop metastatic disease during the course of their disease. A group of experts from the Spanish Society of Medical Oncology, the Spanish Association of Surgeons, the Spanish Society of Radiation Oncology, the Spanish Society of Vascular and Interventional Radiology, and the Spanish Society of Nuclear Medicine and Molecular Imaging met to discuss and provide a multidisciplinary consensus on the management of liver metastases in patients with CRC. The group defined the different scenarios in which the disease can present: fit or unfit patients with resectable liver metastases, patients with potential resectable liver metastases, and patients with unresectable liver metastases. Within each scenario, the different strategies and therapeutic approaches are discussed.
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Affiliation(s)
- R Vera
- Medical Oncology, Complejo Hospitalario de Navarra, Calle Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | | | - C Rubio
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - J Urbano
- Vascular and Interventional Radiology, Vithas Hospitals Group, Madrid, Spain
| | - M Valero Camps
- Nuclear Medicine, Clínica Rotger (Quiron Salud), Palma de Mallorca, Spain
| | - J J Ciampi-Dopazo
- Interventional Radiology Unit, Complejo Hospitalario de Toledo, Toledo, Spain
| | - J Orcajo Rincón
- Nuclear Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - V Morillo Macías
- Radiation Oncology, Hospital Provincial de Castellón, Castellón, Spain
| | - M A Gomez Braco
- Hepatobiliary and Liver Transplantation Unit, University Hospital Virgen del Rocío, Sevilla, Spain
| | - G Suarez-Artacho
- Hepatobiliary and Liver Transplantation Unit, University Hospital Virgen del Rocío, Sevilla, Spain
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Granata V, Fusco R, de Lutio di Castelguidone E, Avallone A, Palaia R, Delrio P, Tatangelo F, Botti G, Grassi R, Izzo F, Petrillo A. Diagnostic performance of gadoxetic acid-enhanced liver MRI versus multidetector CT in the assessment of colorectal liver metastases compared to hepatic resection. BMC Gastroenterol 2019; 19:129. [PMID: 31340755 PMCID: PMC6651923 DOI: 10.1186/s12876-019-1036-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/24/2019] [Indexed: 02/07/2023] Open
Abstract
Background Imaging is an essential tool in the management of patients with Colorectal cancer (CRC) by helping evaluate number and sites of metastases, determine resectability, assess response to treatment, detect drug toxicities and recurrences. Although multidetector computed tomography (MDCT) is the first tool used for staging and patient’s surveillance, magnetic resonance imaging (MRI) is the most reliable imaging modality that allows to assess liver metastases. Our purpose is to compare the diagnostic performance of gadoxetic acid-(Gd-EOB) enhanced liver MRI and contrast-enhanced MDCT in the detection of liver metastasis from colorectal cancer (mCRC). Methods One hundred and twenty-eight patients with pathologically proven mCRC (512 liver metastases) underwent Gd-EOB MRI and MDCT imaging. An additional 46 patients without mCRC were included as control subjects. Three radiologists independently graded the presence of liver nodules on a five-point confidence scale. Sensitivity and specificity for the detection of metastases were calculated. Weighted к values were used to evaluate inter-reader agreement of the confidence scale regarding the presence of the lesion. Results MRI detected 489 liver metastases and MDCT 384. In terms of per-lesion sensitivity in the detection of liver metastasis, all three readers had higher diagnostic sensitivity with Gd-EOB MRI than with MDCT (95.5% vs. 72% reader 1; 90% vs. 72% reader 2; 96% vs. 75% reader 3). Each reader showed a statistical significant difference (p < <.001 at Chi square test). MR imaging showed a higher performance than MDCT in per-patient detection sensitivity (100% vs. 74.2% [p < <.001] reader 1, 98% vs. 73% [p < <.001] reader 2, and 100% vs. 78% [p < <.001] reader 3). In the control group, MRI and MDCT showed similar per-patient specificity (100% vs. 98% [p = 0.31] reader 1, 100% vs. 100% [p = 0.92] reader 2, and 100% vs. 96% [p = 0.047] reader 3). Inter-reader agreement of lesion detection between the three radiologists was moderate to excellent (k range, 0.56–0.86) for Gd-EOB MRI and substantial to excellent for MDCT (k range, 0.75–0.8). Conclusion Gadoxetic acid-enhanced MRI performs significantly better in the detection of mCRC, than MDCT, particularly in patients treated with chemotherapy, in subcapsular lesions, and in peribiliary metastases.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Roberta Fusco
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.
