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Park S, Park HS, Jang S, Cho J, Kim JH, Yu MH, Jung SI, Kim YJ, Hwang DY. Utility of abbreviated MRI in the post-treatment evaluation of rectal cancer. Acta Radiol 2024; 65:689-699. [PMID: 38778748 DOI: 10.1177/02841851241253936] [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: 05/25/2024]
Abstract
BACKGROUND Post-treatment evaluation of patients with rectal cancer (RC) using magnetic resonance imaging (MRI) burdens medical resources, necessitating an exploration of abbreviated protocols. PURPOSE To evaluate the diagnostic performance of abbreviated MRI (A-MRI) for the post-treatment evaluation of RC patients. MATERIAL AND METHODS This retrospective study included RC patients who underwent non-contrast rectal MRI and standard liver MRI, as well as abdominal contrast-enhanced computed tomography (CECT) for post-treatment evaluation. A-MRI comprised diffusion-weighted imaging (DWI) and T2-weighted imaging of the upper abdomen and the pelvic cavity. Three radiologists independently reviewed A-MRI, CECT, and standard liver MRI in the detection of viable disease. The diagnostic performances were compared using a reference standard considering all available information, including pathology, FDG-PET, endoscopic results, and clinical follow-up. RESULTS We included 78 patients (50 men, 28 women; mean age=60.9 ± 10.2 years) and observed viable disease in 34 (43.6%). On a per-patient-basis analysis, A-MRI showed significantly higher sensitivity (95% vs. 81%, P = 0.04) and higher accuracy (93% vs. 82%, P < 0.01), compared to those of CECT, while A-MRI showed comparable sensitivity (91% vs. 91%, P = 0.42) and accuracy (97% vs. 98%, P = 0.06) to that of standard liver MRI. On a per-lesion-based analysis, A-MRI exhibited significantly superior lesion detectability than that of CECT (figure of merit 0.91 vs. 0.77, P < 0.01) and comparable to that of standard liver MRI (figure of merit 0.91 vs. 0.92, P = 0.75). CONCLUSION A-MRI exhibited higher sensitivity and diagnostic accuracy than those of CECT in the post-treatment evaluation of RC, while it showed comparable performances with standard liver MRI. A-MRI provides diagnostic added value in the follow-up of RC patients.
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Affiliation(s)
- Sungeun Park
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Siwon Jang
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dae-Yong Hwang
- Department of Surgery, Colorectal Cancer Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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Sun L, Yin S, Xing B, Li Z, Fan Z, Yan K. Contrast-Enhanced Ultrasound With SonoVue and Sonazoid for the Diagnosis of Colorectal Liver Metastasis After Chemotherapy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:355-362. [PMID: 35734885 DOI: 10.1002/jum.16042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/15/2022] [Accepted: 05/27/2022] [Indexed: 05/23/2023]
Abstract
PURPOSE To compare the diagnostic efficacy of SonoVue and Sonazoid contrast-enhanced ultrasound (CEUS) in correctly detecting and characterizing colorectal liver metastasis (CRLM) after chemotherapy. MATERIALS AND METHODS Patients with CRLMs treated with chemotherapy and subsequently scheduled for hepatic resection were prospectively enrolled from April 2020 to January 2021. Lesions detected by SonoVue or Sonazoid CEUS were recorded as and characterized as metastases or non-metastatic lesions respectively. Histopathology or intraoperative ultrasound with MRI were the reference standard. RESULTS A total of 348 focal liver lesions in 42 patients were investigated, including 297 CRLMs and 51 non-metastatic lesions. SonoVue showed significantly higher diagnostic accuracy (64.7% versus 54.0%; P < .001) and sensitivity (63.3% versus 50.5%; P < .001) in the diagnosis of CRLMs than Sonazoid, both methods presented with similar specificity (72.5% versus 74.5%; P = 1.0). Forty metastases appeared non-hypoenhancing (hyperenhancing or isoenhancing) in the late phase and postvascular phase of Sonazoid CEUS and were mischaracterized as benign lesions. CONCLUSION SonoVue performed significantly better than Sonazoid in the diagnosis of CRLMs after chemotherapy.
