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Auer TA. Diffusion-weighted imaging for the detection of liver metastases in the preoperative evaluation of pancreatic cancer - are we really at the end of the road? Eur Radiol 2024; 34:103-105. [PMID: 37603127 PMCID: PMC10791716 DOI: 10.1007/s00330-023-10159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Timo A Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Campus Virchow (CVK), Augustenburger Platz 1, 13353, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
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Şahin E, Elboğa U, Çelen YZ, Sever ÖN, Çayırlı YB, Çimen U. Comparison of 68Ga-DOTA-FAPI and 18FDG PET/CT imaging modalities in the detection of liver metastases in patients with gastrointestinal system cancer. Eur J Radiol 2021; 142:109867. [PMID: 34315086 DOI: 10.1016/j.ejrad.2021.109867] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/15/2021] [Accepted: 07/14/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE We aimed to compare the diagnostic performance of PET/CT imaging performed with 68Ga-DOTA-FAPI and 18FDG in detection of liver metastases in patients with gastrointestinal system (GIS) cancer. METHODS A total of 31 patients who underwent 68Ga-DOTA-FAPI and 18F-FDG PET/CT examinations and diagnosed with GIS cancer (15 colorectal, 9 pancreas, 4 stomach and 3 other cancers) were included in the study. The presence of liver metastasis was decided based on histopathologic diagnosis, PET/CT, other radiologic examinations or tumor biomarker findings, and both PET/CT imaging findings were compared on the patient and lesion basis. RESULTS Of the 31 patients, 28 were found as true positive with 68Ga-DOTA-FAPI-PET/CT and 17 with 18FDG-PET/CT. Of the 98 metastatic liver lesions determined according to our diagnostic criteria, 92 were found as true positive lesions with 68Ga-DOTA-FAPI-PET/CT and 65 with 18FDG-PET/CT. There was a statistically significant difference between both imaging modalities in the patient and lesion based comparisons (p < 0.05). When semiquantitative values (SUVmax, mlr) obtained from the lesions were compared between the two imaging methods, mlr values showed statistically significant difference in all tumor subgroups (p < 0.05). CONCLUSION It was concluded that 68Ga-DOTA-FAPI-PET/CT was superior over 18FDG-PET/CT in detection of liver metastases of GIS cancers and it can be a complementary method especially in negative cases with 18FDG-PET/CT.
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Affiliation(s)
- Ertan Şahin
- Gaziantep University Hospital, Department of Nuclear Medicine, Gaziantep, Turkey.
| | - Umut Elboğa
- Gaziantep University Hospital, Department of Nuclear Medicine, Gaziantep, Turkey
| | - Yusuf Zeki Çelen
- Gaziantep University Hospital, Department of Nuclear Medicine, Gaziantep, Turkey
| | - Özlem Nuray Sever
- Gaziantep University Hospital, Department of Nuclear Medicine, Gaziantep, Turkey
| | - Yusuf Burak Çayırlı
- Gaziantep University Hospital, Department of Nuclear Medicine, Gaziantep, Turkey
| | - Ufuk Çimen
- Gaziantep University Hospital, Department of Nuclear Medicine, Gaziantep, Turkey
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Litjens G, Rivière DM, van Geenen EJM, Radema SA, Brosens LAA, Prokop M, van Laarhoven CJHM, Hermans JJ. Diagnostic accuracy of contrast-enhanced diffusion-weighted MRI for liver metastases of pancreatic cancer: towards adequate staging and follow-up of pancreatic cancer - DIA-PANC study: study protocol for an international, multicenter, diagnostic trial. BMC Cancer 2020; 20:744. [PMID: 32778061 PMCID: PMC7418197 DOI: 10.1186/s12885-020-07226-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND At the time of surgery, approximately 10-20% of the patients with pancreatic cancer are considered unresectable because of unexpected liver metastasis, peritoneal carcinomatosis or locally advanced disease. This leads to futile surgical treatment with all the associated morbidity, mortality and costs. More than 50% of all liver metastases develop in the first six months postoperatively. These (subcentimeter) liver metastases are most likely already present at the time of diagnosis and have not been identified pre-operatively, due to the poor sensitivity of routine preoperative contrast-enhanced CT (CECT). METHODS The DIA-PANC study is a prospective, international, multicenter, diagnostic cohort study investigating diffusion-weighted, contrast-enhanced MRI for the detection of liver metastases in patients with all stages of pancreatic cancer. Indeterminate or malignant liver lesions on MRI will be further investigated histopathologically. For patients with suspected liver lesions without histopathological proof, follow up imaging with paired CT and MRI at 3-, 6- and 12-months will serve as an alternative reference standard. DISCUSSION The DIA-PANC trial is expected to report high-level evidence of the diagnostic accuracy of MRI for the detection of liver metastases, resulting in significant value for clinical decision making, guideline development and improved stratification for treatment strategies and future trials. Furthermore, DIA-PANC will contribute to our knowledge of liver metastases regarding incidence, imaging characteristics, their number and extent, and their change in time with or without treatment. It will enhance the worldwide implementation of MRI and consequently improve personalized treatment of patients with suspected pancreatic ductal adenocarcinoma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03469726 . Registered on March 19th 2018 - Retrospectively registered.
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Affiliation(s)
- G. Litjens
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - D. M. Rivière
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - E. J. M. van Geenen
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, The Netherlands
| | - S. A. Radema
- Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - L. A. A. Brosens
- Department of Pathology, Radboudumc, Nijmegen, The Netherlands
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - M. Prokop
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | | | - J. J. Hermans
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
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Schulz A, Joelsen-Hatlehol ES, Brudvik KW, Aasand KK, Hanekamp B, Viktil E, Johansen CK, Dormagen JB. Preoperative detection of colorectal liver metastases: DWI alone or combined with MDCT is no substitute for Gd-EOB-DTPA-enhanced MRI. Acta Radiol 2020; 61:302-311. [PMID: 31335157 DOI: 10.1177/0284185119864000] [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: 11/16/2022]
Abstract
Background Magnetic resonance imaging (MRI) with hepatocyte specific contrast has the highest sensitivity for colorectal liver metastases but comes at high costs and long examination times. Purpose To evaluate if preoperative detection of colorectal liver metastases with less resource-consuming diffusion-weighted imaging (DWI) alone or in combination with multidetector computed tomography (MDCT) can compete with gadolinium-etoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced MRI. Material and Methods Forty-four patients with 123 colorectal liver metastases received MDCT and Gd-EOB-DTPA-enhanced MRI including DWI before liver resection for colorectal liver metastases. Five image sets were evaluated by two radiologists. The DWI set consisted of DWI, ADC map, coronal, axial T2-weighted single-shot sequences. The DWI-T2F set contained additionally respiratory-triggered T2-weighted TSE-SPIR sequences. The MDCT set consisted of four-phase MDCT, the MDCT-DWI set also contained DWI. The CE-MRI set contained all MRI sequences including Gd-EOB-DTPA. Reference standards was histopathology and follow-up. Results CE-MRI set had highest sensitivity ( P ≤ 0.013) with 95% compared to 72%, 73%, 73%, and 87% the for DWI set, DWI-T2W-FS set, MDCT set, and MDCT-DWI set, respectively. The CE-MRI set had the highest sensitivity ( P≤0.012) for colorectal liver metastases <10 mm with 87% compared to 55%, 52%, 23%, and 58% for the DWI set, DWI-T2W-FS set, MDCT set, and MDCT-DWI set, respectively. The MDCT-DWI set improved sensitivity overall and in size-dependent subgroup analyses compared to the MDCT set ( P ≤ 0.031). The MDCT-DWI set showed the highest specificity of 98% followed by 98%, 98%, 95%, and 88% for the DWI set, DWI-T2W-FS set, MDCT set, and CE-MRI set, respectively. Conclusion The less resource and time-consuming DWI sets are inferior to Gd-EOB-DTPA-enhanced MRI for the detection of colorectal liver metastases. Gd-EOB-DTPA-enhanced MRI with its excellent sensitivity should be the preferred preoperative modality when meticulous lesion identification is essential. Combination of DWI with MDCT improved significantly sensitivity compared to each modality alone.