| | | | - Antonio Avallone
- Gastrointestinal Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Raffaele Palaia
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Paolo Delrio
- Colorectal Abdominal Surgery Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Fabiana Tatangelo
- Pathology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Gerardo Botti
- Pathology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Roberto Grassi
- Radiology Division, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy
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27
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Detection of liver metastases on gadobenate dimeglumine-enhanced MRI: systematic review, meta-analysis, and similarities with gadoxetate-enhanced MRI. Eur Radiol 2019; 29:5205-5216. [PMID: 30915560 DOI: 10.1007/s00330-019-06110-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/16/2019] [Accepted: 02/13/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the sensitivity and positive predictive value (PPV) of gadobenate-enhanced MR imaging for the detection of liver metastases. METHODS This systematic review and meta-analysis was conducted according to PRISMA guidelines. A comprehensive search (EMBASE, PubMed) was performed to identify relevant articles up to December 2017. Studies eligible for inclusion were performed using appropriate methodology with complete verification by means of histopathology, intraoperative observation and/or follow-up, and sufficient information to permit determination of true-positive (TP), false-negative (FN), and false-positive (FP) values. Sources of bias were assessed using the QUADAS-2 tool. An inverse variance-weighted random-effects model was used to obtain sensitivity and PPV estimates. Information was analyzed and presented using Cochran's Q statistic, funnel plots, and modified Deeks' analysis. RESULTS Ten articles (256 patients, 562 metastases) were included. Sensitivity estimates for pre-contrast (unenhanced) imaging, gadobenate-enhanced dynamic imaging, and combined unenhanced, dynamic, and delayed hepatobiliary phase imaging for detecting liver metastases on a per-lesion basis were 77.8% (95% CI 71.4-84.3%, 7 assessments), 88.1% (95% CI, 84.0-92.2%, 13 assessments), and 95.1% (95% CI 93.1-97.1%, 15 assessments), respectively. The addition of hepatobiliary phase images significantly improved the detection of liver metastases. The overall PPV was 90.9% (95% CI 86.6-95.1%, 11 assessments). Deeks' funnel analysis revealed no association between sample size and sensitivity (β = 0.02, p = 0.814) indicating no significant publication bias. CONCLUSIONS Gadobenate-enhanced MR imaging has high sensitivity and PPV for the detection of liver metastases on a per-lesion basis. The sensitivity and PPV for detection is comparable to reported values for the pure liver-specific agent gadoxetate. KEY POINTS • Gadobenate dimeglumine is a hepatobiliary MR contrast agent that permits acquisition of contrast-enhanced liver images during the immediate post-injection dynamic phase, like any extracellular agent, and in the delayed hepatobiliary phase, after specific uptake by the hepatocytes. • The hepatobiliary phase improves detection of liver metastases when compared either to pre-contrast unenhanced images alone or to pre-contrast + gadobenate-enhanced dynamic phase images. • The meta-analysis showed an overall sensitivity of 95.1% and PPV of 90.9% of gadobenate-enhanced MRI for the detection of metastases, when based on the evaluation of all available acquisitions.
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Lesion detection performance of an abbreviated gadoxetic acid–enhanced MRI protocol for colorectal liver metastasis surveillance. Eur Radiol 2019; 29:5852-5860. [DOI: 10.1007/s00330-019-06113-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/07/2019] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
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PET/MRI for Gastrointestinal Imaging: Current Clinical Status and Future Prospects. Gastroenterol Clin North Am 2018; 47:691-714. [PMID: 30115444 DOI: 10.1016/j.gtc.2018.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Positron emission tomography (PET)/computed tomography (CT) with 2-deoxy-2-[18F]fluoro-d-glucose (FDG) has become the standard of care for the initial staging and subsequent treatment response assessment for numerous gastrointestinal malignancies. However, it is often supplemented by magnetic resonance imaging (MRI) for local tumor staging. Hybrid PET/MRI scanners, which acquire PET data and MRI data simultaneously, have the potential to provide accurate whole-body staging in a single examination. Furthermore, to address certain limitations of FDG, many new PET tracers have been developed to probe distinctive aspects of tumor biology.
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Granata V, Fusco R, Avallone A, Catalano O, Piccirillo M, Palaia R, Nasti G, Petrillo A, Izzo F. A radiologist's point of view in the presurgical and intraoperative setting of colorectal liver metastases. Future Oncol 2018; 14:2189-2206. [PMID: 30084273 DOI: 10.2217/fon-2018-0080] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Multidisciplinary management of patients with metastatic colorectal cancer requires in each phase an adequate choice of the most appropriate imaging modality. The first challenging step is liver lesions detection and characterization, using several imaging modality ultrasound, computed tomography, magnetic resonance and positron emission tomography. The criteria to establish the metastases resectability have been modified. Not only the lesions number and site but also the functional volume remnant after surgery and the quality of the nontumoral liver must be taken into account. Radiologists should identify the liver functional volume remnant and during liver surgical procedures should collaborate with the surgeon to identify all lesions, including those that disappeared after the therapy, using intraoperative ultrasound with or without contrast medium.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Roberta Fusco
- Radiology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Antonio Avallone
- Abdominal Oncology Division, Istitutonazionale Tumori - IRCSS - Fondazione G Pascale, Napoli, Italia
| | - Orlando Catalano
- Radiology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Mauro Piccirillo
- Hepatobiliary Surgical Oncology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Raffaele Palaia
- Hepatobiliary Surgical Oncology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Guglielmo Nasti
- Abdominal Oncology Division, Istitutonazionale Tumori - IRCSS - Fondazione G Pascale, Napoli, Italia
| | - Antonella Petrillo
- Radiology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, Istitutonazionale Tumori - IRCCS - Fondazione G Pascale, Napoli, Italia
