Austrian consensus guidelines on imaging requirements prior to hepatic surgery and during follow-up in patients with malignant hepatic lesions

Abstract

SummaryRapid advances in imaging technology have improved the detection, characterization and staging of colorectal liver metastases, hepatocellular carcinoma and cholangiocarcinoma. A variety of imaging modalities are available and play a pivotal role in the work-up of patients, particularly as imaging findings determine resectability. Surgery often represents the only measure that can render long-term survival possible. Imaging is also indispensable for the assessment of responses to neoadjuvant treatment and for the detection of recurrence. At a consensus meeting held in June 2017 in Vienna, Austria, Austrian experts in the fields of surgery and radiology discussed imaging requirements prior to and after hepatic surgery for malignant liver lesions. This consensus was refined by online voting on a total of 47 items. Generally, the degree of consensus was high. The recommendations relate to the type of preferred preoperative imaging modalities, technical settings with respect to computed tomography and magnetic resonance imaging, use of contrast agents, reporting, postoperative follow-up, and long-term follow-up. Taking local resources into account, these consensus recommendations can be implemented in daily clinical practice at specialized centers as well as outpatient diagnostic institutes in Austria.

Clinical added value of MRI to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): study protocol for an international multicentre prospective diagnostic accuracy study

“…The current routine diagnostic workup of patients with suspected CRLM consists of contrast-enhanced computed tomography (CT) [12][13][14]. While CT provides adequate whole-body staging and has a sensitivity of 70-90% for CRLM lesions of more than 10 mm, the reported sensitivity of CT in the detection of small CRLM (≤10 mm) ranges from 22 to 68% [15][16][17].…”

Preoperative imaging for colorectal liver metastases: a nationwide population-based study

“…Some authors propose using 18 F‐FDG PET–CT during follow‐up to assess intrahepatic and extrahepatic metastases. Several European countries have preoperative imaging guidelines that contain advice regarding the use of both ceMRI and 18 F‐FDG PET–CT. Guidelines in the UK and Japan, as well as the European Society for Medical Oncology consensus guideline on metastatic colorectal cancer, point out that ceMRI and 18 F‐FDG PET–CT can be performed in the preoperative work‐up.…”

Guidelines for imaging reach a new quality level towards computer-assisted diagnosis

“…The reasons may be limitations in their design and implementation as well as the primary stakeholders' intentions to reduce costs and radiation exposure instead of focussing on the clinical needs. In this issue of the Wiener Klinische Wochenschrift-Central European Journal of Medicine, Tamandl et al publish consensus guidelines for imaging of hepatic tumors [1]. Their design has the potential for overcoming these limitations by following new quality standards and by integrating the European level of knowledge.…”