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Fenwick A, Black C, Linehan V, Gala-Lopez BL, Costa AF. Resection of colorectal carcinoma liver metastases: A population-based study in outcomes and factors associated with recurrent disease. Curr Probl Diagn Radiol 2024; 53:481-487. [PMID: 38702281 DOI: 10.1067/j.cpradiol.2024.04.007] [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] [Received: 12/04/2023] [Revised: 03/15/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To assess the hepatic disease-free survival (HDFS) and overall survival (OS) of patients who underwent resection of colorectal cancer liver metastases (CRCLM) in our population, and evaluate what factors are associated with these outcomes. METHODS Patients with resected non-mucinous CRCLM between January 2013-February 2020 were retrospectively identified. Dates of diagnosis, surgery, and, if applicable, death were recorded. HDFS and OS were calculated using a census date of 24 September 2022. Separate Cox multivariate regression analyses were performed to evaluate for association between HDFS and OS and the following factors: pre-operative imaging interval (<4 weeks vs. ≥4 weeks); pre-operative imaging modality (CT only vs. MRI+CT); extrahepatic disease at time of hepatectomy (yes vs. no); tumor burden score (TBS, where TBS2 = (largest axial dimension of CRCLM)2 + (number of CRCLM)2); pT and pN; and neoadjuvant chemotherapy. RESULTS 137 subjects (mean age, 61 ± 11 years, 86 males) were included. Associations with recurrent hepatic disease were found with chemotherapy (HR 2.11[95 % CI = 1.13-3.92]), TBS (HR 1.30[95 % CI = 1.17-1.45]), MRI+CT (HR 2.12[95 % CI = 1.29-3.48]), and extrahepatic disease at hepatectomy (HR 2.16[95 % CI = 1.08-4.35]). For mortality, associations were found with TBS (HR 1.22[95 % CI = 1.09-1.37]), pT (HR 1.45[95 % CI = 1.05-2.00]), and extrahepatic disease at hepatectomy (HR 2.10[95 % CI = 1.31-3.36]). CONCLUSION In our population, non-imaging related factors TBS, neoadjuvant chemotherapy, pT and presence of extrahepatic disease at time of hepatectomy were associated with HDFS and/or OS. The preoperative imaging interval and use of preoperative MRI were not associated with improved patient outcomes.
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Affiliation(s)
- Andrew Fenwick
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, Canada B3H 2Y9
| | - Curtis Black
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, Canada B3H 2Y9
| | - Victoria Linehan
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, Canada B3H 2Y9
| | - Boris L Gala-Lopez
- Department of Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, Canada B3H 2Y9; Beatrice Hunter Cancer Research Institute. Suite 2L-A2, Tupper Link, 5850 College Street P.O. Box 15000 Halifax, NS B3H 4R2
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University. Victoria General Building, 3rd floor, 1276 South Park Street, Halifax, Nova Scotia, Canada B3H 2Y9..
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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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Wang SH, Song L, Tang JY, Sun WP, Li Z. Safety and long-term prognosis of simultaneous versus staged resection in synchronous colorectal cancer with liver metastasis: a systematic review and meta-analysis. Eur J Med Res 2022; 27:297. [PMID: 36529740 PMCID: PMC9762091 DOI: 10.1186/s40001-022-00937-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The optimal time point for surgical resection of synchronous colorectal liver metastases (SCLMs) is still controversial. This meta-analysis evaluated the safety and long-term prognoses of simultaneous and staged resection of SCLM to provide a reference for clinical selection. METHODS A systematic literature search for studies published by October 2022 was performed using PubMed, Web of Science, Embase, Scopus and Cochrane Library. The evaluated outcome parameters were total, gastrointestinal and hepatic complications, as well as perioperative mortality, intraoperative blood loss, total hospital stay, 5-year disease-free survival (DFS) and 5-year overall survival (OS). RESULTS This meta-analysis included 22 nonrandomised and one randomised study comprising 4862 patients. The patients undergoing simultaneous resection of SCLM had similar total (OR = 0.88, 95% CI [0.66-1.19], P = 0.409), gastrointestinal (OR = 1.19, 95% CI [0.89-1.59], P = 0.241) and hepatic (OR = 1.04, 95% CI [0.83-1.31], P = 0.734) complications, as well as perioperative mortality (OR = 1.79, 95% CI [0.88-3.64], P = 0.108), 5-year DFS (HR = 1.26, 95% CI [0.96-1.66], P = 0.098) and 5-year OS (HR = 1.13, 95% CI [0.95-1.34], P = 0.164). Lower intraoperative blood loss (SMD = - 0.39, 95% CI [- 0.60 to - 0.18], P < 0.001) and shorter total hospital stay (WMD = - 5.43, 95% CI [- 7.29 to - 3.58], P < 0.001) were observed in the simultaneous-resection group versus the staged group. CONCLUSIONS Simultaneous resection is safe and effective for SCLM patients. The long-term prognosis is equivalent to that of the traditional staged resection. Correct selection of resectable SCLM patients for the simultaneous resection of the primary tumour and liver metastases can be the first choice. Owing to the potential heterogeneity, more RCTs should be included to verify our conclusions.