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Lo GC, Kambadakone A. MR Imaging of Pancreatic Neuroendocrine Tumors. Magn Reson Imaging Clin N Am 2018; 26:391-403. [DOI: 10.1016/j.mric.2018.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sivesgaard K, Larsen LP, Sørensen M, Kramer S, Schlander S, Amanavicius N, Bharadwaz A, Tønner Nielsen D, Viborg Mortensen F, Morre Pedersen E. Diagnostic accuracy of CE-CT, MRI and FDG PET/CT for detecting colorectal cancer liver metastases in patients considered eligible for hepatic resection and/or local ablation. Eur Radiol 2018; 28:4735-4747. [PMID: 29736846 DOI: 10.1007/s00330-018-5469-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/29/2018] [Accepted: 04/09/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the diagnostic performance of contrast-enhanced computed tomography (CE-CT), magnetic resonance imaging (MRI) and combined fluorodeoxyglucose/positron emission tomography/computed tomography (FDG-PET/CT) for detection of colorectal liver metastases (CRLM) in patients eligible for local treatment. MATERIALS AND METHODS This health-research ethics-committee-approved prospective consecutive diagnostic accuracy study, with written informed consent, included 80 cases (76 patients, four participating twice) between 29 June 2015 and 7 February 2017. Prior chemotherapy or local treatment did not exclude participation. Combined FDG-PET/CT including CE-CT and MRI was performed within 0-3 days shortly before local treatment. CE-CT and MRI images were read independently by two readers for each modality. The combined FDG-PET/CT images were read independently by two pairs of readers. A composite reference standard was used. Sensitivities, specificities and area under the receiver operating characteristic curves (AUCROC) were calculated and compared. RESULTS In total, 260 CRLMs were confirmed. The MRI readers had significantly higher per-lesion sensitivity (85.9% and 83.8%) than both CE-CT readers (69.1% and 62.3%) and both PET/CT reader pairs (72.0% and 72.1%) (p<0.001). There were no significant differences in per-lesion specificity. MRI readers had significantly higher AUCROC (0.92 and 0.88) than both CE-CT readers (0.80 and 0.82) (p≤0.001). AUCROC for MR reader 1 was higher than that of both PET/CT reader pairs (0.83 and 0.84) (p≤0.0001). CONCLUSION MRI performed significantly better than both CE-CT and combined FDG-PET/CT for detection of CRLM in consecutive patients eligible for local treatment irrespective of prior chemotherapy or local treatment. KEY POINTS • Patients eligible for local treatment of colorectal liver-metastases require optimal imaging. • In 80 consecutive patients, MRI had superior per lesion diagnostic performance. • Findings were independent of prior treatment and type of planned local treatment. • Equally, MRI had superior diagnostic performance on per segment basis.
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Affiliation(s)
- Kim Sivesgaard
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark.
| | - Lars P Larsen
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Michael Sørensen
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Stine Kramer
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Sven Schlander
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Nerijus Amanavicius
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Arindam Bharadwaz
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Dennis Tønner Nielsen
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Frank Viborg Mortensen
- Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery), Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Erik Morre Pedersen
- Department of Radiology, Aarhus University Hospital, NBG Noerrebrogade 44, 8000, Aarhus, Denmark
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Fowler KJ, Kaur H, Cash BD, Feig BW, Gage KL, Garcia EM, Hara AK, Herman JM, Kim DH, Lambert DL, Levy AD, Peterson CM, Scheirey CD, Small W, Smith MP, Lalani T, Carucci LR. ACR Appropriateness Criteria ® Pretreatment Staging of Colorectal Cancer. J Am Coll Radiol 2018; 14:S234-S244. [PMID: 28473079 DOI: 10.1016/j.jacr.2017.02.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 12/17/2022]
Abstract
Colorectal cancers are common tumors in the United States and appropriate imaging is essential to direct appropriate care. Staging and treatment differs between tumors arising in the colon versus the rectum. Local staging for colon cancer is less integral to directing therapy given radical resection is often standard. Surgical options for rectal carcinoma are more varied and rely on accurate assessment of the sphincter, circumferential resection margins, and peritoneal reflection. These important anatomic landmarks are best appreciated on high-resolution imaging with transrectal ultrasound or MRI. When metastatic disease is suspected, imaging modalities that provide a global view of the body, such as CT with contrast or PET/CT may be indicated. Rectal cancer often metastasizes to the liver and so MRI of the liver with and without contrast provides accurate staging for liver metastases. This article focuses on local and distant staging and reviews the appropriateness of different imaging for both variants. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Kathryn J Fowler
- Principal Author, Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
| | - Harmeet Kaur
- Co-author, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons
| | | | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Joseph M Herman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | - David H Kim
- University of Wisconsin Hospital and Clinic, Madison, Wisconsin
| | - Drew L Lambert
- University of Virginia Health System, Charlottesville, Virginia
| | - Angela D Levy
- Georgetown University Hospital, Washington, District of Columbia
| | | | | | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tasneem Lalani
- Speciality Chair, Inland Imaging Associates and University of Washington, Seattle, Washington
| | - Laura R Carucci
- Panel Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Kim HJ, Park MS, Lee JY, Han K, Chung YE, Choi JY, Kim MJ, Kang CM. Incremental Role of Pancreatic Magnetic Resonance Imaging after Staging Computed Tomography to Evaluate Patients with Pancreatic Ductal Adenocarcinoma. Cancer Res Treat 2018; 51:24-33. [PMID: 29397657 PMCID: PMC6333990 DOI: 10.4143/crt.2017.404] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 02/04/2018] [Indexed: 02/08/2023] Open
Abstract
Purpose The purpose of this study was to investigate the impact of contrast enhanced pancreatic magnetic resonance imaging (MRI) in resectability and prognosis evaluation after staging computed tomography (CT) in patients with pancreatic ductal adenocarcinoma (PDA). Materials and Methods From January 2005 to December 2012, 298 patients were diagnosed to have potentially resectable stage PDA on CT. Patients were divided into CT+MR (patients underwent both CT and MRI; n=216) and CT only groups (n=82). Changes in resectability staging in the CT+MR group were evaluated. The overall survival was compared between the two groups. The recurrence-free survival and median time to liver metastasis after curative surgery were compared between the two groups. Results Staging was changed from resectable on CT to unresectable state on MRI in 14.4% of (31 of 216 patients) patients of the CT+MR group. The overall survival and recurrence-free survival rates were not significantly different between the two groups (p=0.162 and p=0.721, respectively). The median time to liver metastases after curative surgery in the CT+MR group (9.9 months) was significantly longer than that in the CT group (4.2 months) (p=0.011). Conclusion Additional MRI resulted in changes of resectability and treatment modifications in a significant proportion of patients who have potentially resectable state at CT and in prolonged time to liver metastases in patients after curative surgery. Additional MRI to standard staging CT can be recommended for surgical candidates of PDA.