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Affiliation(s)
- Liqi Sun
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Shanshan Yin
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Baocai Xing
- Department of Hepatopancreatobiliary Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhongwu Li
- Department of Pathology, Key Laboratory of carcinogenesis and Translational Research(Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhihui Fan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
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Chen JY, Dai HY, Li CY, Jin Y, Zhu LL, Zhang TF, Zhang YX, Mai WH. Improved sensitivity and positive predictive value of contrast-enhanced intraoperative ultrasound in colorectal cancer liver metastasis: a systematic review and meta-analysis. J Gastrointest Oncol 2022; 13:221-230. [PMID: 35284117 PMCID: PMC8899757 DOI: 10.21037/jgo-21-881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/07/2022] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Surgery is an effective treatment for improving the survival rate of patients with colorectal cancer liver metastases (CRLM). However, accurately determining the resection margin of liver lesions during surgery remains challenging. Therefore, this study aimed to evaluate the sensitivity and predictive value of intraoperative contrast-enhanced ultrasound (CE-IOUS) in CRLM patients undergoing surgery. METHODS We performed a literature search of the PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases using the following search terms: metastatic liver cancer, colorectal cancer, sensitivity, contrast-enhanced intraoperative ultrasound, CE-IOUS, colorectal liver metastases, and CRLM. The search period was set from the date of establishment of the database to September 2021. Quality assessment of diagnostic accuracy studies 2 (QUADAS-2) recommended by the Cochrane Collaboration was used to assess the methodological quality of the included studies, and network meta-analysis was performed using Stata 15.0 software. RESULTS A total of 10 articles met the inclusion criteria. The meta-analysis results showed that the overall sensitivity and specificity of CE-IOUS were 0.96 [95% confidence interval (CI), 0.95-0.97] and 0.75 (95% CI, 0.70-0.80), respectively. The overall sensitivity and specificity of IOUS were 0.84 (95% CI, 0.82-0.86) and 0.82 (95% CI, 0.77-0.87), respectively. The area under the summary receiving operating characteristic (SROC) curves (AUCs) of CE-IOUS and IOUS were 0.9753 and 0.8590, respectively. The odds ratio (OR) and 95% CI of CE-IOUS changed the surgical margin were 0.205 and 0.071-0.465, P=0.000, the difference was statistically significant. DISCUSSION Based on the results of this meta-analysis, CE-IOUS improved the sensitivity and predictive value of CRLM detection compared with IOUS, and is more suitable for intraoperative planning of surgical margins. At present, it is the most sensitive imaging method available, and is recommended for use during liver resection to provide doctors with more reliable information during surgery.