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Affiliation(s)
- Shi-hao Wang
- grid.412633.10000 0004 1799 0733Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China ,grid.412633.10000 0004 1799 0733Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052 China
| | - Lei Song
- grid.207374.50000 0001 2189 3846Academy of Medical Science, Zhengzhou University, Zhengzhou, China
| | - Ji-yan Tang
- grid.412633.10000 0004 1799 0733Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China ,grid.412633.10000 0004 1799 0733Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052 China
| | - Wei-peng Sun
- grid.412633.10000 0004 1799 0733Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China ,grid.412633.10000 0004 1799 0733Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052 China
| | - Zhen Li
- grid.412633.10000 0004 1799 0733Department of General Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China ,grid.412633.10000 0004 1799 0733Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, 450052 China
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Yamada S, Kishi Y, Miyake M, Nara S, Esaki M, Shimada K. Characteristics of false-positive lesions in evaluating colorectal liver metastases on gadoxetic acid-enhanced magnetic resonance imaging. Surg Today 2022; 52:1178-1184. [PMID: 35043218 DOI: 10.1007/s00595-022-02451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Gadoxetic acid-enhanced MRI (Gd-EOB-MRI) shows higher sensitivity for colorectal liver metastases (CRLM) than contrast-enhanced computed tomography (CECT). However, the details of false-positive lesions for each imaging modality are unknown. METHODS Cases undergoing hepatectomy for CRLM following a preoperative evaluation with both CECT and Gd-EOB-MRI between July 2008 and December 2016 were reviewed. The false-positive and false-negative rates were assessed for each modality, and the characteristics of false-positive lesions were evaluated. RESULTS We evaluated 275 partial hepatectomies in 242 patients without preoperative chemotherapy. Among the 275 hepatectomies, 546 lesions were recognized by CECT and/or Gd-EOB-MRI. The false-positive rates for CECT and Gd-EOB-MRI were 4% (18/422) and 7% (37/536), respectively. The size of false-positive lesions was significantly smaller than that of correctly diagnosed lesions (median: 28 mm [3-120 mm] vs 7.6 mm [320 mm], P < 0.001). Compared with the 233 correctly diagnosed lesions ≤ 20 mm in diameter, false-positive lesions were more frequently located near the liver surface or vasculobiliary structures than true lesions (33/37 [89%] vs 149/233 [64%], respectively; P = 0.0021). CONCLUSION Gd-EOB-MRI had a 7% false-positive rate. A small size and tumor location near the surface or near vasculobiliary structures were associated with false positivity.
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Affiliation(s)
- Shuhei Yamada
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yoji Kishi
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Division of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Mototaka Miyake
- Division of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Satoshi Nara
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Minoru Esaki
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kazuaki Shimada
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Wybranski C, Siedek F, Damm R, Gazis A, Wenzel O, Haneder S, Persigehl T, Steinhauser S, Pech M, Fischbach F, Fischbach K. Respiratory motion artefacts in Gd-EOB-DTPA (Primovist/Eovist) and Gd-DOTA (Dotarem)-enhanced dynamic phase liver MRI after intensified and standard pre-scan patient preparation: A bi-institutional analysis. PLoS One 2020; 15:e0230024. [PMID: 32196535 PMCID: PMC7083299 DOI: 10.1371/journal.pone.0230024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/18/2020] [Indexed: 12/15/2022] Open
Abstract
Objective The objective of this study is to evaluate if intensified pre-scan patient preparation (IPPP) that comprises custom-made educational material on dynamic phase imaging and supervised pre-imaging breath-hold training in addition to standard informative conversation with verbal explanation of breath-hold commands (standard pre-scan patient preparation–SPPP) might reduce the incidence of gadoxetate disodium (Gd-EOB-DTPA)-related transient severe respiratory motion (TSM) and severity of respiratory motion (RM) during dynamic phase liver MRI. Material and methods In this bi-institutional study 100 and 110 patients who received Gd-EOB-DTPA for dynamic phase liver MRI were allocated to either IPPP or SPPP at site A and B. The control group