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Affiliation(s)
- Hye Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Yong Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology, Yonsei Biomedical Research Institute, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Moo Kang
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Iwata K, Moriya T, Nakagawa S, Ogasawara K. [Evaluation of Efficiencies on the Gadoxetic Acid-enhanced MRI for Preoperative Assessment of Liver Metastases from Colorectal Carcinoma]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:29-38. [PMID: 29353834 DOI: 10.6009/jjrt.2018_jsrt_74.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
THE AIMS OF OUR STUDY WERE 1) to evaluate efficiencies of gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI) for preoperative assessment of liver metastases from colorectal carcinoma, and 2) to compare them with other diagnostic imaging modalities. The subjects of the analysis were outpatients with advanced colorectal cancer who are at risk of developing liver metastases (initial setting: pre-test probability=20%). At initial setting, we performed a decision analysis to calculate numbers of true positive (TP), false negative (FN), false positive (FP) and true negative (TN) test results per 1000 patients of Gd-EOB-MRI and other imaging modalities (conventional contrast agent-enhanced MRI, contrast-enhanced CT and 18F-FDG PET/CT). From the result of decision analysis, we calculated the cost of detection per one patient with liver metastases (detection cost). Also, we calculated positive predictive value (PPV) and negative predictive value (NPV). Moreover, these values were defined as efficiencies in this study. In the initial setting, number of TP, FN, FP TN results and detection cost of Gd-EOB-MRI were 197, 3, 40, 760, and 224,032.8 Japanese Yen, respectively. Also, PPV and NPV were 83.1% and 99.7%, respectively. In comparison with other imaging modalities, efficiencies of Gd-EOB-MRI were superior to them, except detection cost. We consider that the efficiencies of Gd-EOB-MRI, which we had assessed are easy to understand and useful when they are used for explanation to patients.
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Affiliation(s)
- Kunihiro Iwata
- Section of Radiological Technology, Department of Medical Technology, Asahikawa Medical University Hospital
| | - Toshiharu Moriya
- Section of Radiological Technology, Department of Medical Technology, Asahikawa Medical University Hospital
| | - Sadahiro Nakagawa
- Section of Radiological Technology, Department of Medical Technology, Asahikawa Medical University Hospital
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Ko Y, Kim J, Park JKH, Kim H, Cho JY, Kang SB, Ahn S, Lee KJ, Lee KH. Limited detection of small (≤ 10 mm) colorectal liver metastasis at preoperative CT in patients undergoing liver resection. PLoS One 2017; 12:e0189797. [PMID: 29244853 PMCID: PMC5731738 DOI: 10.1371/journal.pone.0189797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 12/02/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To retrospectively determine the sensitivity of preoperative CT in the detection of small (≤ 10 mm) colorectal liver metastasis (CRLM) nodules in patients undergoing liver resection. METHODS The institutional review board approved the study and waived informed consent. We included 461 pathologically confirmed CRLM nodules in 211 patients (including 71 women; mean age, 66.4 years) who underwent 229 liver resections following abdominal CT. Prior to 163 resections, gadoxetic acid-enhanced liver MR imaging was also performed. Nodules were matched between pathology reports and prospective CT reports following a predefined algorithm. Per-nodule sensitivity of CT was calculated by nodule-size category. Generalized estimating equations were used to adjust for within-case correlation. RESULTS Fourteen nodule sizes were missing in the pathology report. Nodules of 1-5 mm and 6-10 mm accounted for 8.1% (n = 36) and 23.5% (n = 105) of the remaining 447 nodules, and the number of nodules gradually decreased as nodule size increased beyond 10 mm. The overall sensitivity of CT was 81.2% (95% confidence interval, 77.1%, 85.2%; 365/461). The sensitivity was 8% (0%, 17%; 3/36), 55% (45%, 65%; 59/105), 91%, 95%, and 100% for nodules of 1-5 mm, 6-10 mm, 11-15 mm, 16-20 mm, and >20 mm, respectively. The nodule-size distribution was similar between resections undergoing gadoxetic acid-enhanced MR imaging and those not undergoing the MR imaging. CONCLUSION CT has limited sensitivity for nodules of ≤ 10 mm and particularly of ≤ 5 mm.