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Affiliation(s)
- Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | | | | | | | - Bettina Hanekamp
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Ellen Viktil
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Cathrine K Johansen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
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Zhou W, Michalak G, Weaver J, Ferrero A, Gong H, Fetterly KA, McCollough CH, Leng S. Determination of iodine detectability in different types of multiple-energy images for a photon-counting detector computed tomography system. J Med Imaging (Bellingham) 2019; 6:043501. [PMID: 31620546 DOI: 10.1117/1.jmi.6.4.043501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/16/2019] [Indexed: 11/14/2022] Open
Abstract
In addition to low-energy-threshold images (TLIs), photon-counting detector (PCD) computed tomography (CT) can generate virtual monoenergetic images (VMIs) and iodine maps. Our study sought to determine the image type that maximizes iodine detectability. Adult abdominal phantoms with iodine inserts of various concentrations and lesion sizes were scanned on a PCD-CT system. TLIs, VMIs at 50 keV, and iodine maps were generated, and iodine contrast-to-noise ratio (CNR) was measured. A channelized Hotelling observer was used to determine the area under the receiver-operating-characteristic curve (AUC) for iodine detectability. Iodine map CNR ( 0.57 ± 0.42 ) was significantly higher ( P < 0.05 ) than for TLIs ( 0.46 ± 0.26 ) and lower ( P < 0.001 ) than for VMIs at 50 keV ( 0.74 ± 0.33 ) for 0.5 mgI/cc and a 35-cm phantom. For the same condition and an 8-mm lesion, iodine detectability from iodine maps ( AUC = 0.95 ± 0.01 ) was significantly lower ( P < 0.001 ) than both TLIs ( AUC = 0.99 ± 0.00 ) and VMIs ( AUC = 0.99 ± 0.01 ). VMIs at 50 keV had similar detectability to TLIs and both outperformed iodine maps. The lowest detectable iodine concentration was 0.5 mgI/cc for an 8-mm lesion and 1.0 mgI/cc for a 4-mm lesion.
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Affiliation(s)
- Wei Zhou
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Gregory Michalak
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Jayse Weaver
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Andrea Ferrero
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Hao Gong
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
| | - Kenneth A Fetterly
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States.,Mayo Clinic, Department of Cardiovascular Medicine, Rochester, Minnesota, United States
| | | | - Shuai Leng
- Mayo Clinic, Department of Radiology, Rochester, Minnesota, United States
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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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Diffusion-weighted imaging as a part of PET/MR for small lesion detection in patients with primary abdominal and pelvic cancer, with or without TOF reconstruction technique. Abdom Radiol (NY) 2019; 44:2639-2647. [PMID: 30863998 DOI: 10.1007/s00261-019-01980-x] [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: 10/27/2022]
Abstract
OBJECTIVES To investigate the value of diffusion-weighted imaging (DWI) in detection of small lesions (≤ 10 mm) in patients with primary abdominal and pelvic cancer in hybrid PET/MR with or without time-of-flight (TOF) technique. MATERIALS AND METHODS Twenty patients (11 females and 9 males, mean age 67.23 ± 12.90 years) with histologically confirmed primary abdominal and pelvic cancer underwent hybrid PET/MR examination. A total of 64 small lesions were included in this study, which were divided into two groups (≤ 10 mm and 10-30 mm). Visual scores of small lesion detection ability were rated by five-point ordinal scale. The visual scores and detectability of small lesions on TOF PET image, noTOF PET image, and DWI sequences of hybrid PET/MR examination with or without TOF technique were analyzed. Logistic regression model was established for analysis in the value of DWI in hybrid PET/MR examination with or without TOF technique in detection of the small lesions between two groups. RESULTS The visual evaluation revealed the small lesion (≤ 10 mm) visual scores of DWI (mean ± SD: 4.23 ± 1.41), TOF PET image (mean ± SD: 4.14 ± 0.89), and noTOF PET image (mean ± SD: 2.68 ± 1.13);.and the visual scores of small lesions (10-30 mm) on DWI (mean ± SD: 4.98 ± 0.15), TOF PET image (mean ± SD: 4.57 ± 0.59), and noTOF PET image (mean ± SD: 3.98 ± 1.05). The visual scores of all small lesions on DWI were higher than that on TOF PET data and noTOF PET data in both two groups (**P < 0.01). The missed diagnosis rates of small FDG avid lesions (≤ 10 mm) of DWI and noTOF PET image were 9.1% and 9.1%, respectively. However, the TOF PET-based clinical diagnosis detected all small lesions (≤ 30 mm). DWI was of great importance in detection of small lesions (≤ 10 mm) in the absence of TOF technique in PET/MR examination (**P < 0.01). DWI's effect on detection of small lesions(10-30 mm) has shown no difference between PET/MR examinations with TOF and without TOF techniques (P > 0.05). CONCLUSION DWI has significant value in the detection of small lesions (≤ 10 mm) in hybrid PET/MR examination without TOF technique for patients with primary abdominal and pelvic cancer. However, it had less detection benefits in the small lesions (≤ 10 mm) in hybrid PET/MR examination with TOF PET image.
