Update on the Role of Imaging in Management of Metastatic Colorectal Cancer

Tirumani, Sree Harsha; Kim, Kyung Won; Nishino, Mizuki; Howard, Stephanie A.; Krajewski, Katherine M.; Jagannathan, Jyothi P.; Cleary, James M.; Ramaiya, Nikhil H.; Shinagare, Atul B.

doi:10.1148/rg.347130090

Cited by 88 publications

(58 citation statements)

References 60 publications

(77 reference statements)

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“…With gadoxetic acid, 50% of the dose is taken up by hepatocytes and eliminated by biliary excretion, compared with 3–5% with gadobenate dimeglumine. Hepatobiliary phase images are acquired 20–40 min after gadoxetic acid injection or 1–4 h after gadobenate dimeglumine injection . With gadoxetic acid, the blood flow in lesions can be evaluated using dynamic imaging, and high contrast can also be generated between tumors and the surrounding hepatocytes due to the uptake of the contrast agent by hepatocytes during the hepatobiliary phase.…”

Section: Role Of Gadoxetic Acid‐enhanced Mri For Liver Metastasesmentioning

confidence: 99%

“…MRI has higher accuracy than PET/CT in the determination of the exact extent of the disease and the involved segments, which may impact the management therapeutic approaches . In our opinion, PET/CT should be considered to detect additional sites of extrahepatic disease as it may alter patient management and prognosis . PET/CT may also be used for the detection of occult disease in patients with increased tumor markers (e.g.…”

Section: Clinical Utility Of Pet Imaging Comparing With Gadoxetic Acimentioning

confidence: 99%

“…PET/CT may also be used for the detection of occult disease in patients with increased tumor markers (e.g. carcinoembryonic antigen levels) or a negative anatomical (CT or MRI) work‐up . New PET equipment, such as PET/MRI scanners, are also now available in selected departments in Japan ; however, there are few reports that evaluate the clinical features of the liver using PET/MRI.…”

Section: Clinical Utility Of Pet Imaging Comparing With Gadoxetic Acimentioning

confidence: 99%

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Current evidence for the diagnostic value of gadoxetic acid‐enhanced magnetic resonance imaging for liver metastasis

Tsurusaki

Sofue

Murakami

2016

Hepatology Research

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A variety of imaging techniques, including ultrasonography (US), multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) and positron emission tomography combined with CT scan (PET/CT), are available for diagnosis and treatment planning in liver metastasis. Contrast-enhanced MDCT is a relatively non-invasive, widely available and standardized method for hepatic work-up. Gadoxetic acid (gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid; EOB Primovist®]) is a recently developed liver-specific hepatobiliary MR contrast agent that offers both dynamic imaging as well as liver-specific static hepatocyte imaging, referred to as the hepatobiliary phase. Following contrast injection, this technique reveals dynamic vascular phases (arterial, portal venous and delayed phases), in addition to the hepatobiliary phase upon uptake by functional hepatocytes. The overall sensitivity of gadoxetic acid-enhanced MRI was significantly higher than that of contrast-enhanced CT. Specifically, the higher sensitivity of gadoxetic acid-enhanced MRI was observed in lesions smaller than 1 cm in diameter. Gadoxetic acid-enhanced MRI is considered an extremely useful tool for the diagnosis of liver metastases. Future studies will focus on diagnostic algorithms involving combinations of modalities such as MRI, MDCT and/or (18) F-fluorodeoxyglucose PET/CT, which may impact the treatment plan for these patients.

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Section: Role Of Gadoxetic Acid‐enhanced Mri For Liver Metastasesmentioning

confidence: 99%

Section: Clinical Utility Of Pet Imaging Comparing With Gadoxetic Acimentioning

confidence: 99%

Section: Clinical Utility Of Pet Imaging Comparing With Gadoxetic Acimentioning

confidence: 99%

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Current evidence for the diagnostic value of gadoxetic acid‐enhanced magnetic resonance imaging for liver metastasis

