Skip to main content
Erschienen in: European Radiology 8/2013

01.08.2013 | Hepatobiliary-Pancreas

Preoperative evaluation of colorectal liver metastases: comparison between gadoxetic acid-enhanced 3.0-T MRI and contrast-enhanced MDCT with histopathological correlation

verfasst von: M. Scharitzer, A. Ba-Ssalamah, H. Ringl, C. Kölblinger, T. Grünberger, M. Weber, W. Schima

Erschienen in: European Radiology | Ausgabe 8/2013

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat Abdalla EK, Vauthey JN, Ellis LM et al (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239:818–825, discussion 825–817PubMedCrossRef Abdalla EK, Vauthey JN, Ellis LM et al (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239:818–825, discussion 825–817PubMedCrossRef
2.
Zurück zum Zitat Choti MA, Sitzmann JV, Tiburi MF et al (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766PubMedCrossRef Choti MA, Sitzmann JV, Tiburi MF et al (2002) Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766PubMedCrossRef
3.
Zurück zum Zitat Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318, discussion 318–321PubMedCrossRef Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318, discussion 318–321PubMedCrossRef
4.
Zurück zum Zitat Malik HZ, Hamady ZZ, Adair R et al (2007) Prognostic influence of multiple hepatic metastases from colorectal cancer. Eur J Surg Oncol 33:468–473PubMedCrossRef Malik HZ, Hamady ZZ, Adair R et al (2007) Prognostic influence of multiple hepatic metastases from colorectal cancer. Eur J Surg Oncol 33:468–473PubMedCrossRef
5.
Zurück zum Zitat Clavien PA, Petrowsky H, DeOliveira ML, Graf R (2007) Strategies for safer liver surgery and partial liver transplantation. N Engl J Med 356:1545–1559PubMedCrossRef Clavien PA, Petrowsky H, DeOliveira ML, Graf R (2007) Strategies for safer liver surgery and partial liver transplantation. N Engl J Med 356:1545–1559PubMedCrossRef
6.
Zurück zum Zitat Tamandl D, Herberger B, Gruenberger B et al (2008) Adequate preoperative staging rarely leads to a change of intraoperative strategy in patients undergoing surgery for colorectal cancer liver metastases. Surgery 143:648–657PubMedCrossRef Tamandl D, Herberger B, Gruenberger B et al (2008) Adequate preoperative staging rarely leads to a change of intraoperative strategy in patients undergoing surgery for colorectal cancer liver metastases. Surgery 143:648–657PubMedCrossRef
7.
Zurück zum Zitat Hamm B, Staks T, Muhler A et al (1995) Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging. Radiology 195:785–792PubMed Hamm B, Staks T, Muhler A et al (1995) Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging. Radiology 195:785–792PubMed
8.
Zurück zum Zitat Halavaara J, Breuer J, Ayuso C et al (2006) Liver tumor characterization: comparison between liver-specific gadoxetic acid disodium-enhanced MRI and biphasic CT—a multicenter trial. J Comput Assist Tomogr 30:345–354PubMedCrossRef Halavaara J, Breuer J, Ayuso C et al (2006) Liver tumor characterization: comparison between liver-specific gadoxetic acid disodium-enhanced MRI and biphasic CT—a multicenter trial. J Comput Assist Tomogr 30:345–354PubMedCrossRef
9.
Zurück zum Zitat Huppertz A, Balzer T, Blakeborough A et al (2004) Improved detection of focal liver lesions at MR imaging: multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings. Radiology 230:266–275PubMedCrossRef Huppertz A, Balzer T, Blakeborough A et al (2004) Improved detection of focal liver lesions at MR imaging: multicenter comparison of gadoxetic acid-enhanced MR images with intraoperative findings. Radiology 230:266–275PubMedCrossRef
10.
