Colorectal Liver Metastases: CT, MR Imaging, and PET for Diagnosis—Meta-analysis

Bipat, Shandra; Leeuwen, Maarten S. van; Comans, Emile F.I.; Pijl, Milan E. J.; Bossuyt, Patrick M.; Zwinderman, Aeilko H.; Stoker, Jaap

doi:10.1148/radiol.2371042060

Cited by 497 publications

(325 citation statements)

References 83 publications

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“…25 A recent meta-analysis has provided sensitivity estimates for CT, MRI, and PET with respect to the detection of colorectal liver metastases. 26 Sensitivity estimates on a per-patient basis for nonhelical CT, helical CT, MRI, and PET were 60.2%, 64.7%, 75.8%, and 94.6%, respectively. On a per-lesion basis, sensitivity estimates for nonhelical CT, helical CT, MRI, and PET were 52.3%, 63.8%, 64.4% and 75.9%, respectively.…”

Section: Discussionmentioning

confidence: 93%

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Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG‐PET‐CT

Wildi

Gubler

Hany

et al. 2007

J of Clinical Ultrasound

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Background. Combined fluorine 18-fluorodeoxyglucose-positron emission tomography-CT imaging has been shown to be of good diagnostic value in the preoperative evaluation of patients with colorectal cancer and liver metastases. The adjunctive use of intraoperative sonography (IOUS) may have a limited impact on treatment selection in these patients.Purpose. To compare the diagnostic performance of preoperative positron emission tomography (PET)-CT alone and PET-CT combined with IOUS in the evaluation of patients who are considered for curative resection of hepatic metastases from colorectal carcinoma.Materials and Methods. Patients with colorectal cancer who underwent resection of hepatic metastases and preoperative PET-CT (with or without contrast-enhanced CT) and IOUS were identified. The performance of the imaging techniques was evaluated through review of the radiologic reports, correlation with surgical and histopathologic findings, and clinical follow-up.Results. Thirty-one patients (mean age, 63.5 years [range, 53-82 years]) were analyzed. Fifteen patients had received preoperative chemotherapy. The mean interval between PET-CT and IOUS was 22.6 days (range, 1-56 days). In 4 cases, neither PET-CT nor IOUS correctly diagnosed the liver metastases. In all 31 patients, the sensitivity of PET-CT alone and PET-CT combined with IOUS was 63% (95% CI 44-80%) and 93% (95% CI 78-98%), respectively; the positive predictive value was 81% and 89%, respectively. In patients without preoperative chemotherapy (n 5 16), the sensitivity of PET-CT alone and PET-CT combined with IOUS was 77% (95% CI 49-94%) and 100% (95% CI 79-100%), respectively. In 11 cases (35%), IOUS altered the surgical strategy.Conclusion. In patients with colorectal carcinoma and potentially resectable liver metastases on preoperative PET-CT, IOUS can provide additional information that may alter decision making with regard to surgical technique. Keywords: colorectal cancer; liver metastases; intraoperative sonography; FDG-PET-CT C olorectal cancer is the second leading cause of cancer-related death in the western hemisphere. Up to 70% of patients with colorectal cancer eventually develop liver metastases. In 30-40% of these patients, metastases are confined to the liver at the time of detection. Hepatic resection is the only therapeutic strategy that offers a chance of cure. In patients who undergo successful hepatic resection with curative intent, the expected 5-year survival rate is approximately 33%, and the 5-year disease-free survival rate is 22%. 1 A large number of patients develop intraor extrahepatic tumor recurrence after curative

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Section: Discussionmentioning

confidence: 93%

“…The reported sensitivity estimate of PET in the literature is only 75%. 26 The study may also be limited by the fact that IOUS was incomplete in 6 patients, which may have affected the positive predictive value. To date, there are no studies investigating the value of IOUS in patients who were evaluated preoperatively with PET-CT.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG‐PET‐CT

Wildi

Gubler

Hany

et al. 2007

J of Clinical Ultrasound

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“…In addition, only 26% of LMs that disappeared on both CT scans and MRI studies were detected at surgery or recurred during follow-up compared with 43% of LMs that were not evaluated by MRI. In a meta-analysis of imaging techniques for colorectal LMs, 9 MRI with intravenous contrast was significantly more sensitive than helical CT. MRI may be particularly useful in the setting of chemotherapy-induced hepatic steatosis, which may be responsible for some DLMs. 10,11 Another difference between studies was the chemotherapy regimen.…”

Section: Evaluated 66mentioning

confidence: 98%

Predictors of a true complete response among disappearing liver metastases from colorectal cancer after chemotherapy