Tsurusaki

Sofue

Murakami

2016

Hepatology Research

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“…However, that also means new challenges for the imaging of CRLM treated with chemotherapy, especially if a more targeted treatment such as anti-angiogenic agents are used [46,82]. Recent studies have shown that alternative treatment response criteria like immune-related response criteria or PERCIST may be more predictive of pathologic response in metastatic colorectal cancer than conventional criteria such as RECIST 1.1 [81,[120][121][122]. In particular, disappearing CRLM (no longer detectable by imaging = complete clinical response) do not guarantee complete pathological response or cure.…”

Section: Tumor Biologymentioning

confidence: 99%

Impact of Contrast-Enhanced Intraoperative Ultrasound on Operation Strategy in Case of Colorectal Liver Metastasis

et al. 2012

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Background Surgical treatment is the only option for long-term survival in patients with colorectal liver metastasis (CRLM). Contrast-enhanced CT and MRI are usually used for preoperative liver imaging. The initial surgical strategy for liver resection is based upon these findings. Further optimization of the surgical strategy by contrast-enhanced intraoperative ultrasound (CE-IOUS) might further improve the surgical outcome. Purpose To evaluate the current impact of CE-IOUS with SonoVue® on the initial surgical strategy for CRLM. Material and Methods Eighty-six consecutive patients undergoing open liver resection for CRLM were evaluated retrospectively over a 2.5-year period. The patients underwent 97 operations. Preoperative staging was performed with contrast-enhanced CT in all patients and MRI was available in 66 of 86 patients. CE-IOUS was performed in all patients according to a standardized examination technique. Curved array and linear transducers were used. CRLM were identified in venous phase as hypovascular lesions. CE-IOUS findings were compared with preoperative staging. Results Combined CT/MRI identified preoperatively 328 CRLM (mean 3.4, range 0-14). Seventy-two additional lesions (18%) were identified in 38 patients during the operation. Intraoperatively 41 additional CRLM in 20 patients were identified by inspection, palpation, and CE-IOUS (10%), and another 31 CRLM in 17 patients were identified by CE-IOUS alone (8%). All additional CRLM detected by CE-IOUS were confirmed by histology if resection was performed. CE-IOUS changed planned operation strategy in 29.9% of operations. A larger resection was necessary in 13.4% of the cases, reduced liver resection was found sufficient in 11.3%, and 5.2% were found inoperable. For patients diagnosed preoperatively with solitary lesions CE-IOUS changed operation strategy in 19% and radical tumor resection would have failed in 4.8% without CE-IOUS. Conclusion CE-IOUS is essential to ensure optimal and complete tumor resection both in patient with solitary CRLM and multiple metastases.

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“…One caveat to be mindful of is the identification of new hypoattenuating or hyperattenuating lesions on post-treatment CT which may represent lesions which were imperceptible on pretreatment CT due to isoattenuation with the normal hepatic parenchyma. This phenomenon may mimic disease progression in spite of chemotherapy but is actually a result of alteration in the attenuation of the liver due to steatosis [53].…”

Section: Imaging Findings Following Neoadjuvant Treatmentmentioning

confidence: 99%

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

et al. 2015

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Surgical resection of colorectal metastatic disease has increased as surgeons have adopted a more aggressive ideology. Current exclusion criteria are patients for whom a negative resection margin is not feasible or a future liver remnant (FLR) of greater than 20% is not achievable. The goal of preoperative imaging is to identify the number and distribution of liver metastases, in addition to establishing their relation to relevant intrahepatic structures. FLR can be calculated utilizing cross-sectional imaging to select out patients at risk for hepatic dysfunction after resection. MRI, specifically with gadoxetic acid contrast, is currently the preferred modality for assessment of hepatic involvement for patients with newly diagnosed colorectal cancer, to include those who have undergone neoadjuvant chemotherapy. Employment of liver-directed therapies has recently expanded and they may provide an alternative to hepatectomy in order to obtain locoregional control in poor surgical candidates or convert patients with initially unresectable disease into surgical candidates.

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Update on the Role of Imaging in Management of Metastatic Colorectal Cancer

Cited by 88 publications

References 60 publications

Current evidence for the diagnostic value of gadoxetic acid‐enhanced magnetic resonance imaging for liver metastasis

Current evidence for the diagnostic value of gadoxetic acid‐enhanced magnetic resonance imaging for liver metastasis

Impact of Contrast-Enhanced Intraoperative Ultrasound on Operation Strategy in Case of Colorectal Liver Metastasis

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

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