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Development of a Prognostic Nomogram for Liver Metastasis of Uveal Melanoma Patients Selected by Liver MRI. Cancers (Basel) 2019; 11:cancers11060863. [PMID: 31234340 PMCID: PMC6627813 DOI: 10.3390/cancers11060863] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/17/2022] Open
Abstract
Patients with liver metastases of uveal melanoma (LMUM) die from their metastatic evolution within 2 years. We established a nomogram to choose a treatment adapted to life expectancy. From 2002 to 2013, we reviewed 224 patients with LMUM selected by liver MRI. A nomogram was developed based on a Cox model. The predictive performance of the model was assessed according to the C-statistic, Kaplan–Meier curve, and calibration plots. The median follow-up was 49.2 months (range, 0.6–70.9). The survival rates at 6, 12, and 24 months were 0.88 (0.95 CI [0.84–0.93]), 0.68 (0.95 CI [0.62–0.75]), and 0.26 (0.95 CI [0.21–0.33]), respectively. The four factors selected for the nomogram with a worse prognosis were: A disease-free interval between the UM and LMUM groups of less than 6 months (HR = 3.39; 0.95 CI [1.90–6.05]), more than 10 LMUM (HR = 3.95; 0.95 CI [1.97–4.43]), a maximum LMUM of more than 1200 mm2 (HR = 2.47; 0.95 CI [1.53–3.98]), and a lactate dehydrogenase (LDH) value greater than 1.5 (HR = 3.72; 0.95 CI [2.30–6.00]). The model achieved relatively good discrimination and calibration (C-statistic 0.71). This nomogram could be useful for decision-making and risk stratification for therapeutic options.
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Improving preoperative detection of synchronous liver metastases in pancreatic cancer with combined contrast-enhanced and diffusion-weighted MRI. Abdom Radiol (NY) 2019; 44:1756-1765. [PMID: 30659309 DOI: 10.1007/s00261-018-1867-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To explore the value of gadolinium-enhanced MRI combined with diffusion-weighted MRI (Gd-enhanced MRI with DWI) in addition to contrast-enhanced CT (CECT) for detection of synchronous liver metastases for potentially resectable pancreatic cancer. METHODS By means of a retrospective cohort study we included patients with potentially resectable pancreatic cancer on CECT, who underwent Gd-enhanced MRI with DWI between January 2012 and December 2016. A single observer evaluated MRI and CT and was blinded to imaging, pathology, and surgery reports. Liver lesions were scored in both modalities, using a 3-point scale: 1-benign, 2-indeterminate, 3- malignant (i.e., metastasis). The primary outcome parameters were the presence of liver metastases on Gd-enhanced MRI with DWI and the sensitivity of Gd-enhanced MRI with DWI for synchronous liver metastases. RESULTS We included 66 patients (42 men, 24 women; median age 65 years, range 36-82 years). In 19 patients, liver metastases were present, which were confirmed by histopathology (n = 12), 18FDG-PET (n = 6), or surgical inspection (n = 1). Gd-enhanced MRI with DWI showed metastases in 16/19 patients (24%), which resulted in a sensitivity of 84% (95% CI 60-97%). Contrast-enhanced MRI showed 156 and DWI 397 metastases (p = 0.051), and 339 were particularly small (< 5 mm). CONCLUSIONS In this study, Gd-enhanced MRI with DWI detected synchronous liver metastases in 24% of patients with potentially resectable pancreatic cancer on CECT with a sensitivity of 84%. Diffusion-weighted MRI showed a greater number of metastases than any other sequence, particularly small metastases (< 5 mm).
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Marion-Audibert AM, Vullierme MP, Ronot M, Mabrut JY, Sauvanet A, Zins M, Cuilleron M, Sa-Cunha A, Lévy P, Rode A. Routine MRI With DWI Sequences to Detect Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Carcinoma and Normal Liver CT: A Prospective Multicenter Study. AJR Am J Roentgenol 2018; 211:W217-W225. [PMID: 30240298 DOI: 10.2214/ajr.18.19640] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance of systematic MRI with DWI for the detection of liver metastases (LM) in patients with potentially resectable pancreatic ductal carcinoma and normal liver findings at CT. SUBJECTS AND METHODS Patients with potentially resectable pancreatic ductal carcinoma and a normal liver at CT were enrolled in a prospective multicenter study between March 2011 and July 2013 and underwent preoperative MRI. The reference standard was pathologic analysis of detected hepatic lesions. RESULTS A total of 118 patients were enrolled. MRI depicted liver lesions that were not visible at CT in 16 patients. All lesions were visualized both with and without DWI. Lesions were LM in 12 (10.2%) patients and were confirmed in seven patients by preoperative biopsy, four by intraoperative frozen section, and one at 6-month follow-up evaluation after pancreatic resection. All but one liver metastatic lesion diagnosed with MRI were smaller than 10 mm. Four of 118 (3.4%) patients had a false-positive diagnosis of LM at MRI and remained LM free after a follow-up period of 24 months or longer. Three of 102 (2.9%) patients with normal MRI findings had subcapsular LM that were diagnosed intraoperatively. At follow-up, 99 of 118 (83.9%) patients were LM free after a mean of 24 months. The patient-based sensitivity of MRI for the detection of LM was 80.0% (95% CI, 51.9-95.7%); specificity, 96.1% (95% CI, 90.4-98.9%); positive predictive value, 75.0% (95% CI, 47.6-92.7%); and negative predictive value, 97.1% (95% CI, 91.6-99.4%). CONCLUSION Compared with CT, preoperative MRI improves the detection of LM in patients with potentially resectable pancreatic ductal carcinoma and may change management and the rate of unnecessary laparotomy and pancreatectomy for 10% of patients.