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Affiliation(s)
- Yousun Ko
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | | | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Kyong Joon Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Saing S, Haywood P, Duncan JK, Ma N, Cameron AL, Goodall S. Cost-effective imaging for resectability of liver lesions in colorectal cancer: an economic decision model. ANZ J Surg 2017; 88:E507-E511. [PMID: 28982209 DOI: 10.1111/ans.14194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/28/2017] [Accepted: 07/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aimed to determine the cost-effectiveness of contrast-enhanced magnetic resonance imaging (CE-MRI) compared with multiphase CE computed tomography (CE-CT) scan to characterize suspected liver lesions in patients with known colorectal carcinoma. METHODS A decision analytic model linking diagnostic accuracy to health outcomes in patients with colorectal carcinoma was constructed. The model assumed that CE-MRI has superior sensitivity and equivalent specificity to CE-CT, and patients with a colorectal liver metastasis could be eligible for curative surgery or chemotherapy and palliation. Delayed diagnosis or misdiagnosis was associated with worse health outcomes (disutility). Cost-effectiveness was calculated as the incremental cost relative to the incremental benefit, the benefit was estimated using quality-adjusted life years. Sensitivity analyses were conducted to test the robustness of the results. RESULTS The clinical evidence supports increased sensitivity of CE-MRI compared with CE-CT (0.943 versus 0.768). CE-MRI was more effective and more costly than CE-CT. The incremental cost-effectiveness ratio was estimated to be $40 548 per quality-adjusted life year gained. The model is most sensitive to the cost of MRI, cost of palliative treatment and the disutility associated with delayed palliative care. The results were also sensitive to the assumptions made about the clinical algorithm. CONCLUSION The results provide evidence of the potential cost-effectiveness associated with CE-MRI for the diagnosis of liver metastases in patients with identified colorectal carcinoma. CE-MRI can be recommended as cost-effective provided it replaces CE-CT and that improved diagnostic accuracy results in earlier, curative, disease management.
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Affiliation(s)
- Sopany Saing
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Phil Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joanna K Duncan
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Ning Ma
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Alun L Cameron
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
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Pech L, Cercueil JP, Jooste V, Krause D, Facy O, Bouvier AM. Current use of MRI in patients with liver metastatic colorectal cancer: a population-based study. Eur J Gastroenterol Hepatol 2017; 29:1126-1130. [PMID: 28678043 DOI: 10.1097/meg.0000000000000933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver MRI is recommended as the preoperative imaging strategy in liver metastatic colorectal cancers. OBJECTIVE The aim of the study was to assess for the first time the use of liver MRI in a French population-based cancer registry. PATIENTS AND METHODS All liver-only metastatic colorectal cancers resected for their primary tumour diagnosed between 2009 and 2013 were included. Nonconditional logistic regression was used to search for associations between the MRI order and the characteristics of patients and tumours. RESULTS The primary tumour and liver metastases were resected for cure in 30% (69/233) of cases, and in 72% of these liver MRI was performed before resection of the liver metastases. Preoperative MRI ordering was not significantly higher in patients younger than 70 years when compared with that in older patients. Among patients who did not undergo resection of their liver metastasis, 22% had undergone a liver MRI. After adjustment for comorbidities, the probability of having undergone an MRI was higher for patients managed in the university hospital (P=0.004) and lower in those managed in nonuniversity hospitals (P=0.002) compared with the mean of odds for all facilities. Patients more than or equal to 70 years were 2.4 times less likely than younger patients to undergo an MRI (P=0.043). CONCLUSION Liver MRI was underused in patients with colorectal liver-only synchronous metastasis undergoing curative resection for metastases and in elderly patients.
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Affiliation(s)
- Laurianne Pech
- aDepartment of Vascular, Oncologic and Interventional Radiology, University of Dijon School of Medicine bDigestive Cancer Registry of Burgundy, INSERM U866, Burgundy University cDepartment of Digestive Surgical Oncology, University Hospital, Dijon, France
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Weledji EP. Centralization of Liver Cancer Surgery and Impact on Multidisciplinary Teams Working on Stage IV Colorectal Cancer. Oncol Rev 2017; 11:331. [PMID: 28814999 PMCID: PMC5538223 DOI: 10.4081/oncol.2017.331] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/15/2016] [Accepted: 07/17/2017] [Indexed: 12/17/2022] Open
Abstract
Surgical resection is the most effective treatment approach for colorectal liver metastases but only a minority of patients is suitable for upfront surgery. The treatment strategies of stage IV colorectal cancer have shifted towards a continuum of care in which medical and surgical treatment combinations are tailored to the clinical setting of the individual patient. The optimization of treatment through appropriate decision-making and multimodal therapy for stage IV colorectal cancer require a joint multidisciplinary meeting in a centralized liver cancer unit.