comprised 202 patients who received gadoterate meglumine (Gd-DOTA) of which each 101 patients were allocated to IPPP or SPPP at site B. RM artefacts were scored retrospectively in dynamic phase images (1: none– 5: extensive) by five and two blinded readers at site A and B, respectively, and in the hepatobiliary phase of the Gd-EOB-DTPA-enhanced scans by two blinded readers at either site. Results The incidence of TSM was 15% at site A and 22.7% at site B (p = 0.157). IPPP did not reduce the incidence of TSM in comparison to SPPP: 16.7% vs. 21.6% (p = 0.366). This finding was consistent at site A: 12% vs. 18% (p = 0.401) and site B: 20.6% vs. 25% (p = 0.590). The TSM incidence in patients with IPPP and SPPP did not differ significantly between both sites (p = 0.227; p = 0.390). IPPP did not significantly mitigate RM in comparison to SPPP in any of the Gd-EOB-DTPA-enhanced dynamic phases and the hepatobiliary phase in patients without TSM (all p≥0.072). In the Gd-DOTA control group on the other hand, IPPP significantly mitigated RM in all dynamic phases in comparison to SPPP (all p≤0.031). Conclusions We conclude that Gd-EOB-DTPA-related TSM cannot be mitigated by education and training and that Gd-EOB-DTPA-related breath-hold difficulty does not only affect the subgroup of patients with TSM or exclusively the arterial phase as previously proposed.
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Affiliation(s)
- Christian Wybranski
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Florian Siedek
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- * E-mail:
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
| | - Angelos Gazis
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
| | - Ortrud Wenzel
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
| | - Stefan Haneder
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Susanne Steinhauser
- Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
| | - Katharina Fischbach
- Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
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Oba A, Mise Y, Ito H, Hiratsuka M, Inoue Y, Ishizawa T, Arita J, Matsueda K, Takahashi Y, Saiura A. Clinical implications of disappearing colorectal liver metastases have changed in the era of hepatocyte-specific MRI and contrast-enhanced intraoperative ultrasonography. HPB (Oxford) 2018. [PMID: 29534862 DOI: 10.1016/j.hpb.2018.02.377] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical implication of disappearing liver metastases (DLMs) from colorectal cancer after chemotherapy needs to be reviewed in the era of modern imaging studies. METHODS Between 2010 and 2015, 184 patients underwent curative hepatectomy for colorectal liver metastases following preoperative chemotherapy. The sites of metastases detected on pre-chemotherapy CE-CT were examined post-chemotherapy using CE-CT, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI), and contrast-enhanced intraoperative ultrasonography (CE-IOUS). DLMs were defined as tumors that disappeared on CE-CT post chemotherapy. The detection rate of DLMs with EOB-MRI and CE-IOUS were assessed, and the outcome of DLMs resected and those left in place were reviewed. RESULTS A total of 275 DLMs were noted in 59 patients. On EOB-MRI, 71 lesions (26%) were visible and were resected, 92% (65/71) of which contained viable disease. Using CE-IOUS, an additional 94 lesions were identified. A total of 165 DLMs (60%) were identified and resected by sequential use of EOB-MRI and CE-IOUS, 77% (127/165) of which contained viable disease. Of 110 DLMs not identified, 68 were resected, 4% (3/68) of which contained viable disease. Among 42 lesions left in place, 6 (14%) recurred during the median follow-up period of 27 (9-72) months. DISCUSSION EOB-MRI and CE-IOUS exploration identified clinically relevant DLMs containing viable disease with a high level of accuracy.
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Affiliation(s)
- Atsushi Oba
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Yoshihiro Mise
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Hiromichi Ito
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Makiko Hiratsuka
- Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Yosuke Inoue
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Takeaki Ishizawa
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Junichi Arita
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Kiyoshi Matsueda
- Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Yu Takahashi
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Akio Saiura
- Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan.