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Affiliation(s)
| | - Marie-Pierre Vullierme
- 2 Department of Medical Imaging, Beaujon University Hospital, 100 Blvd Leclerc, Clichy-la-Garenne, 92110, France
| | - Maxime Ronot
- 2 Department of Medical Imaging, Beaujon University Hospital, 100 Blvd Leclerc, Clichy-la-Garenne, 92110, France
| | - Jean-Yves Mabrut
- 3 Department of Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon, France
| | - Alain Sauvanet
- 4 Department of Digestive Surgery and Liver Transplantation, Beaujon University Hospital, Clichy-la-Garenne, France
| | - Marc Zins
- 5 Department of Medical Imaging, Saint-Joseph Hospital, Paris, France
| | - Muriel Cuilleron
- 6 Department of Medical Imaging, Nord University Hospital, Saint-Etienne, France
| | - Antonio Sa-Cunha
- 7 Department of Digestive Surgery and Liver Transplantation, University Hospital of Bordeaux, France
- 8 Present address: Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Philippe Lévy
- 9 Department of Pancreatology, Beaujon University Hospital, Clichy-la-Garenne, France
| | - Agnès Rode
- 10 Department of Medical Imaging, Croix-Rousse University Hospital, Lyon, France
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Abstract
CLINICAL/METHODICAL ISSUE Detection and characterization of focal liver lesions. STANDARD RADIOLOGICAL METHODS Due to its excellent soft tissue contrast, the availability of liver-specific contrast agents and the possibility of functional imaging, magnetic resonance imaging (MRI) is the method of choice for the evaluation of focal liver lesions. METHODICAL INNOVATIONS Diffusion-weighted imaging (DWI) enables generation of functional information about the microstructure of a tissue besides morphological information. PERFORMANCE In the detection of focal liver lesions DWI shows a better detection rate compared to T2w sequences and a slightly poorer detection rate compared to dynamic T1w sequences. In principle, using DWI it is possible to distinguish malignant from benign liver lesions and also to detect a therapy response at an early stage. ACHIEVEMENTS For both detection and characterization of focal liver lesions, DWI represents a promising alternative to the morphological sequences; however, a more detailed characterization with the use of further sequences should be carried out particularly for the characterization of solid benign lesions. For the assessment and prognosis of therapy response, DWI offers advantages compared to morphological sequences. PRACTICAL RECOMMENDATIONS For the detection of focal liver lesions DWI is in principle sufficient. After visual detection of a solid liver lesion a more detailed characterization should be carried out using further sequences (in particular dynamic T1w sequences). The DWI procedure should be used for the assessment and prognosis of a therapy response.
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Affiliation(s)
- P Riffel
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - S O Schoenberg
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - J Krammer
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Kaur H, Hindman NM, Al-Refaie WB, Arif-Tiwari H, Cash BD, Chernyak V, Farrell J, Grajo JR, Horowitz JM, McNamara MM, Noto RB, Qayyum A, Lalani T, Kamel IR. ACR Appropriateness Criteria ® Suspected Liver Metastases. J Am Coll Radiol 2018; 14:S314-S325. [PMID: 28473088 DOI: 10.1016/j.jacr.2017.01.037] [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] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 12/20/2022]
Abstract
Liver metastases are the most common malignant liver tumors. The accurate and early detection and characterization of liver lesions is the key to successful treatment strategies. Increasingly, surgical resection in combination with chemotherapy is effective in significantly improving survival if all metastases are successfully resected. MRI and multiphase CT are the primary imaging modalities in the assessment of liver metastasis, with the relative preference toward multiphase CT or MRI depending upon the clinical setting (ie, surveillance or presurgical planning). The optimization of imaging parameters is a vital factor in the success of either modality. PET/CT, intraoperative ultrasound are used to supplement CT and MRI. 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)
| | - Harmeet Kaur
- Principal Author, University of Texas, MD Anderson Cancer Center, Houston, Texas.
| | - Nicole M Hindman
- Co-author, New York University Medical Center, New York, New York
| | - Waddah B Al-Refaie
- Georgetown University Hospital, Washington, District of Columbia; American College of Surgeons
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | | | - James Farrell
- Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut; American Gastroenterological Association
| | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | | | - Richard B Noto
- Brown University Rhode Island Hospital, Providence, Rhode Island
| | - Aliya Qayyum
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Tasneem Lalani
- Specialty Chair, Inland Imaging Associates and University of Washington, Seattle, Washington
| | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ludwig DR, Mintz AJ, Sanders VR, Fowler KJ. Liver Imaging for Colorectal Cancer Metastases. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abraham-Nordling M, Öistämö E, Josephson T, Hjern F, Blomqvist L. The value of preoperative computed tomography combined with ultrasound in the investigation of small indeterminate liver lesions in patients with colorectal cancer. Acta Radiol 2017; 58:1288-1293. [PMID: 28286979 DOI: 10.1177/0284185117693461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Computed tomography (CT) is used routinely for the preoperative detection of colorectal cancer (CRC) metastases. When small indeterminate focal liver lesions are detected that are too small to characterize (TSTC) on CT, additional imaging is usually needed, resulting in a potential delay in obtaining a complete diagnostic work-up. Purpose To determine the diagnostic accuracy of ultrasound (US) of the liver performed in direct conjunction to CT in the preoperative investigation among patients with newly diagnosed CRC when indeterminate liver lesions were found on CT. Material and Methods Preoperative investigations with CT and consecutive US where CT had shown at least one focal liver lesion in 74 patients diagnosed with CRC between June 2009 and February 2012 were retrospectively reviewed. Either histopathological findings or a combination of imaging and clinical follow-up one to three years after surgery was used as the reference. Results Liver metastases were diagnosed with CT/US in 13 out of 74 patients (17.6%). In one patient, a liver cyst was preoperatively regarded as liver metastasis by a combined CT/US. The sensitivity and specificity for the CT with consecutive US procedure was 100% (13/13) and 98.4% (60/61). Conclusion US performed in conjunction with CT in patients with indeterminate focal liver lesions on CT is an accurate work-up for detection of liver metastases in patients with newly diagnosed CRC. Although our results are promising, they cannot be considered safely generalizable to all hospitals.
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Affiliation(s)
- Mirna Abraham-Nordling
- Division of Coloproctology, Center of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Emma Öistämö
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Josephson
- Department of Clinical Sciences, Division of Radiology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Hjern
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Blomqvist
- Department of Diagnostic Radiology, Department of Molecular Medicine and Surgery Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
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Chen Y, Yue X, Fujita H, Fu S. Three-way decision support for diagnosis on focal liver lesions. Knowl Based Syst 2017. [DOI: 10.1016/j.knosys.2017.04.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Sivesgaard K, Jöhnk ML, Larsen LP, Sørensen M, Kramer S, Løgager VB, Hansen F, Pedersen EM. Comparison of four MRI protocols for detection of extrahepatic colorectal cancer metastases. J Magn Reson Imaging 2017; 46:1619-1630. [PMID: 28301099 DOI: 10.1002/jmri.25704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/27/2017] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To compare three magnetic resonance imaging (MRI) protocols containing diffusion-weighted imaging with background suppression (DWIBS) and one traditional protocol for detecting extrahepatic colorectal cancer metastases. MATERIALS AND METHODS Thirty patients with extrahepatic colorectal cancer metastases were scanned in three stations from the skull base to the upper thighs using a 1.5T MRI system with six different MRI sequences; transverse and coronal T2 -weighted (T2 W) turbo spin-echo (TSE), coronal short tau inversion recovery (STIR), 3D T1 W TSE, DWIBS, and a contrast-enhanced T1 W 3D gradient echo (GRE) sequence. The six sequences were used to build four hypothetical MRI interpretive sets which were read by two readers in consensus, blinded to prior imaging. Lesions were categorized into 13 anatomic regions. Fluorodeoxyglucose / positron emission tomography / computed tomography (FDG-PET/CT) read with full access to prior imaging and clinical records was used as the reference standard. Sensitivity, specificity, and false discovery rate (FDR) were calculated as appropriate and receiver operating characteristic (ROC) curves were constructed. RESULTS In all, 177 malignant lesions were detected by FDG-PET/CT and distributed in 92 out of 390 scanned anatomic regions. The sensitivity was statistically higher in two out of three sets incorporating DWIBS on a per-lesion basis (66.7%, 63.3%, and 66.7% vs. 57.6%) (P = 0.01, P = 0.11, and P = 0.01, respectively) and in all sets incorporating DWIBS on a per-region basis (75.0%, 75.0%, and 77.2 vs. 66.3%) (P = 0.04, P = 0.04, and P = 0.01, respectively). There was no difference in specificity, FDR, or AUCROC . There was no difference between sets containing DWIBS irrespective of the use of a contrast-enhanced sequence. CONCLUSION MRI sets containing DWIBS had superior sensitivity. This sensitivity was retained when omitting a contrast-enhanced sequence. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1619-1630.