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Chew C, O'Dwyer PJ. The value of liver magnetic resonance imaging in patients with findings of resectable pancreatic cancer on computed tomography. Singapore Med J 2017; 57:334-8. [PMID: 27353741 DOI: 10.11622/smedj.2016109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Accurate staging of patients with pancreatic cancer is important to avoid unnecessary operations. The aim of this study was to prospectively assess the impact of magnetic resonance (MR) imaging on preoperative staging of liver in patients with findings of resectable pancreatic cancer on computed tomography (CT). METHODS All patients who presented to a tertiary referral centre with pancreatic cancer between April 2012 and December 2013 were included in the study. Patients with findings of resectable disease on CT underwent further liver diffusion-weighted MR imaging, using a hepatocyte-specific contrast agent. RESULTS A total of 583 patients with pancreatic cancer were referred. 69 (11.8%) had resectable disease on CT. Of these 69 patients, 16 (23.2%) had liver metastases on MR imaging, while 6 (8.7%) had indeterminate lesions. Of the 16 patients with positive MR imaging findings of liver metastases, 11 died of pancreatic cancer, with a mean survival time of nine months (95% confidence interval [CI] 5.22-14.05). The mean survival time of the 47 patients with negative MR imaging findings was 16 months (95% CI 14.33-18.10; p = 0.001). Subsequently, 22 of these patients underwent surgery, and only 1 (4.5%) patient was found to have liver metastasis at surgery. CONCLUSION The results of the present study indicate that MR imaging improves the staging of disease in patients with resectable pancreatic cancer.
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Affiliation(s)
- Cindy Chew
- Department of Radiology, Hairmyres Hospital, Glasgow, United Kingdom
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Asato N, Tsurusaki M, Sofue K, Hieda Y, Katsube T, Kitajima K, Murakami T. Comparison of gadoxetic acid-enhanced dynamic MR imaging and contrast-enhanced computed tomography for preoperative evaluation of colorectal liver metastases. Jpn J Radiol 2017; 35:197-205. [DOI: 10.1007/s11604-017-0622-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/15/2017] [Indexed: 12/19/2022]
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Carlbom L, Caballero-Corbalán J, Granberg D, Sörensen J, Eriksson B, Ahlström H. Whole-body MRI including diffusion-weighted MRI compared with 5-HTP PET/CT in the detection of neuroendocrine tumors. Ups J Med Sci 2017; 122:43-50. [PMID: 27894208 PMCID: PMC5361431 DOI: 10.1080/03009734.2016.1248803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIM We wanted to explore if whole-body magnetic resonance imaging (MRI) including diffusion-weighted (DW) and liver-specific contrast agent-enhanced imaging could be valuable in lesion detection of neuroendocrine tumors (NET). [11C]-5-Hydroxytryptophan positron emission tomography/computed tomography (5-HTP PET/CT) was used for comparison. MATERIALS AND METHODS Twenty-one patients with NET were investigated with whole-body MRI, including DW imaging (DWI) and contrast-enhanced imaging of the liver, and whole-body 5-HTP PET/CT. Seven additional patients underwent upper abdomen MRI including DWI, liver-specific contrast agent-enhanced imaging, and 5-HTP PET/CT. RESULTS There was a patient-based concordance of 61% and a lesion-based concordance of 53% between the modalities. MRI showed good concordance with PET in detecting bone metastases but was less sensitive in detecting metastases in mediastinal lymph nodes. MRI detected more liver metastases than 5-HTP PET/CT. CONCLUSION Whole-body MRI with DWI did not detect all NET lesions found with whole-body 5-HTP PET/CT. Our findings indicate that MRI of the liver including liver-specific contrast agent-enhanced imaging and DWI could be a useful complement to whole-body 5-HTP PET/CT.
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Affiliation(s)
- Lina Carlbom
- Institute of Surgical Sciences, Department of Radiology, Uppsala University, Uppsala, Sweden
| | | | - Dan Granberg
- Department of Medical Sciences. Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- Institute of Surgical Sciences, Department of Radiology, Uppsala University, Uppsala, Sweden
| | - Barbro Eriksson
- Department of Medical Sciences. Uppsala University, Uppsala, Sweden
| | - Håkan Ahlström
- Institute of Surgical Sciences, Department of Radiology, Uppsala University, Uppsala, Sweden
- CONTACT Håkan Ahlström Institute of Surgical Sciences, Department of Radiology, Entrance 70, 2nd floor, Uppsala University, Uppsala University Hospital, SE-75185, Uppsala. Sweden
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Ricke J, Seidensticker M. Molecular imaging and liver function assessment by hepatobiliary MRI. J Hepatol 2016; 65:1081-1082. [PMID: 27729223 DOI: 10.1016/j.jhep.2016.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/29/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Jens Ricke
- Department of Radiology and Nuclear Medicine, University Magdeburg, Germany.