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Affiliation(s)
- Jun-Yao Chen
- Department of Ultrasonography, Hainan Cancer Hospital, Haikou, China
| | - Hui-Yong Dai
- Department of Ultrasonic Diagnosis, The 928 Hospital of PLA, Haikou, China
| | - Cai-Yang Li
- Department of Ultrasonography, Hainan Cancer Hospital, Haikou, China
| | - Ying Jin
- Department of Ultrasonography, Hainan Cancer Hospital, Haikou, China
| | - Ling-Ling Zhu
- Department of Ultrasonic Diagnosis, The 928 Hospital of PLA, Haikou, China
| | - Tian-Fei Zhang
- Department of Ultrasonic Diagnosis, The 928 Hospital of PLA, Haikou, China
| | - Yan-Xia Zhang
- Department of Ultrasonic Diagnosis, The 928 Hospital of PLA, Haikou, China
| | - Wen-Hao Mai
- Department of Anorectal Diseases, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
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Structured reporting of CT or MRI for perihilar cholangiocarcinoma: usefulness for clinical planning and interdisciplinary communication. Jpn J Radiol 2020; 39:349-356. [PMID: 33175312 DOI: 10.1007/s11604-020-01068-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/27/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the content and communication between the radiologist and the clinicians for treatment planning of structured reports (SRs) and narrative reports (NRs) for reporting CT/MRI findings in patients with perihilar cholangiocarcinoma. MATERIALS AND METHOD This retrospective study included 54 patients with perihilar cholangiocarcinoma who underwent CT/MRI before ERCP or surgery. For all patients, we generated both NRs and SRs for perihilar cholangiocarcinoma and compared the number of key features between NRs and SRs. In addition, three clinicians performed a questionnaire evaluation that included three questions regarding assessment of the sufficiency of information for surgical or procedural planning, the effort required for information extraction, and the report quality rated on a Likert scale. RESULTS SRs included significantly more predefined key features (6.89 ± 0.31) than NRs (5.87 ± 0.70) (p < 0.001). SRs provided greater sufficiency of information for clinical planning than NRs (89.9% vs. 18.5% of the cases, respectively; p < 0.001). Extraction of information was easier from SRs than NRs (94.4% vs. 9.3%, respectively) (p < 0.001). SRs received a higher overall report quality rating (5.96 ± 0.19) than NRs (4.31 ± 0.77) (p < 0.001). CONCLUSIONS SRs of CT/MRI findings for hilar cholangiocarcinoma can reveal more predefined key features, provide more sufficiency of information, and yield higher satisfaction levels, in comparison with NRs.
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Barachini O, Bernt R, Mirzaei S, Pirich C, Hergan K, Zandieh S. The impact of 18F-FDOPA-PET/MRI image fusion in detecting liver metastasis in patients with neuroendocrine tumors of the gastrointestinal tract. BMC Med Imaging 2020; 20:22. [PMID: 32093632 PMCID: PMC7038547 DOI: 10.1186/s12880-020-00424-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/11/2020] [Indexed: 12/16/2022] Open
Abstract
Background This study assesses the value of image fusion using 18F-fluoro-L-DOPA (18F-DOPA) positron emission tomography (PET) and magnetic resonance imaging (MRI) for examining patients with neuroendocrine tumors (NETs) and a suspicion of metastasis of the liver. Methods Eleven patients (five women and six men aged between 20 and 81, with a mean age of 54.6 years) were included in the study. All patients underwent whole-body 18F-DOPA PET examinations and contrast-enhanced MRI with diffusion-weighted sequences (DWS). Image fusion was performed using a semiautomatic voxel-based algorithm. Images obtained using PET and MRI were assessed separately. Side-by-side evaluations of fused PET/MRI images were also performed. Results In total, 55 liver lesions (52 liver metastases and 3 benign lesions) were detected in the 11 patients. Sensitivity detection for liver lesions was higher when using PET/CT than when using contrast-enhanced MRI without DWSs and lower than using MRI with DWSs. The sensitivity of PET/MRI image fusion in the detection of liver metastasis was significantly higher than that of MRI with DWSs (P < 0.05). Conclusion Images of the liver obtained using PET and MRI in patients with NETs exhibited characteristic features. These findings suggest that an appropriate combination of available imaging modalities can optimize patient evaluations.