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Affiliation(s)
- Kim Sivesgaard
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars P Larsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Sørensen
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Stine Kramer
- Department of Nuclear Medicine & PET-Center, Aarhus University Hospital, Aarhus, Denmark
| | - Vibeke Berg Løgager
- Department of Radiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Flemming Hansen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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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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Barral M, Eveno C, Hoeffel C, Boudiaf M, Bazeries P, Foucher R, Pocard M, Dohan A, Soyer P. Diffusion-weighted magnetic resonance imaging in colorectal cancer. J Visc Surg 2016; 153:361-369. [PMID: 27618699 DOI: 10.1016/j.jviscsurg.2016.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Magnetic resonance imaging (MRI) plays now a major role in patients with colorectal cancer regarding tumor staging, surgical planning, therapeutic decision, assessment of tumor response to chemoradiotherapy and surveillance of rectal cancer, and detection and characterization of liver or peritoneal metastasis of colorectal cancers. Diffusion-weighted MRI (DW-MRI) is a functional imaging tool that is now part of the standard MRI protocol for the investigation of patients with colorectal cancer. DW-MRI reflects micro-displacements of water molecules in tissues and conveys high degrees of accuracy to discriminate between benign and malignant colorectal conditions. Thus, in addition to morphological imaging, DW-MRI has an important role to accurately detect colorectal neoplasms and peritoneal implants, to differentiate benign focal liver lesions from metastases and to detect tumor relapse within fibrotic changes. This review provides a comprehensive overview of basic principles, clinical applications and future trends of DW-MRI in colorectal cancers.
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Affiliation(s)
- M Barral
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris, France; Université Diderot-Paris 7, Sorbonne Paris Cité, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; UMR INSERM 965, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - C Eveno
- Department of digestive surgery, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - C Hoeffel
- Department of Radiology, Hôpital Robert-Debré, CHU de Reims, 51092 Reims cedex, France
| | - M Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris, France
| | - P Bazeries
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris, France.
| | - R Foucher
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris, France; Université Diderot-Paris 7, Sorbonne Paris Cité, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Pocard
- Université Diderot-Paris 7, Sorbonne Paris Cité, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; UMR INSERM 965, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; Department of digestive surgery, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - A Dohan
- UMR INSERM 965, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - P Soyer
- Université Diderot-Paris 7, Sorbonne Paris Cité, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; UMR INSERM 965, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
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Current Status of Imaging to Evaluate Liver Metastases From Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Brendle C, Schwenzer NF, Rempp H, Schmidt H, Pfannenberg C, la Fougère C, Nikolaou K, Schraml C. Assessment of metastatic colorectal cancer with hybrid imaging: comparison of reading performance using different combinations of anatomical and functional imaging techniques in PET/MRI and PET/CT in a short case series. Eur J Nucl Med Mol Imaging 2015. [DOI: 10.1007/s00259-015-3137-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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21
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Wagner M, Ronot M, Doblas S, Giraudeau C, Van Beers B, Belghiti J, Paradis V, Vilgrain V. Assessment of the residual tumour of colorectal liver metastases after chemotherapy: diffusion-weighted MR magnetic resonance imaging in the peripheral and entire tumour. Eur Radiol 2015; 26:206-15. [DOI: 10.1007/s00330-015-3800-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 04/07/2015] [Accepted: 04/13/2015] [Indexed: 12/13/2022]
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22
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Diffusion-weighted MRI for uveal melanoma liver metastasis detection. Eur Radiol 2015; 25:2263-73. [DOI: 10.1007/s00330-015-3662-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/11/2014] [Accepted: 02/11/2015] [Indexed: 01/16/2023]
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Xia Q, Feng Y, Wu C, Huang G, Liu J, Chen T, Sun X, Song S, Tong L, Ni Y. Differentiation between Malignant and Benign Solitary Lesions in the Liver with (18)FDG PET/CT: Accuracy of Age-related Diagnostic Standard. J Cancer 2015; 6:40-7. [PMID: 25553087 PMCID: PMC4278913 DOI: 10.7150/jca.10422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/15/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study was to determine the reliability of age-stratified diagnostic index in differential diagnosis of malignant and benign solitary lesions in the liver using fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ((18)FDG PET/CT). METHODS The enrolled 272 patients with solitary lesions in the liver were divided into three age groups, younger group (under 50 years), middle-aged group (50-69 years), and elderly group (70 years and above). Patients' ages were compared, and the optimal cut-offs of the standard uptake value (SUV) ratio (tumor-to-non-tumor ratio of the SUV), as well as areas under the curves (AUC), were evaluated in terms of malignant and benign lesions in each age group by using receiver operating characteristic (ROC) analysis. Based on optimal cut-offs, the sensitivity, specificity, accuracy were calculated, and the diagnostic accordance rate was compared between each age group and all patients, supported by (18)FDG PET/CT imaging data. RESULTS There was a significant age difference between the malignant and benign groups (t=3.905 p=0.0001). ROC analysis showed that the optimal cut-off value in all patients, younger group, middle-aged group and elderly group was 1.25, 1.17, 1.45 and 1.25 for SUVratio, and 0.856, 0.962, 0.650, 0.973 for AUC. The chi-square test proved that diagnostic accordance rate of (18)FDG PET/CT in younger group and elderly group were superior to that in all patients (χ(2)=13.352, P=0.0003) and (χ(2)=8.494, P=0.0036). Conversely, overall diagnostic accordance rate in all patient group was higher than that in middle-aged group (χ(2)=9.057, P=0.0026). Representative (18)FDG PET/CT imaging findings are demonstrated. CONCLUSION This study indicates that diagnostic optimal cut-offs of SUVratio of liver solitary lesions of (18)FDG PET/CT were different in each age group. In addition, the diagnostic performance of SUVratio was better in younger and elderly groups than that in all patients, and was poorer in middle-aged group than that in all patients. Therefore, age difference appears to be one of the important factors for discriminating malignant liver lesions from benign ones using (18) FDG PET/CT.