Zurück zum Zitat Vogl TJ, Kummel S, Hammerstingl R et al (1996) Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA. Radiology 200:59–67PubMed Vogl TJ, Kummel S, Hammerstingl R et al (1996) Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA. Radiology 200:59–67PubMed
11.
Zurück zum Zitat Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007) MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA. Magn Reson Med Sci 6:43–52PubMedCrossRef Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007) MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA. Magn Reson Med Sci 6:43–52PubMedCrossRef
12.
Zurück zum Zitat Kim YK, Park G, Kim CS, Yu HC, Han YM (2012) Diagnostic efficacy of gadoxetic acid-enhanced MRI for the detection and characterisation of liver metastases: comparison with multidetector-row CT. Br J Radiol 85:539–547PubMedCrossRef Kim YK, Park G, Kim CS, Yu HC, Han YM (2012) Diagnostic efficacy of gadoxetic acid-enhanced MRI for the detection and characterisation of liver metastases: comparison with multidetector-row CT. Br J Radiol 85:539–547PubMedCrossRef
13.
Zurück zum Zitat Muhi A, Ichikawa T, Motosugi U et al (2011) Diagnosis of colorectal hepatic metastases: comparison of contrast-enhanced CT, contrast-enhanced US, superparamagnetic iron oxide-enhanced MRI, and gadoxetic acid-enhanced MRI. J Magn Reson Imaging 34:326–335PubMedCrossRef Muhi A, Ichikawa T, Motosugi U et al (2011) Diagnosis of colorectal hepatic metastases: comparison of contrast-enhanced CT, contrast-enhanced US, superparamagnetic iron oxide-enhanced MRI, and gadoxetic acid-enhanced MRI. J Magn Reson Imaging 34:326–335PubMedCrossRef
14.
Zurück zum Zitat Holzapfel K, Eiber MJ, Fingerle AA, Bruegel M, Rummeny EJ, Gaa J (2012) Detection, classification, and characterization of focal liver lesions: value of diffusion-weighted MR imaging, gadoxetic acid-enhanced MR imaging and the combination of both methods. Abdom Imaging 37:74–82PubMedCrossRef Holzapfel K, Eiber MJ, Fingerle AA, Bruegel M, Rummeny EJ, Gaa J (2012) Detection, classification, and characterization of focal liver lesions: value of diffusion-weighted MR imaging, gadoxetic acid-enhanced MR imaging and the combination of both methods. Abdom Imaging 37:74–82PubMedCrossRef
15.
Zurück zum Zitat Hekimoglu K, Ustundag Y, Dusak A et al (2011) Small colorectal liver metastases: detection with SPIO-enhanced MRI in comparison with gadobenate dimeglumine-enhanced MRI and CT imaging. Eur J Radiol 77:468–472PubMedCrossRef Hekimoglu K, Ustundag Y, Dusak A et al (2011) Small colorectal liver metastases: detection with SPIO-enhanced MRI in comparison with gadobenate dimeglumine-enhanced MRI and CT imaging. Eur J Radiol 77:468–472PubMedCrossRef
16.
Zurück zum Zitat Chang KJ, Kamel IR, Macura KJ, Bluemke DA (2008) 3.0-T MR imaging of the abdomen: comparison with 1.5T. RadioGraphics 28:1983–1998PubMedCrossRef Chang KJ, Kamel IR, Macura KJ, Bluemke DA (2008) 3.0-T MR imaging of the abdomen: comparison with 1.5T. RadioGraphics 28:1983–1998PubMedCrossRef
17.
Zurück zum Zitat Laghi A (2007) Multidetector CT (64 Slices) of the liver: examination techniques. Eur Radiol 17:675–683PubMedCrossRef Laghi A (2007) Multidetector CT (64 Slices) of the liver: examination techniques. Eur Radiol 17:675–683PubMedCrossRef
18.
Zurück zum Zitat Couinaud CC (1957) Le foie: e’tudes anatomiques et chirurgicales. Masson, Paris Couinaud CC (1957) Le foie: e’tudes anatomiques et chirurgicales. Masson, Paris
19.