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Clinical impact of preoperative liver MRI in the evaluation of synchronous liver metastasis of colon cancer. Eur Radiol 2018; 28:4234-4242. [PMID: 29691635 DOI: 10.1007/s00330-018-5422-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/14/2018] [Accepted: 03/09/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate whether additional MRI including gadoxetic acid enhancement is associated with survival rate (SR) in patients with synchronous liver metastasis of colon cancer (sCLM), compared with patients assessed only with CT. METHODS Fifty-two patients underwent only CT (CT group) and 65 underwent additional MRI (CT+MRI group) for preoperative work-up of sCLM. In the CT+MRI group, the discrepancy between CT and MRI was analyzed. The 5-year SR was compared between the groups, and affecting factors were investigated. The inverse probability treatment weighting analysis (IPTW) adjusted by propensity scores was performed. RESULTS In the CT+MRI group, 44 (67.7%) showed a discrepancy in the number of sCLMs between CT and MRI. MRI detected 39 additional sCLMs initially missed on CT in 26 patients. The number of detected sCLMs was better correlated with the pathologic findings in the CT+MRI group than in the CT group (p = 0.008). The estimated 5-year SR in the CT+MRI group was 70.8%, while that in the CT group was 48.1%. On adjusted multivariate analyses after the IPTW, the CT+MRI group showed a significantly lower risk of overall mortality than the CT group. CONCLUSION Additional preoperative evaluation by MRI allowed us to more precisely detect sCLM and was associated with a better SR. KEY POINTS • CT+MRI group showed significantly higher 5-year survival rates than CT group. • CT+MRI group was an independent prognostic factor of overall mortality. • MRI facilitates more accurate detection and better lesion characterization. • MRI selected better candidates for curative treatment. • The benefits of MRI were reflected by better survival.
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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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Shenoy-Bhangle A, Baliyan V, Kordbacheh H, Guimaraes AR, Kambadakone A. Diffusion weighted magnetic resonance imaging of liver: Principles, clinical applications and recent updates. World J Hepatol 2017; 9:1081-1091. [PMID: 28989564 PMCID: PMC5612839 DOI: 10.4254/wjh.v9.i26.1081] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/06/2017] [Accepted: 06/07/2017] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI), a functional imaging technique exploiting the Brownian motion of water molecules, is increasingly shown to have value in various oncological and non-oncological applications. Factors such as the ease of acquisition and ability to obtain functional information in the absence of intravenous contrast, especially in patients with abnormal renal function, have contributed to the growing interest in exploring clinical applications of DWI. In the liver, DWI demonstrates a gamut of clinical applications ranging from detecting focal liver lesions to monitoring response in patients undergoing serial follow-up after loco-regional and systemic therapies. DWI is also being applied in the evaluation of diffuse liver diseases such as non-alcoholic fatty liver disease, hepatic fibrosis and cirrhosis. In this review, we intend to review the basic principles, technique, current clinical applications and future trends of DW-MRI in the liver.
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Affiliation(s)
| | - Vinit Baliyan
- Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Hamed Kordbacheh
- Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
| | | | - Avinash Kambadakone
- Harvard Medical School, Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA 02114, United States
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Accuracy of Whole-Body DWI for Metastases Screening in a Diverse Group of Malignancies: Comparison With Conventional Cross-Sectional Imaging and Nuclear Scintigraphy. AJR Am J Roentgenol 2017; 209:477-490. [PMID: 28678578 DOI: 10.2214/ajr.17.17829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study is to assess the role of whole-body (WB) DWI as a screening modality for the detection of metastases and to compare it to conventional cross-sectional imaging modalities or nuclear scintigraphy in a population with various histopathologic malignancies. SUBJECTS AND METHODS WB DWI and conventional imaging (CT, MRI, or scintigraphy) were performed for patients with known malignancies for metastatic workup, and these patients were followed up for a period of 1 year. Two radiologists assessed WB DW images separately, and conventional images were assessed by the senior radiologist. The metastatic lesions were classified into four regions: liver, lung, skeletal system, and lymph nodes. The reference standard was considered on the basis of histopathologic confirmation or clinical follow-up of the metastatic lesions. RESULTS WB DWI was slightly inferior to conventional imaging modalities for the detection of hepatic metastases (sensitivity, 86.6% vs 93.3%; specificity, 91.6% vs 95.8%; and accuracy, 89.7% vs 94.8%) and skeletal metastases (sensitivity, 81.8% vs 89.4%; specificity, 86.4% vs 94.3%; and accuracy, 85.2% vs 93.0%); however, the differences were not statistically significant (p = 0.625 for hepatic metastases and p = 0.0953 for skeletal metastases, McNemar test). WB DWI was statistically significantly inferior to conventional imaging for the detection of lymph node metastases (sensitivity, 74.0% vs 81.5%; specificity, 87.9% vs 90.1%; accuracy, 81.4% vs 86.0%; p = 0.0389). WB DWI was statistically significantly inferior to conventional imaging for the detection of pulmonary metastases (sensitivity, 33.3% vs 100.0%; specificity, 90.9% vs 100.0%; accuracy, 60.8% vs 100.0%; p = 0.045). CONCLUSION WB DWI can be used for screening hepatic and skeletal metastases, but its reliability as the sole imaging sequence for the detection of lymph nodal and pulmonary metastases is poor and, at present, it cannot replace conventional imaging modalities.
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