| | - Max Seidensticker
- Department of Radiology and Nuclear Medicine, University Magdeburg, Germany
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Kim SS, Song KD, Kim YK, Kim HC, Huh JW, Park YS, Park JO, Kim ST. Disappearing or residual tiny (≤5 mm) colorectal liver metastases after chemotherapy on gadoxetic acid-enhanced liver MRI and diffusion-weighted imaging: Is local treatment required? Eur Radiol 2016; 27:3088-3096. [DOI: 10.1007/s00330-016-4644-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/03/2016] [Accepted: 10/10/2016] [Indexed: 02/08/2023]
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Vreugdenburg TD, Ma N, Duncan JK, Riitano D, Cameron AL, Maddern GJ. Comparative diagnostic accuracy of hepatocyte-specific gadoxetic acid (Gd-EOB-DTPA) enhanced MR imaging and contrast enhanced CT for the detection of liver metastases: a systematic review and meta-analysis. Int J Colorectal Dis 2016; 31:1739-1749. [PMID: 27682648 DOI: 10.1007/s00384-016-2664-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE This systematic review evaluated the diagnostic accuracy and impact on patient management of hepatocyte-specific gadoxetic acid enhanced magnetic resonance imaging (GA-MRI) compared to contrast enhanced computed tomography (CE-CT) in patients with liver metastases. METHOD Four biomedical databases (PubMed, EMBASE, Cochrane Library, York CRD) were searched from January 1991 to February 2016. Studies investigating the accuracy or management impact of GA-MRI compared to CE-CT in patients with known or suspected liver metastases were included. Bias was evaluated using QUADAS-II. Univariate meta-analysis of sensitivity ratios (RR) were conducted in the absence of heterogeneity, calculated using I 2 , Tau values (τ) and prediction intervals. RESULTS Nine diagnostic accuracy studies (537 patients with 1216 lesions) and four change in management studies (488 patients with 281 lesions) were included. Per-lesion sensitivity and specificity estimates for GA-MRI ranged from 86.9-100.0 % and 80.2-98.0 %, respectively, compared to 51.8-84.6 % and 77.2-98.0 % for CE-CT. Meta-analysis found GA-MRI to be significantly more sensitive than CE-CT (RR = 1.29, 95 % CI = 1.18-1.40, P < 0.001), with equivalent specificity (RR = 0.97, 95 % CI 0.910-1.042, P = 0.44). The largest difference was observed for lesions smaller than 10 mm for which GA-MRI was significantly more sensitive (RR = 2.21, 95 % CI = 1.47-3.32, P < 0.001) but less specific (RR = 0.92, 95 % CI 0.87-0.98, P = 0.008). GA-MRI affected clinical management in 26 of 155 patients (16.8 %) who had a prior CE-CT; however, no studies investigated the consequences of using GA-MRI instead of CE-CT. CONCLUSION GA-MRI is significantly more sensitive than CE-CT for detecting liver metastases, which leads to a modest impact on patient management in the context of an equivocal CE-CT result.
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Affiliation(s)
- Thomas D Vreugdenburg
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia.
| | - Ning Ma
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Joanna K Duncan
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Dagmara Riitano
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Alun L Cameron
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Guy J Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
- Discipline of Surgery, University of Adelaide and The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Matos AP, Altun E, Ramalho M, Velloni F, AlObaidy M, Semelka RC. An overview of imaging techniques for liver metastases management. Expert Rev Gastroenterol Hepatol 2016; 9:1561-76. [PMID: 26414180 DOI: 10.1586/17474124.2015.1092873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Evaluation of liver metastases is one of the most common indications for liver imaging. Imaging plays a key role in the of assessment liver metastases. A variety of imaging techniques, including ultrasonography, computed tomography, MRI and PET combined with CT scan are available for diagnosis, planning treatment, and follow-up treatment response. In this paper, the authors present the role of imaging for the assessment of liver metastases and the contribution of each of the different imaging techniques for their evaluation and management. Following recent developments in the field of oncology, the authors also present the importance of imaging for the assessment of liver metastases response to therapy. Finally, future perspectives on imaging of liver metastases are presented.
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Affiliation(s)
- António P Matos
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Ersan Altun
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Miguel Ramalho
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Fernanda Velloni
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Mamdoh AlObaidy
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
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Yu J, Xu Q, Huang DY, Song JC, Li Y, Xu LL, Shi HB. Prognostic aspects of dynamic contrast-enhanced magnetic resonance imaging in synchronous distant metastatic rectal cancer. Eur Radiol 2016; 27:1840-1847. [PMID: 27595835 DOI: 10.1007/s00330-016-4532-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To explore the correlations between DCE-MRI quantitative parameters and synchronous distant metastasis and the clinicopathological factors in rectal cancers. METHODS Sixty-three patients with rectal cancer (synchronous distant metastasis, n = 31; non-metastasis, n = 32) were enrolled in this study. Student's t test and ANOVA were used to compare DCE-MRI parameters (K trans , K ep and V e ). The receiver operating characteristic (ROC) analysis was used to find the reasonable threshold of DCE-MRI parameters to differentiate lesions with synchronous distant metastasis from those without metastasis. RESULTS The K trans , K ep , and V e value were significantly higher in the lesions with distant metastasis than in the lesions without distant metastasis (0.536 ± 0.242 vs. 0.299 ± 0.118 min-1, p < 0.001; 1.598 ± 0.477 vs. 1.341 ± 0.390 min-1, p = 0.022; and 0.324 ± 0.173 vs. 0.249 ± 0.091, p = 0.034; respectively). The K trans showed the highest AUCs of 0.788 (p < 0.001), with sensitivity of 61.29 % and specificity of 87.5 %, respectively. CONCLUSIONS DCE-MRI parameters may represent a prognostic indicator for synchronous distant metastases in patients with rectal cancer. KEY POINTS • The K trans , K ep and V e values correlated with synchronous distant metastasis. • Higher K trans , K ep and V e values were noted among patients with metastasis. • DCE-MRI parameters might represent a prognostic indicator for synchronous distant metastases.