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Affiliation(s)
- O Barachini
- Institute of Radiology and Nuclear Medicine, Hanusch-Hospital, Heinrich-Collin-Strasse 30, A-1140, Vienna, Austria
| | - R Bernt
- Institute of Radiology and Nuclear Medicine, Hanusch-Hospital, Heinrich-Collin-Strasse 30, A-1140, Vienna, Austria
| | - S Mirzaei
- Department of Nuclear Medicine with PET-Center, Wilhelminen-Hospital, Vienna, Austria
| | - C Pirich
- Department of Nuclear Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - K Hergan
- Department of Radiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - S Zandieh
- Institute of Radiology and Nuclear Medicine, Hanusch-Hospital, Heinrich-Collin-Strasse 30, A-1140, Vienna, Austria. .,Department of Radiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
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Hong SB, Choi SH, Kim KW, Kim SY, Kim JH, Kim S, Lee NK. Meta‐analysis of MRI for the diagnosis of liver metastasis in patients with pancreatic adenocarcinoma. J Magn Reson Imaging 2019; 51:1737-1744. [DOI: 10.1002/jmri.26969] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Seung Baek Hong
- Department of Radiology, Biomedical Research InstitutePusan National University Hospital, Pusan National University School of Medicine Korea
| | - Sang Hyun Choi
- Department of Radiology and the Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Korea
| | - Kyung won Kim
- Department of Radiology and the Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Korea
| | - So Yeon Kim
- Department of Radiology and the Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Korea
| | - Jin Hee Kim
- Department of Radiology and the Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical Center Korea
| | - Suk Kim
- Department of Radiology, Biomedical Research InstitutePusan National University Hospital, Pusan National University School of Medicine Korea
| | - Nam Kyung Lee
- Department of Radiology, Biomedical Research InstitutePusan National University Hospital, Pusan National University School of Medicine Korea
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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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Diagnostic performance of [18F]FDG-PET/MRI for liver metastasis in patients with primary malignancy: a systematic review and meta-analysis. Eur Radiol 2019; 29:3553-3563. [DOI: 10.1007/s00330-018-5909-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/18/2018] [Accepted: 11/22/2018] [Indexed: 12/21/2022]
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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: 60] [Impact Index Per Article: 10.0] [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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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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Jhaveri KS, Fischer SE, Hosseini-Nik H, Sreeharsha B, Menezes RJ, Gallinger S, Moulton CAE. Prospective comparison of gadoxetic acid-enhanced liver MRI and contrast-enhanced CT with histopathological correlation for preoperative detection of colorectal liver metastases following chemotherapy and potential impact on surgical plan. HPB (Oxford) 2017; 19:992-1000. [PMID: 28760631 DOI: 10.1016/j.hpb.2017.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/20/2017] [Accepted: 06/28/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced CT (CECT) for preoperative detection of colorectal liver metastases (CRLM) following chemotherapy and to evaluate the potential change in the hepatic resection plan. METHODS 51 patients with CRLM treated with preoperative chemotherapy underwent liver imaging by EOB-MRI and CECT prospectively. Two independent blinded readers characterized hepatic lesions on each imaging modality using a 5-point scoring system. 41 patients underwent hepatic resection and histopathological evaluation. RESULTS 151 CRLM were confirmed by histology. EOB-MRI, compared to CECT, had significantly higher sensitivity in detection of CRLM ≤1.0 cm (86% vs. 45.5%; p < 0.001), significantly lower indeterminate lesions diagnosis (7% vs. 33%; p < 0.001) and significantly higher interobserver concordance rate in characterizing the lesions ≤1.0 cm (72% vs. 51%; p = 0.041). The higher yield of EOB-MRI could have changed the surgical plan in 45% of patients. CONCLUSION Following preoperative chemotherapy, EOB-MRI is superior to CECT in detection of small CRLM (≤1 cm) with significantly higher sensitivity and diagnostic confidence and interobserver concordance in lesion characterization. This improved diagnostic performance can alter the surgical plan in almost half of patients scheduled for liver resection.