Zurück zum Zitat Blakeborough A, Ward J, Wilson D et al (1997) Hepatic lesion detection at MR imaging: a comparative study with four sequences. Radiology 203:759–765PubMed Blakeborough A, Ward J, Wilson D et al (1997) Hepatic lesion detection at MR imaging: a comparative study with four sequences. Radiology 203:759–765PubMed
20.
Zurück zum Zitat Blyth S, Blakeborough A, Peterson M, Cameron IC, Majeed AW (2008) Sensitivity of magnetic resonance imaging in the detection of colorectal liver metastases. Ann R Coll Surg Engl 90:25–28PubMedCrossRef Blyth S, Blakeborough A, Peterson M, Cameron IC, Majeed AW (2008) Sensitivity of magnetic resonance imaging in the detection of colorectal liver metastases. Ann R Coll Surg Engl 90:25–28PubMedCrossRef
21.
Zurück zum Zitat Hagspiel KD, Neidl KF, Eichenberger AC, Weder W, Marincek B (1995) Detection of liver metastases: comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5T with dynamic CT, intraoperative US, and percutaneous US. Radiology 196:471–478PubMed Hagspiel KD, Neidl KF, Eichenberger AC, Weder W, Marincek B (1995) Detection of liver metastases: comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5T with dynamic CT, intraoperative US, and percutaneous US. Radiology 196:471–478PubMed
22.
Zurück zum Zitat Hammerstingl R, Huppertz A, Breuer J et al (2008) Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 18:457–467PubMedCrossRef Hammerstingl R, Huppertz A, Breuer J et al (2008) Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 18:457–467PubMedCrossRef
23.
Zurück zum Zitat Kim MJ, Kim JH, Chung JJ, Park MS, Lim JS, Oh YT (2003) Focal hepatic lesions: detection and characterization with combination gadolinium- and superparamagnetic iron oxide-enhanced MR imaging. Radiology 228:719–726PubMedCrossRef Kim MJ, Kim JH, Chung JJ, Park MS, Lim JS, Oh YT (2003) Focal hepatic lesions: detection and characterization with combination gadolinium- and superparamagnetic iron oxide-enhanced MR imaging. Radiology 228:719–726PubMedCrossRef
24.
Zurück zum Zitat Muller RD, Vogel K, Neumann K et al (1999) SPIO-MR imaging versus double-phase spiral CT in detecting malignant lesions of the liver. Acta Radiol 40:628–635PubMedCrossRef Muller RD, Vogel K, Neumann K et al (1999) SPIO-MR imaging versus double-phase spiral CT in detecting malignant lesions of the liver. Acta Radiol 40:628–635PubMedCrossRef
25.
Zurück zum Zitat Reimer P, Jahnke N, Fiebich M et al (2000) Hepatic lesion detection and characterization: value of nonenhanced MR imaging, superparamagnetic iron oxide-enhanced MR imaging, and spiral CT-ROC analysis. Radiology 217:152–158PubMed Reimer P, Jahnke N, Fiebich M et al (2000) Hepatic lesion detection and characterization: value of nonenhanced MR imaging, superparamagnetic iron oxide-enhanced MR imaging, and spiral CT-ROC analysis. Radiology 217:152–158PubMed
26.
Zurück zum Zitat Semelka RC, Cance WG, Marcos HB, Mauro MA (1999) Liver metastases: comparison of current MR techniques and spiral CT during arterial portography for detection in 20 surgically staged cases. Radiology 213:86–91PubMed Semelka RC, Cance WG, Marcos HB, Mauro MA (1999) Liver metastases: comparison of current MR techniques and spiral CT during arterial portography for detection in 20 surgically staged cases. Radiology 213:86–91PubMed
27.