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Affiliation(s)
- Jing Yu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Qing Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Dong-Ya Huang
- Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia-Cheng Song
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Yan Li
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Lu-Lu Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China.
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Fraum TJ, Owen JW, Fowler KJ. Beyond Histologic Staging: Emerging Imaging Strategies in Colorectal Cancer with Special Focus on Magnetic Resonance Imaging. Clin Colon Rectal Surg 2016; 29:205-15. [PMID: 27582645 DOI: 10.1055/s-0036-1584288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Imaging plays an increasingly important role in the staging and management of colorectal cancer. In recent years, magnetic resonance imaging (MRI) has supplanted transrectal ultrasound as the preferred modality for the locoregional staging of rectal cancer. Furthermore, the advent of both diffusion-weighted imaging and hepatobiliary contrast agents has significantly enhanced the ability of MRI to detect colorectal liver metastases. In clinical practice, MRI routinely provides prognostic information, helps to guide surgical strategy, and determines the need for neoadjuvant therapies related to both the primary tumor and metastatic disease. Expanding on these roles for MRI, positron emission tomography (PET)/MRI is the newest clinical hybrid imaging modality and combines the metabolic information of PET with the high soft tissue contrast of MRI. The addition of PET/MRI to the clinical staging armamentarium has the potential to provide comprehensive state-of-the-art colorectal cancer staging in a single examination.
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Affiliation(s)
- Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Joseph W Owen
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri
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Reiter MJ, Hannemann NP, Schwope RB, Lisanti CJ, Learn PA. Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know. ACTA ACUST UNITED AC 2016. [PMID: 26194812 DOI: 10.1007/s00261-015-0507-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Surgical resection of colorectal metastatic disease has increased as surgeons have adopted a more aggressive ideology. Current exclusion criteria are patients for whom a negative resection margin is not feasible or a future liver remnant (FLR) of greater than 20% is not achievable. The goal of preoperative imaging is to identify the number and distribution of liver metastases, in addition to establishing their relation to relevant intrahepatic structures. FLR can be calculated utilizing cross-sectional imaging to select out patients at risk for hepatic dysfunction after resection. MRI, specifically with gadoxetic acid contrast, is currently the preferred modality for assessment of hepatic involvement for patients with newly diagnosed colorectal cancer, to include those who have undergone neoadjuvant chemotherapy. Employment of liver-directed therapies has recently expanded and they may provide an alternative to hepatectomy in order to obtain locoregional control in poor surgical candidates or convert patients with initially unresectable disease into surgical candidates.
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Affiliation(s)
- Michael J Reiter
- Department of Radiology, Stony Brook University Medical Center, HSC Level 4, Room 120 East Loop Road, Stony Brook, NY, 11794, USA.
| | - Nathan P Hannemann
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ryan B Schwope
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Christopher J Lisanti
- Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Peter A Learn
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
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50
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Karaosmanoglu AD, Onur MR, Ozmen MN, Akata D, Karcaaltincaba M. Magnetic Resonance Imaging of Liver Metastasis. Semin Ultrasound CT MR 2016; 37:533-548. [PMID: 27986172 DOI: 10.1053/j.sult.2016.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Liver magnetic resonance imaging (MRI) is becoming the gold standard in liver metastasis detection and treatment response assessment. The most sensitive magnetic resonance sequences are diffusion-weighted images and hepatobiliary phase images after Gd-EOB-DTPA. Peripheral ring enhancement, diffusion restriction, and hypointensity on hepatobiliary phase images are hallmarks of liver metastases. In patients with normal ultrasonography, computed tomography (CT), and positron emission tomography (PET)-CT findings and high clinical suspicion of metastasis, MRI should be performed for diagnosis of unseen metastasis. In melanoma, colon cancer, and neuroendocrine tumor metastases, MRI allows confident diagnosis of treatment-related changes in liver and enables differential diagnosis from primary liver tumors. Focal nodular hyperplasia-like nodules in patients who received platinum-based chemotherapy, hypersteatosis, and focal fat can mimic metastasis. In cancer patients with fatty liver, MRI should be preferred to CT. Although the first-line imaging for metastases is CT, MRI can be used as a problem-solving method. MRI may be used as the first-line method in patients who would undergo curative surgery or metastatectomy. Current limitation of MRI is low sensitivity for metastasis smaller than 3mm. MRI fingerprinting, glucoCEST MRI, and PET-MRI may allow simpler and more sensitive diagnosis of liver metastasis.
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Affiliation(s)
- Ali Devrim Karaosmanoglu
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Akata
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Musturay Karcaaltincaba
- Liver Imaging Team, Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.
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