Auer

White

Kemeny

et al. 2010

Cancer

165

134

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BACKGROUND: During chemotherapy, some colorectal liver metastases (LMs) disappear on serial imaging. This disappearance may represent a complete response (CR) or a reduction in the sensitivity of imaging during chemotherapy. The objective of the current study was to determine the fate of disappearing LMs (DLMs) and the factors that predict a true CR. METHODS: Between 2000 and 2003, 435 patients who were evaluated by hepatobiliary surgeons received chemotherapy before they were considered for resection. Inclusion criteria were <12 LMs before chemotherapy, at least 1 DLM on a computed tomography (CT) scan, and either surgical resection or 1 year of clinical follow-up after the disappearance of LMs. A true CR was defined as either a pathologic CR (no tumor detected in the resection specimen) or a durable clinical CR (did not reappear on follow-up imaging). Clinical and pathologic factors were analyzed to identify those associated with a true CR. RESULTS: During chemotherapy, 39 patients (9%) had a total of 118 DLMs on follow-up CT scans. Sixty-eight DLMs were resected, and 50 were followed clinically. Overall, 75 DLMs (64%) were true CRs, including 44 pathologic CRs and 31 durable clinical CRs. On multivariate analysis, the use of hepatic arterial infusion (HAI) chemotherapy (odds ratio [OR], 6.2; P ¼ .02), the inability to observe the DLM on a magnetic resonance image (OR, 4.7; P ¼ .005), and normalization of serum carcinoembryonic antigen levels (OR, 4.6; P ¼ .006) were associated independently with a true CR. CONCLUSIONS: Approximately 66% of DLMs represented a true CR according to assessment by resection or radiologic follow-up. Predictive factors may help to stratify patients who are likely to harbor residual disease. Cancer 2010;116:1502-9.

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“…Despite this positive aspect, it has to be noted that the preoperative and the postoperative (pathological) presence of extrahepatic disease in patients with CLM is associated with a higher neoplastic recurrence and a worse patient survival [9,23] . This fact should raise concern regarding need for a stricter patient selection when extrahepatic disease is found on preoperative imaging, as only curative resection is a valid option for these patients [24] . Also, even though no conclusive data exist at the present time, the finding of intraoperative extrahepatic disease probably deserves a closer postoperative follow-up with a more aggressive use of complementary chemotherapeutical treatment.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors and time-related changes influence results of colorectal liver metastases surgical treatment: A single-center analysis

Martı́¹,

Modolo²,

Fuster³

et al. 2009

WJG

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AIM: To analyze the prognostic factors involved in survival and cancer recurrence in patients undergoing surgical treatment for colorectal liver metastases (CLM) and to describe the effects of time-related changes on survival and recurrence in these patients. METHODS:From January 1994 to January 2006, 236 patients with CLM underwent surgery with the aim of performing curative resection of neoplastic disease at our institution and 189 (80%) of these patients underwent resection of CLM with curative intention. Preoperative, intraoperative and postoperative data, including primary tumor and CLM pathology results, were retrospectively reviewed. Patients were divided into two time periods: a first period from January 1994 to January 2000 (n = 93), and a second period from February 2000 to January 2006 (n = 143). RESULTS:Global survival at 1, 3 and 5 years in patients undergoing hepatic resection was 91%, 54% and 47%, respectively. Patients with preoperative extrahepatic disease, carcinoembryonic antigen (CEA) levels over 20 ng/dL, more than four nodules or extrahepatic invasion at pathological analysis had worse survival. Tumor recurrence rate at 1 year was 48.3%, being more frequent in patients with preoperative and pathological extrahepatic disease and CEA levels over 20 ng/dL. Although patients in the second time period had more adverse prognostic fa c t o r s , no di ffe re nc e s in ove ra l l s ur v iva l a n d recurrence were observed between the two periods. CONCLUSION:Despite advances in surgical technique and better adjuvant treatments and preoperative imaging, careful patient staging and selection is crucial to continue offering a chance of cure to patients with CLM.

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Colorectal Liver Metastases: CT, MR Imaging, and PET for Diagnosis—Meta-analysis

Abstract: FDG PET had significantly higher sensitivity on a per-patient basis, compared with that of the other modalities, but not on a per-lesion basis. Sensitivity estimates for MR imaging with contrast agent were significantly superior to those for helical CT with 45 g of iodine or less.

Cited by 497 publications

References 83 publications

Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG‐PET‐CT

Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG‐PET‐CT

Predictors of a true complete response among disappearing liver metastases from colorectal cancer after chemotherapy

Prognostic factors and time-related changes influence results of colorectal liver metastases surgical treatment: A single-center analysis

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