Zurück zum Zitat Seneterre E, Taourel P, Bouvier Y et al (1996) Detection of hepatic metastases: ferumoxides-enhanced MR imaging versus unenhanced MR imaging and CT during arterial portography. Radiology 200:785–792PubMed Seneterre E, Taourel P, Bouvier Y et al (1996) Detection of hepatic metastases: ferumoxides-enhanced MR imaging versus unenhanced MR imaging and CT during arterial portography. Radiology 200:785–792PubMed
28.
Zurück zum Zitat Niekel MC, Bipat S, Stoker J (2010) Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology 257:674–684PubMedCrossRef Niekel MC, Bipat S, Stoker J (2010) Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology 257:674–684PubMedCrossRef
29.
Zurück zum Zitat Bartolozzi C, Donati F, Cioni D et al (2004) Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT. Eur Radiol 14:14–20PubMedCrossRef Bartolozzi C, Donati F, Cioni D et al (2004) Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT. Eur Radiol 14:14–20PubMedCrossRef
30.
Zurück zum Zitat Floriani I, Torri V, Rulli E et al (2010) Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: a systematic review and meta-analysis. J Magn Reson Imaging 31:19–31PubMedCrossRef Floriani I, Torri V, Rulli E et al (2010) Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: a systematic review and meta-analysis. J Magn Reson Imaging 31:19–31PubMedCrossRef
31.
Zurück zum Zitat Rappeport ED, Loft A, Berthelsen AK et al (2007) Contrast-enhanced FDG-PET/CT vs. SPIO-enhanced MRI vs. FDG-PET vs. CT in patients with liver metastases from colorectal cancer: a prospective study with intraoperative confirmation. Acta Radiol 48:369–378PubMedCrossRef Rappeport ED, Loft A, Berthelsen AK et al (2007) Contrast-enhanced FDG-PET/CT vs. SPIO-enhanced MRI vs. FDG-PET vs. CT in patients with liver metastases from colorectal cancer: a prospective study with intraoperative confirmation. Acta Radiol 48:369–378PubMedCrossRef
32.
Zurück zum Zitat Dahlqvist Leinhard O, Dahlstrom N, Kihlberg J et al (2012) Quantifying differences in hepatic uptake of the liver specific contrast agents Gd-EOB-DTPA and Gd-BOPTA: a pilot study. Eur Radiol 22:642–653PubMedCrossRef Dahlqvist Leinhard O, Dahlstrom N, Kihlberg J et al (2012) Quantifying differences in hepatic uptake of the liver specific contrast agents Gd-EOB-DTPA and Gd-BOPTA: a pilot study. Eur Radiol 22:642–653PubMedCrossRef
33.
Zurück zum Zitat Eiber M, Fingerle AA, Brugel M, Gaa J, Rummeny EJ, Holzapfel K (2012) Detection and classification of focal liver lesions in patients with colorectal cancer: retrospective comparison of diffusion-weighted MR imaging and multi-slice CT. Eur J Radiol 81:683–691PubMedCrossRef Eiber M, Fingerle AA, Brugel M, Gaa J, Rummeny EJ, Holzapfel K (2012) Detection and classification of focal liver lesions in patients with colorectal cancer: retrospective comparison of diffusion-weighted MR imaging and multi-slice CT. Eur J Radiol 81:683–691PubMedCrossRef
34.
Zurück zum Zitat Ward J, Robinson PJ, Guthrie JA et al (2005) Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology 237:170–180PubMedCrossRef Ward J, Robinson PJ, Guthrie JA et al (2005) Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology 237:170–180PubMedCrossRef
35.
Zurück zum Zitat Kuszyk BS, Bluemke DA, Urban BA et al (1996) Portal-phase contrast-enhanced helical CT for the detection of malignant hepatic tumors: sensitivity based on comparison with intraoperative and pathologic findings. AJR Am J Roentgenol 166:91–95PubMedCrossRef Kuszyk BS, Bluemke DA, Urban BA et al (1996) Portal-phase contrast-enhanced helical CT for the detection of malignant hepatic tumors: sensitivity based on comparison with intraoperative and pathologic findings. AJR Am J Roentgenol 166:91–95PubMedCrossRef
36.