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Affiliation(s)
- Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
| | - Sandra E Fischer
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hooman Hosseini-Nik
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Boraiah Sreeharsha
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Ravi J Menezes
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Steven Gallinger
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Carol-Anne E Moulton
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
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Lee DH, Lee JM. Primary malignant tumours in the non-cirrhotic liver. Eur J Radiol 2017; 95:349-361. [PMID: 28987692 DOI: 10.1016/j.ejrad.2017.08.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 07/25/2017] [Accepted: 08/28/2017] [Indexed: 12/12/2022]
Abstract
Intrahepatic chlangiocarcinomas (CCs), the second most common primary malignant liver tumours, usually occur in non-cirrhotic liver, and can be classified into three types based on gross morphology: mass-forming; periductal infiltrating; and intraductal growing. Among them, mass-forming intrahepatic CCs are the most common type and characterized by homogeneous mass with an irregular but well-defined margin with peripheral enhancement on late arterial phase and delayed enhancement in central portion of tumours corresponding to the fibrous stroma. Several imaging features such as enhancement pattern and degree of diffusion restriction have been suggested as prognostic markers for mass-forming CCs. Hepatocellular carcinomas (HCCs) are the most common primary malignant liver tumors, and usually arise from the cirrhotic liver. However, approximately 20% of HCCs involve the non-cirrhotic liver (hereafter, non-cirrhotic HCC), and non-cirrhotic HCCs are often detected at an advanced stage due to the lack of surveillance for patients with non-cirrhotic liver. Other primary malignant liver tumours other than CCs and HCCs including angiosarcoma, undifferentiated embryonal sarcoma are quite rare, and imaging diagnosis is often difficult. This review offers a brief overview of epidemiology, risk factors and imaging features of primary malignant tumours in non-cirrhotic liver. Understanding of radiologic appearance and predisposing clinical features as well as differentials of primary malignant tumour in non-cirrhotic liver can be helpful for radiologists to adequately assess these tumours, and subsequently to make optimal management plan.
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Affiliation(s)
- Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Republic of Korea; Seoul National University College of Medicine, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Republic of Korea; Seoul National University College of Medicine, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Republic of Korea.
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Park MJ, Hong N, Han K, Kim MJ, Lee YJ, Park YS, Rha SE, Park S, Lee WJ, Park SH, Lee CH, Nam CM, An C, Kim HJ, Kim H, Park MS. Use of Imaging to Predict Complete Response of Colorectal Liver Metastases after Chemotherapy: MR Imaging versus CT Imaging. Radiology 2017; 284:423-431. [DOI: 10.1148/radiol.2017161619] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Min Jung Park
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Nurhee Hong
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Kyunghwa Han
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Min Ju Kim
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Yoon Jin Lee
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Yang Shin Park
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Sung Eun Rha
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Sumi Park
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Won Jae Lee
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Seong Ho Park
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Chang Hee Lee
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Chung Mo Nam
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Chansik An
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Hye Jin Kim
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Honsoul Kim
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
| | - Mi-Suk Park
- From the Departments of Radiology (M.J.P., K.H., C.A., H.J.K., H.K., M.S.P.) and Biostatistics (K.H., C.M.N.), Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 120-752, Korea; Department of Radiology, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea (N.H., S.H.P.); Center for Colorectal Cancer, National Cancer Center, Ilsan, Korea (M.J.K.); Department of Radiology, Seoul National University College of Medicine, Bundang Hospital, Bundang,
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Detection and Viability of Colorectal Liver Metastases After Neoadjuvant Chemotherapy: A Multiparametric PET/CT-MRI Study. Clin Nucl Med 2017; 42:258-263. [PMID: 28166142 DOI: 10.1097/rlu.0000000000001538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to compare combined gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced and diffusion-weighted (DW) MRI with IV contrast-enhanced F-FDG PET/CT to detect and assess the viability of colorectal liver metastases (CLMs) after neoadjuvant chemotherapy (NAC). PATIENTS AND METHODS After NAC, 45 patients with CLMs were prospectively enrolled and underwent combined Gd-EOB-DTPA-enhanced and DW-MRI and contrast-enhanced F-FDG PET/CT. Forty patients subsequently underwent surgery based on intraoperative ultrasound, which served as the reference standard for the presence of CLMs. The number of metastases detected by each technique was then compared. In 69 resected metastases, the SUVmean and SUVmax, mean and maximum target-to-background ratio (TBR), total lesion glycolysis, metabolic tumor volume, and mean and minimum apparent diffusion coefficient (ADC) were examined to identify correlations with the corresponding tumor viability (TV) determined from histological specimens. RESULTS Intraoperative ultrasound revealed 153 CLMs, 122 of which were resected. The detection rate of MRI and contrast-enhanced F-FDG PET/CT were similar (P = 0.61). The SUVmax and minimum ADC were negatively correlated (r = -0.34, P = 0.005) on preoperative imaging after NAC. However, TV was significantly correlated with the maximum TBR (r = 0.33, P = 0.006) and mean TBR (r = 0.37, P = 0.002), but not with the minimum ADC (r = -0.02, P = 0.9) or mean ADC (r = 0.01, P = 0.9). CONCLUSIONS Combined Gd-EOB-DTPA-enhanced and DW-MRI and contrast-enhanced F-FDG PET/CT allow confident detection of CLMs, but only F-FDG PET metrics are associated with TV after NAC.