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Affiliation(s)
- Qian Xia
- 1. Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuanbo Feng
- 2. Department of Imaging and Pathology, University Hospitals, KU Leuven, Leuven, Belgium
| | - Cheng Wu
- 3. Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Gang Huang
- 1. Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Liu
- 1. Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Chen
- 1. Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoguang Sun
- 1. Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shaoli Song
- 1. Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Linjun Tong
- 1. Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yicheng Ni
- 2. Department of Imaging and Pathology, University Hospitals, KU Leuven, Leuven, Belgium
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Maegerlein C, Fingerle AA, Souvatzoglou M, Rummeny EJ, Holzapfel K. Detection of liver metastases in patients with adenocarcinomas of the gastrointestinal tract: comparison of 18F-FDG PET/CT and MR imaging. ACTA ACUST UNITED AC 2014; 40:1213-22. [DOI: 10.1007/s00261-014-0283-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Presurgical planning for hepatobiliary malignancies: clinical and imaging considerations. Magn Reson Imaging Clin N Am 2014; 22:447-65. [PMID: 25086939 DOI: 10.1016/j.mric.2014.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There are many considerations in the evaluation of liver malignancy before planned surgical treatment. This article focuses on interpretation of MR imaging of the liver for surgical treatment planning of hepatocellular carcinoma, colorectal cancer metastases, and hilar cholangiocarcinoma. Clinical status, anatomic variants, future liver remnant, and underlying liver disease are all important factors in the decision to proceed with liver resection. The primary objective of preoperative imaging is to correctly identify patients who are candidates for curative intervention and to accurately stage their disease. Treatment planning for these complex patients is best done with a multidisciplinary team approach.
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Albrecht MH, Wichmann JL, Müller C, Schreckenbach T, Sakthibalan S, Hammerstingl R, Bechstein WO, Zangos S, Ackermann H, Vogl TJ. Assessment of colorectal liver metastases using MRI and CT: impact of observer experience on diagnostic performance and inter-observer reproducibility with histopathological correlation. Eur J Radiol 2014; 83:1752-8. [PMID: 25082480 DOI: 10.1016/j.ejrad.2014.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/01/2014] [Accepted: 07/05/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION To compare the diagnostic performance and inter-observer reproducibility of CT and MRI in detecting colorectal liver metastases (CRLM) of observers with different levels of experience. MATERIALS AND METHODS Data from 51 CT and 54 MRI examinations of 105 patients with CRLM were analysed. Intraoperative and histopathological findings served as the reference standard. Analyses were performed by four observers with varying levels of experience regarding imaging of CRLM (reviewers A, B, C and D with respectively >20, >5, <1 and 0 years of experience). Per-segment sensitivity, specificity, Cohen's kappa (κ) for diagnosed segments and Intra-class Correlation Coefficients (ICC) for reported number of lesions were calculated. RESULTS CT sensitivity and specificity was for reviewer A 89.71%/94.41%, B 78.50%/88.37%, C 63.55%/85.58%, D 84.11%/78.60% and regarding MRI A 90.40%/95.43%, B 74.40%/90.04%, C 60.00%/85.89% and D 65.60%/75.90%. The overall inter-observer agreement was higher for CT (κ=0.43, p<0.001; ICC=0.75, p<0.001) than MRI (κ=0.38, p<0.001; ICC=0.65, p<0.001). The experienced reviewers A and B achieved better agreement for MRI (κ=0.54, p<0.001; ICC=0.77, p<0.001) than CT (κ=0.52, p<0.00; ICC=0.76, p<0.001) unlike the less experienced C and D (MRI κ=0.38, ICC=0.63 and CT κ=0.41, ICC=0.74, respectively, p<0.001). CONCLUSIONS The proficiency in detection of CRLM is significantly influenced by observer experience, although CT interpretation is less affected than MRI analysis.
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Affiliation(s)
- Moritz H Albrecht
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Julian L Wichmann
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Cindy Müller
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Theresa Schreckenbach
- University Hospital Frankfurt, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Sreekanth Sakthibalan
- Barts and the London, Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom
| | - Renate Hammerstingl
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Wolf O Bechstein
- University Hospital Frankfurt, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Stephan Zangos
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Hanns Ackermann
- University Hospital Frankfurt, Department of Biostatistics and Medical Information, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Thomas J Vogl
- University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Current status of imaging and emerging techniques to evaluate liver metastases from colorectal carcinoma. Ann Surg 2014; 259:861-72. [PMID: 24509207 DOI: 10.1097/sla.0000000000000525] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. Liver is a common site of tumor spread and in approximately 30% of the cases; synchronous liver disease is present at the time of diagnosis. Early detection of liver metastases is crucial to appropriately select patients who may benefit from hepatic resection among those needing chemotherapy, to improve 5-year survival. Advances in imaging techniques have contributed greatly to the management of these patients. Multidetector computed tomography is the most useful test for initial staging and in posttreatment surveillance settings. Magnetic resonance imaging is considered superior to multidetector computed tomography and positron emission tomography for the detection and characterization of small lesions and for liver evaluation in the presence of background fatty liver changes. Positron emission tomography-computed tomography has a problem-solving role in the detection of distant metastasis and in posttreatment evaluation. The advanced imaging methods also serve a role in selecting appropriate patients for radiologically targeted therapies and in monitoring response to conventional and novel therapies.
