Gd-EOB-DTPA-Enhanced MRI for Detection of Liver Metastases from Colorectal Cancer: A Surgeon’s Perspective!

Abstract

Colorectal cancer affects over one million people worldwide annually, with the liver being the most common site of metastatic spread. Adequate resection of hepatic metastases is the only chance for a cure in a subset of patients, and five-year survival increases to 35% with complete resection. Traditionally, computed tomographic imaging (CT) was utilized for staging and to evaluate metastases in the liver. Recently, the introduction of hepatobiliary contrast-enhanced magnetic resonance imaging (MRI) agents including gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Eovist in the United States, Primovist in Europe, or Gd-EOB-DTPA) has proved to be a sensitive method for detection of hepatic metastases. Accurate detection of liver metastases is critical for staging of colorectal cancer as well as preoperative planning.

Gadoxetic acid-enhanced MRI and diffusion-weighted imaging for the detection of colorectal liver metastases after neoadjuvant chemotherapy

“…In a recent metaanalysis study by van Kessel et al [15], CT, FDG-PET and FDG-PET/CT showed lower diagnostic performances for the evaluation of CRLMs in patients treated with chemotherapy compared to chemonaive patients, whereas MRI showed a high pooled sensitivity of 85.7 % in patients who underwent chemotherapy. Recently, gadoxetic acid (Gd-EOB-DTPA, Primovist®; Bayer Healthcare, Berlin, Germany), which is a hepatocyte-specific MR contrast agent, has received much attention as a promising contrast medium for the evaluation of liver metastases [16][17][18]. In addition, several studies have demonstrated that the combination of DWI and gadoxetic acid-enhanced MRI can improve the accuracy and sensitivity for the detection of liver metastasis, especially for small liver metastasis, as well as after preoperative chemotherapy [19][20][21][22][23].…”

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in colorectal liver metastasis: the radiologist’s perspective

“…5D). However, the cost-benefit ratio for performing a single evaluation of the whole abdomen with P-MRI remains unclear [27][28][29]. Volumetric calculation is operator dependent and crucial to prevent PHLF postsurgery.…”

Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know

“…The addition of diffusion weighted imaging (DWI) permits detection of small lesions adjacent to hepatic vessels that otherwise would be obscured on postcontrast images due to the suppression of intrahepatic vascular signal on DWI [29]. Despite having the highest upfront cost amongst most imaging modalities, MRI with gadoxetic acid actually shows the best cost savings when reimaging and unnecessary surgical procedures are factored into the equation [30]. Therefore, MRI with gadoxetic acid is the recommended first-line imaging study.…”

“…With use of hepatocyte-specific contrast agents, both rim enhancement and a ''target sign'' (central hyperenhancement and a hypointense rim) have been described for metastases on the hepatobiliary phase, although homogeneous hypointense lesions are most common (Fig. 5) [30]. Lesions can be classified as benign if they demonstrate homogeneously high signal intensity fill-in and has slightly hyperintense signal relative to the adjacent normal hepatic parenchyma (arrow).…”