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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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16
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Lee DH, Lee JM, Hur BY, Joo I, Yi NJ, Suh KS, Kang KW, Han JK. Colorectal Cancer Liver Metastases: Diagnostic Performance and Prognostic Value of PET/MR Imaging. Radiology 2016; 280:782-92. [DOI: 10.1148/radiol.2016151975] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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Hoareau J, Venara A, Lebigot J, Hamel JF, Lermite E, Caroli-Bosc FX, Aube C. Intraoperative Contrast-Enhanced Ultrasound in Colorectal Liver Metastasis Surgery Improves the Identification and Characterization of Nodules. World J Surg 2016; 40:190-7. [PMID: 26470698 DOI: 10.1007/s00268-015-3269-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The sensitivity of preoperative assessment of colorectal liver metastases (CRLM) ranges from 74 to 80%. Intraoperative ultrasound (IOUS) associated with contrast-enhanced intraoperative ultrasound (CE-IOUS) may be able to improve this. Thus, the aims of this study were to assess the value of IOUS and CE-IOUS for the surgical approach and to determine risk factors both for the detection of new nodules and for the modification of the surgical strategy. MATERIALS AND METHODS Forty-three patients who underwent CRLM surgery were included. These patients had an MRI in the 8 weeks preceding surgery and benefited from intraoperative IOUS and CE-IOUS. RESULTS AND DISCUSSION The use of IOUS/CE-IOUS permitted the identification of 43 additional lesions and an improved characterization of nodules in 23 patients with a resulting modification of surgical strategy. Lesions were down-staged in six patients and up-staged in six patients. Chemotherapy (p = 0.02) and the presence of nodules in the left lobe (p = 0.04) were predictive factors for finding new nodules at IOUS/CE-IOUS. The discovery of a new nodule systematically modified surgical management. IOUS/CE-IOUS improved intraoperative management of liver metastases. The techniques enable pertinent modification of surgical resections and a reduction of residual lesions.