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Arita J, Ono Y, Takahashi M, Inoue Y, Takahashi Y, Saiura A. Usefulness of contrast-enhanced intraoperative ultrasound in identifying disappearing liver metastases from colorectal carcinoma after chemotherapy. Ann Surg Oncol 2014; 21 Suppl 3:S390-7. [PMID: 24570378 DOI: 10.1245/s10434-014-3576-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Preoperative chemotherapy sometimes makes colorectal liver metastases disappear or diminish. Contrast-enhanced intraoperative ultrasound (CE-IOUS) using perflubutane may identify such metastases. METHODS Among 131 consecutive patients who underwent hepatic resection, 86 had received preoperative chemotherapy. Of these patients, 72 were examined using contrast-enhanced computed tomography (CE-CT), gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI), contrast-enhanced ultrasound (CEUS), intraoperative ultrasound (IOUS), and CE-IOUS; these patients were the subject of the present study. Effects of IOUS and CE-IOUS to search for disappearing liver metastases (DLM) and tumors with a diameter of 1 cm or less based on the preoperative imaging were assessed. RESULTS A total of 32 DLMs were noted in 11 patients. Four DLMs were identified using IOUS, and 16 DLMs (including the four DLMs identified using IOUS) were identified using CE-IOUS. Of the 16 DLMs that were missed using both IOUS and CE-IOUS, nine were resected using anatomical resection and seven were not resected. One of the nine resected DLMs was histologically proven to be adenocarcinoma. Three of the seven unresected DLMs showed tumor regrowth during a postoperative follow-up examination. CE-IOUS identified 79 % of the 19 DLMs that were ultimately confirmed as liver metastases, whereas IOUS identified 21 % of them (p < 0.004). Among the 202 tumors that were identified using preoperative imaging, 54 were 1 cm or less in diameter. The sensitivity of CE-IOUS for these tumors were superior to CE-CT (p < 0.04) and IOUS (p < 0.04), respectively. CONCLUSIONS CE-IOUS might be necessary after preoperative chemotherapy for colorectal liver metastasis.
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Affiliation(s)
- Junichi Arita
- Gastroenterological Surgery Department, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan,
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Herzen J, Willner MS, Fingerle AA, Noël PB, Köhler T, Drecoll E, Rummeny EJ, Pfeiffer F. Imaging liver lesions using grating-based phase-contrast computed tomography with bi-lateral filter post-processing. PLoS One 2014; 9:e83369. [PMID: 24465378 PMCID: PMC3894935 DOI: 10.1371/journal.pone.0083369] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 11/02/2013] [Indexed: 12/21/2022] Open
Abstract
X-ray phase-contrast imaging shows improved soft-tissue contrast compared to standard absorption-based X-ray imaging. Especially the grating-based method seems to be one promising candidate for clinical implementation due to its extendibility to standard laboratory X-ray sources. Therefore the purpose of our study was to evaluate the potential of grating-based phase-contrast computed tomography in combination with a novel bi-lateral denoising method for imaging of focal liver lesions in an ex vivo feasibility study. Our study shows that grating-based phase-contrast CT (PCCT) significantly increases the soft-tissue contrast in the ex vivo liver specimens. Combining the information of both signals – absorption and phase-contrast – the bi-lateral filtering leads to an improvement of lesion detectability and higher contrast-to-noise ratios. The normal and the pathological tissue can be clearly delineated and even internal structures of the pathological tissue can be visualized, being invisible in the absorption-based CT alone. Histopathology confirmed the presence of the corresponding findings in the analyzed tissue. The results give strong evidence for a sufficiently high contrast for different liver lesions using non-contrast-enhanced PCCT. Thus, ex vivo imaging of liver lesions is possible with a polychromatic X-ray source and at a spatial resolution of ∼100 µm. The post-processing with the novel bi-lateral denoising method improves the image quality by combining the information from the absorption and the phase-contrast images.
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Affiliation(s)
- Julia Herzen
- Institute of Materials Science, Helmholtz-Zentrum Geesthacht, Geesthacht, Germany
- Physics Department & Institute of Medical Engineering, Technische Universität München, Garching, Germany
- * E-mail:
| | - Marian S. Willner
- Physics Department & Institute of Medical Engineering, Technische Universität München, Garching, Germany
| | | | - Peter B. Noël
- Department of Radiology, Technische Universität München, Munich, Germany
| | - Thomas Köhler
- Philips Technologie GmbH, Innovative Technologies, Research Laboratories, Hamburg, Germany
| | - Enken Drecoll
- Institute of Pathology, Technische Universität München, Munich, Germany
| | - Ernst J. Rummeny
- Department of Radiology, Technische Universität München, Munich, Germany
| | - Franz Pfeiffer
- Physics Department & Institute of Medical Engineering, Technische Universität München, Garching, Germany
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Galea N, Cantisani V, Taouli B. Liver lesion detection and characterization: role of diffusion-weighted imaging. J Magn Reson Imaging 2014; 37:1260-76. [PMID: 23712841 DOI: 10.1002/jmri.23947] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/11/2012] [Indexed: 12/11/2022] Open
Abstract
Diffusion-weighted imaging (DWI) plays an emerging role for the assessment of focal and diffuse liver diseases. This growing interest is due to that fact that DWI is a noncontrast technique with inherent high contrast resolution, with promising results for detection and characterization of focal liver lesions. Recent advances in diffusion image quality have also added interest to this technique in the abdomen. The purpose of this review is to describe the current clinical roles of DWI for the detection and characterization of focal liver lesions, and to review pitfalls, limitations, and future directions of DWI for assessment of focal liver disease.
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Affiliation(s)
- Nicola Galea
- Sapienza University of Rome, Department of Radiological Sciences, Rome, Italy
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31
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Dunne DF, Jones RP, Malik HZ, Fenwick SW, Poston GJ. Surgical management of colorectal liver metastases: a European perspective. Hepat Oncol 2013; 1:121-133. [PMID: 30190946 DOI: 10.2217/hep.13.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The treatment of colorectal cancer metastatic to the liver is increasingly complex as a result of changes in the patient population, advances in preoperative staging, changing definitions of resectability, advances in surgical technique and the expanding chemotherapeutic armamentarium. Management of these patients within a multidisciplinary team is increasingly important and associated with better outcomes. In patients with irresectable hepatic metastases, high secondary resection rates can be achieved with multiagent chemotherapy when managed in conjunction with a liver specialist. Perioperative mortality rates are reducing but morbidity remains high, and enhanced recovery could help reduce morbidity. Despite the advancing age and comorbidity of the patient population, multimodal management is likely to lead to further improvements in perioperative and long-term outcomes.
