Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy

Objectives

To compare the diagnostic accuracy and sensitivity of Gd-EOB-DTPA MRI and diffusion-weighted (DWI) imaging alone and in combination for detecting colorectal liver metastases in patients who had undergone preoperative chemotherapy.

Methods

Thirty-two consecutive patients with a total of 166 liver lesions were retrospectively enrolled. Of the lesions, 144 (86.8 %) were metastatic at pathology. Three image sets (1, Gd-EOB-DTPA; 2, DWI; 3, combined Gd-EOB-DTPA and DWI) were independently reviewed by two observers. Statistical analysis was performed on a per-lesion basis.

Results

Evaluation of image set 1 correctly identified 127/166 lesions (accuracy 76.5 %; 95 % CI 69.3–82.7) and 106/144 metastases (sensitivity 73.6 %, 95 % CI 65.6–80.6). Evaluation of image set 2 correctly identified 108/166 (accuracy 65.1 %, 95 % CI 57.3–72.3) and 87/144 metastases (sensitivity of 60.4 %, 95 % CI 51.9–68.5). Evaluation of image set 3 correctly identified 148/166 (accuracy 89.2 %, 95 % CI 83.4–93.4) and 131/144 metastases (sensitivity 91 %, 95 % CI 85.1–95.1). Differences were statistically significant (P?<?0.001). Notably, similar results were obtained analysing only small lesions (<1 cm).

Conclusions

The combination of DWI with Gd-EOB-DTPA-enhanced MRI imaging significantly increases the diagnostic accuracy and sensitivity in patients with colorectal liver metastases treated with preoperative chemotherapy, and it is particularly effective in the detection of small lesions.

Key Points

? Accurate detection of colorectal liver metastases is essential to determine resectability. ? Almost 80 % of patients are candidates for neoadjuvant chemotherapic treatment at diagnosis. After chemotherapy, metastases usually decrease, and drug-induced liver steatosis may be present. ? The sensitivity of imaging is significantly inferior to that in chemotherapy-naïve patients. ? DWI combined with Gd-EOB-DTPA increases sensitivity in detecting small metastases after chemotherapy.