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Cost evaluation of gadoxetic acid-enhanced magnetic resonance imaging in the diagnosis of colorectal-cancer metastasis in the liver: Results from the VALUE Trial. Eur Radiol 2016; 26:4121-4130. [PMID: 26905871 PMCID: PMC5052297 DOI: 10.1007/s00330-016-4271-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the costs of diagnostic workup and surgery of three strategies for patients with colorectal cancer liver-metastases (CRCLM): gadoxetic-acid-enhanced MRI (Gd-EOB-DTPA-MRI), MRI with extracellular contrast-media (ECCM-MRI) or contrast-enhanced MDCT (CE-MDCT). METHODS The within-trial cost evaluation was modelled as a decision-tree to calculate the cost of diagnosis and surgery. The model used clinical outcomes and resource utilization data from a prospective randomized multicentre study. Analyses were performed for the 354-patient safety population from eight participating countries. RESULTS The diagnostic workup cost using Gd-EOB-DTPA-MRI upfront resulted in savings compared to ECCM-MRI in all countries except Thailand (difference <2 %). Compared to CE-MDCT, initial imaging with Gd-EOB-DTPA-MRI was less costly in all countries except Korea and Spain (differences 4 and 8 %, respectively). Significantly more patients in the Gd-EOB-DTPA-MRI group were eligible for surgery (39.3 % (48/122) vs. 31.0 % (36/116) and 26.7 % (31/116) for ECCM-MRI and CE-MDCT, respectively), allowing more patients to undergo potentially curative surgery, but resulting in higher treatment costs for the strategy starting with Gd-EOB-DTPA-MRI. CONCLUSIONS The benefits of Gd-EOB-DTPA-MRI due to less additional imaging and similar diagnostic workup costs in the three groups suggest that Gd-EOB-DTPA-MRI should be the preferred initial imaging procedure to evaluate hepatic resectability in patients with CRCLM. KEY POINTS • Diagnostic imaging cost to evaluate resectability was similar among the groups • Cost for imaging was rather small compared to the cost of surgery • Significantly more patients in the Gd-EOB-DTPA-MRI arm were eligible for surgery • Gd-EOB-DTPA-MRI is recommended for evaluating hepatic resectability in patients with CRCLM.
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Vilgrain V, Esvan M, Ronot M, Caumont-Prim A, Aubé C, Chatellier G. A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. Eur Radiol 2016; 26:4595-4615. [PMID: 26883327 DOI: 10.1007/s00330-016-4250-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases. METHODS A comprehensive search (EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates. RESULTS Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acid-enhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (p = 0.0001 and p < 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (p < 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm. CONCLUSIONS In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis. KEY POINTS • DW-MRI is less sensitive than gadoxetic acid-enhanced MRI for detecting liver metastases • DW-MRI and gadoxetic acid-enhanced MRI is the best combination • Same results are observed in colorectal liver metastases • Same results are observed in liver metastases smaller than 1 cm • Same results are observed when histopathology alone is the reference standard.
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Affiliation(s)
- Valérie Vilgrain
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. .,University Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Maxime Esvan
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France
| | - Maxime Ronot
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Aurore Caumont-Prim
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France
| | - Christophe Aubé
- Department of Radiology, CHU d'Angers, Angers, France.,Laboratoire HIFIH, LUNAM, Université d'Angers, Angers, France
| | - Gilles Chatellier
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 75006, Paris, France
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Ni P, Lin Y, Zhong Q, Chen Z, Sandrasegaran K, Lin C. Technical advancements and protocol optimization of diffusion-weighted imaging (DWI) in liver. Abdom Radiol (NY) 2016; 41:189-202. [PMID: 26830624 DOI: 10.1007/s00261-015-0602-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
An area of rapid advancement in abdominal MRI is diffusion-weighted imaging (DWI). By measuring diffusion properties of water molecules, DWI is capable of non-invasively probing tissue properties and physiology at cellular and macromolecular level. The integration of DWI as part of abdominal MRI exam allows better lesion characterization and therefore more accurate initial diagnosis and treatment monitoring. One of the most technical challenging, but also most useful abdominal DWI applications is in liver and therefore requires special attention and careful optimization. In this article, the latest technical developments of DWI and its liver applications are reviewed with the explanations of the technical principles, recommendations of the imaging parameters, and examples of clinical applications. More advanced DWI techniques, including Intra-Voxel Incoherent Motion (IVIM) diffusion imaging, anomalous diffusion imaging, and Diffusion Kurtosis Imaging (DKI) are discussed.
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Affiliation(s)
- Ping Ni
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Yuning Lin
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Qun Zhong
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Ziqian Chen
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Kumar Sandrasegaran
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 950 West Walnut St. R2 E124, Indianapolis, IN, 46202, USA
| | - Chen Lin
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 950 West Walnut St. R2 E124, Indianapolis, IN, 46202, USA.
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