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Affiliation(s)
- Declan Fj Dunne
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Robert P Jones
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Hassan Z Malik
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Stephen W Fenwick
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Graeme J Poston
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
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Scharitzer M, Ba-Ssalamah A, Ringl H, Kölblinger C, Grünberger T, Weber M, Schima W. Preoperative evaluation of colorectal liver metastases: comparison between gadoxetic acid-enhanced 3.0-T MRI and contrast-enhanced MDCT with histopathological correlation. Eur Radiol 2013; 23:2187-96. [PMID: 23519439 DOI: 10.1007/s00330-013-2824-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/09/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of this prospective study was to compare the diagnostic performance of 64-row MDCT and gadoxetic-acid-enhanced MRI at 3.0 T in patients with colorectal liver metastases in correlation with histopathological findings. METHODS Lesions detected at MDCT and MRI were interpreted by three blinded readers and compared with histopathological workup as the term of reference. Two subgroups of lesions were additionally evaluated: (1) metastases smaller than 10 mm and (2) lesions in patients with and without steatosis of the liver, assessed histopathologically. RESULTS Surgery and histopathological workup revealed 81 colorectal liver metastases in 35 patients and diffuse metastatic involvement in 3 patients. In a lesion-by-lesion analysis, significant sensitivity differences could only be found for reader 1 (P = 0.035) and reader 3 (P = 0.003). For segment-based evaluation, MRI was more sensitive only for reader 3 (P = 0.012). The number of false-positive results ranged from 3 to 12 for MDCT and 8 to 11 for MRI evaluation. In the group of small lesions, the sensitivity differed significantly between both methods (P = 0.003). In patients with hepatic steatosis, MRI showed a trend toward better performance than MDCT, but without statistical performance. CONCLUSIONS The 3.0-T MRI with liver-specific contrast agents is the preferred investigation in the preoperative setting, especially for the assessment of small colorectal liver metastases. KEY POINTS • Potential surgical treatment requires accurate radiological assessment of colorectal liver metastases • Magnetic resonance imaging with gadoxetic acid is the preferred imaging investigation. • MRI is better than multidetector CT for detecting small liver metastases.
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Affiliation(s)
- M Scharitzer
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Wagner M, Maggiori L, Ronot M, Paradis V, Vilgrain V, Panis Y, Van Beers BE. Diffusion-weighted and T2-weighted MR imaging for colorectal liver metastases detection in a rat model at 7 T: a comparative study using histological examination as reference. Eur Radiol 2013; 23:2156-64. [DOI: 10.1007/s00330-013-2789-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/31/2012] [Accepted: 01/20/2013] [Indexed: 01/03/2023]
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Martinez-Möller A, Eiber M, Nekolla SG, Souvatzoglou M, Drzezga A, Ziegler S, Rummeny EJ, Schwaiger M, Beer AJ. Workflow and Scan Protocol Considerations for Integrated Whole-Body PET/MRI in Oncology. J Nucl Med 2012; 53:1415-26. [DOI: 10.2967/jnumed.112.109348] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Characterization of focal liver lesions using quantitative techniques: comparison of apparent diffusion coefficient values and T2 relaxation times. Eur Radiol 2012; 22:2514-24. [PMID: 22699872 PMCID: PMC3472073 DOI: 10.1007/s00330-012-2519-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 04/18/2012] [Accepted: 05/12/2012] [Indexed: 12/21/2022]
Abstract
Objectives To compare the efficacy of two quantitative methods for discrimination between benign and malignant focal liver lesions (FLLs): apparent diffusion coefficient (ADC) values and T2 relaxation times. Methods Seventy-three patients with 215 confirmed FLLs (115 benign, 100 malignant) underwent 1.5-T MRI with respiratory-triggered single-shot SE DWI (b = 50, 400, 800) and dual-echo T2TSE (TR = 3,000 ms; TE1 = 84 ms; TE2 = 228 ms). ADC values and T2 relaxation times of FLLs were calculated. Sensitivity, specificity and accuracy of both techniques in diagnosing malignancy were assessed. Results The mean ADC value of malignant tumours (1.07 × 10−3 mm2/s) was significantly lower (P < 0.05) than that of benign lesions (1.86 × 10−3 mm2/s ); however, with the use of the optimal cut-off value of 1.25 × 10−3 mm2/s, 20 false positive (FP) and 20 false negative (FN) diagnoses of malignancy were noted, generating 79 % sensitivity, 82.6 % specificity and 80.9 % accuracy. The mean T2 relaxation time of malignant tumours (64.4 ms) was significantly lower (P < 0.05) than that of benign lesions (476.1 ms). At the threshold of 107 ms 22 FP and 1 FN diagnoses were noted; the sensitivity was 99 %, specificity 80.9 % and accuracy 89.3 %. Conclusions Quantitative analysis of T2 relaxation times yielded significantly higher sensitivity and accuracy in diagnosing malignant liver tumour than ADC values. Key Points • Diffusion-weighted magnetic resonance imaging is increasingly used for liver lesions. • But ADC values demonstrated only moderate accuracy for differentiation of liver lesions. • T2 relaxation times yielded higher accuracy in diagnosing malignant liver tumours. • Both ADC and T2 values overlapped between focal nodular hyperplasia and malignant lesions. • Nevertheless T2 liver mapping could be valuable for evaluating focal liver lesions.
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Son SY, Yi NJ, Hong G, Kim H, Park MS, Choi YR, Suh KS, Kim DW, Jeong SY, Park KJ, Park JG, Lee KU. Is neoadjuvant chemotherapy necessary for patients with initially resectable colorectal liver metastases in the era of effective chemotherapy? KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2011; 15:206-17. [PMID: 26421041 PMCID: PMC4582468 DOI: 10.14701/kjhbps.2011.15.4.206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 10/04/2011] [Accepted: 10/21/2011] [Indexed: 12/21/2022]
Abstract
Backgrounds/Aims Hepatic resection has only guaranteed long-term survival in patients with colorectal liver metastasis (CRLM) even in the era of effective chemotherapy. The definite role of neoadjuvant chemotherapy (NCT) is to improve outcomes of unresectable CRLMs, but it its role has not been defined for initially resectable CRLMs (IR-CRLMs). Methods We reviewed the medical records of 226 patients, who had been diagnosed and treated for IR-CRLM between 2003 and 2008; the patients had the following pathologies: 10% had more than 4 nodules, 11% had tumors larger than 5 cm, and 61% had synchronous CRMLs. Among these patients, 20 patients (Group Y) were treated with NCT, and 206 (Group N) did not receive NCT according to their physician's preference. The median follow-up time was 34.1 months. Results The initial surgical plans were changed after NCT to further resection in 20% and to limited resection in 10% of 20 patients. Complication rates of Groups Y (30%) were indifferent from Group N (23%) (p=0.233), but intraoperative transfusions were more frequent in Group N (15%) than in Group Y (5%) (p=0.006). There was one case of hospital mortality (0.44%). Disease-free survival rates in Groups Y and N were 23% and 39%, respectively, and patient survival rates were 42% and 66% (p>0.05). By multivariate analysis, old age (≥60 years), differentiation of primary tumor (poorly/mucinous), resection margin involvement, and no adjuvant chemotherapy were associated with poor patient survival; the number of CRLMs (≥4) was associated with poor disease-free survival. Conclusions NCT had neither a positive impact nor a negative impact on survival, even with intraoperative transfusion, as observed on operative outcomes for patients with IR-CRLM. Further study is required to elucidate the role of NCT for treatment of patient with IR-CRLMs.
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Affiliation(s)
- Sang-Yong Son
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Geun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeyoung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min Su Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Rok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu-Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Gahb Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kuhn-Uk Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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