Zurück zum Zitat Numminen K, Isoniemi H, Halavaara J et al (2005) Preoperative assessment of focal liver lesions: multidetector computed tomography challenges magnetic resonance imaging. Acta Radiol 46:9–15PubMedCrossRef Numminen K, Isoniemi H, Halavaara J et al (2005) Preoperative assessment of focal liver lesions: multidetector computed tomography challenges magnetic resonance imaging. Acta Radiol 46:9–15PubMedCrossRef
37.
Zurück zum Zitat Valls C, Andia E, Sanchez A et al (2001) Hepatic metastases from colorectal cancer: preoperative detection and assessment of resectability with helical CT. Radiology 218:55–60PubMed Valls C, Andia E, Sanchez A et al (2001) Hepatic metastases from colorectal cancer: preoperative detection and assessment of resectability with helical CT. Radiology 218:55–60PubMed
38.
Zurück zum Zitat Vogl TJ, Schwarz W, Blume S et al (2003) Preoperative evaluation of malignant liver tumors: comparison of unenhanced and SPIO (Resovist)-enhanced MR imaging with biphasic CTAP and intraoperative US. Eur Radiol 13:262–272PubMed Vogl TJ, Schwarz W, Blume S et al (2003) Preoperative evaluation of malignant liver tumors: comparison of unenhanced and SPIO (Resovist)-enhanced MR imaging with biphasic CTAP and intraoperative US. Eur Radiol 13:262–272PubMed
39.
Zurück zum Zitat Shimada K, Isoda H, Hirokawa Y, Arizono S, Shibata T, Togashi K (2010) Comparison of gadolinium-EOB-DTPA-enhanced and diffusion-weighted liver MRI for detection of small hepatic metastases. Eur Radiol 20:2690–2698PubMedCrossRef Shimada K, Isoda H, Hirokawa Y, Arizono S, Shibata T, Togashi K (2010) Comparison of gadolinium-EOB-DTPA-enhanced and diffusion-weighted liver MRI for detection of small hepatic metastases. Eur Radiol 20:2690–2698PubMedCrossRef
40.
Zurück zum Zitat Berger-Kulemann V, Schima W, Baroud S et al (2012) Gadoxetic acid-enhanced 3.0T MR imaging versus multidetector-row CT in the detection of colorectal metastases in fatty liver using intraoperative ultrasound and histopathology as a standard of reference. Eur J Surg Oncol 38:670–676PubMedCrossRef Berger-Kulemann V, Schima W, Baroud S et al (2012) Gadoxetic acid-enhanced 3.0T MR imaging versus multidetector-row CT in the detection of colorectal metastases in fatty liver using intraoperative ultrasound and histopathology as a standard of reference. Eur J Surg Oncol 38:670–676PubMedCrossRef
41.
Zurück zum Zitat Kulemann V, Schima W, Tamandl D et al (2011) Preoperative detection of colorectal liver metastases in fatty liver: MDCT or MRI? Eur J Radiol 79:e1–e6PubMedCrossRef Kulemann V, Schima W, Tamandl D et al (2011) Preoperative detection of colorectal liver metastases in fatty liver: MDCT or MRI? Eur J Radiol 79:e1–e6PubMedCrossRef
Metadaten
Titel
Preoperative evaluation of colorectal liver metastases: comparison between gadoxetic acid-enhanced 3.0-T MRI and contrast-enhanced MDCT with histopathological correlation
verfasst von
M. Scharitzer
A. Ba-Ssalamah
H. Ringl
C. Kölblinger
T. Grünberger
M. Weber
W. Schima
Publikationsdatum
01.08.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 8/2013
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-2824-z

Weitere Artikel der Ausgabe 8/2013

European Radiology 8/2013 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.