Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: A systematic review and meta‐analysis

Abstract

Surgery of liver metastases can be effective, and the appropriate selection of surgical candidates relies first on imaging. Different techniques are available, but information on their relative performance is unclear. The aim of this overview is to assess the imaging modality performance in the diagnosis of colorectal cancer (CRC) liver metastases. MEDLINE and EMBASE were searched for articles published from January 2000 to August 2008. Eligible trials had to be conducted on patients with diagnosis/suspicion of CRC liver metastases, comparing more than two modalities among MRI, computed tomography (CT), positron emission tomography using fluoro-18-deoxyglucose (FDG-PET), ultrasonography (US). Pooled estimates of sensitivity, specificity were calculated and pairwise comparisons were performed. Of 6030 screened articles, 25 were eligible. Sensitivity and specificity on a per-patient basis for US, CT, MRI, and FDG-PET were 63.0% and 97.6%, 74.8% and 95.6%, 81.1% and 97.2, and 93.8% and 98.7%, respectively. On a per-lesion basis, sensitivity was 86.3%, 82.6%, 86.3%, and 86.0%, respectively. Specificity was reported in few studies. MRI showed a better sensitivity than CT in per-patient (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.47-0.99; P ¼ 0.05) and in per-lesion analysis (OR: 0.66; 95% CI: 0.55-0.80; P < 0.0001). In per-lesion analysis, the difference was higher when liver-specific contrast agents were administered. Available evidence supports the MRI use for the detection of CRC liver metastases. SURGICAL TREATMENT OF colorectal cancer (CRC) liver metastases is the only treatment associated with demonstrated long-term survival (1). Patients with untreated but potentially resectable metastases show a median survival of 6 to 12 months (2), while 5-year survival rate of 45-60% can be achieved in appropriate selected patients (3) and this selection relies first on imaging. Although in the past 20 years the role of diagnostic imaging has gained an increasing importance, due to a rapid improvement both in imaging technology and in its clinical application, no consensus has yet emerged on the optimal imaging strategy for the preoperative staging of patients with CRC liver metastases (3). Moreover, after preoperative imaging, intraoperative ultrasonography (IOUS) has been reported to identify at least one additional lesion in 10-12% of cases (4). These data indicate that intensive efforts should be used to improve staging to avoid unnecessary laparotomy and nontherapeutic resection procedures, especially because nowadays resection of liver metastases is pursued with increasing aggressiveness.The diagnostic value of ultrasound with contrast agents, multi-detector computed tomography (MDCT), and MRI with extra-cellular contrast media (ECCM) and liver-specific contrast media (LSCM) is debated. Nowadays MDCT is the mainstay of staging and follow-up of these patients, because it provides good coverage of the liver and the complete abdomen and chest in one session. MRI has been shown to be also useful in the preope...

The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus

“…For lesions Ͻ10 mm, MRI was a more sensitive modality than CT. Similar results were reported in another meta-analysis published in 2010, which showed that MRI had better sensitivity than CT both in per patient (81.1% versus 74.8%; p ϭ .05) and in per lesion (86.3% versus 82.6%; p Ͻ .0001) analyses [8]. However, these conclusions should be subject to caution because, as a result of the stringent inclusion criteria, only a few studies were derived from a large body of work.…”

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

“…By focussing only on this group of patients we selected individuals with more complex liver disease such as those with multiple small bilateral liver metastases. This underscores the importance of our findings and explains why we reported an overall sensitivity value of 73.6 %, which is slightly inferior to that reported in the literature (81-91 % [23]). Rather, our sensitivity of 73.6 % should be regarded as remarkable when considering that more than 50 % of the hepatic lesions were smaller than 1 cm and that all patients had a preoperative course of systemic chemotherapy, which may cause liver injuries.…”

Rules, Roles, and Room for Discussion in Gadoxetic Acid-enhanced Magnetic Resonance Liver Imaging: Current Knowledge and Future Challenges

“…45,46 In general, there is no arguing that the high contrast resolution of MR imaging improves diagnoses of small focal liver lesions (Fig. 2a, b).…”