Abstract
BackgroundMRI is the most reliable imaging modality that allows to assess liver metastases. Our purpose is to compare the per-lesion and per-patient detection rate of gadoxetic acid-(Gd-EOB) enhanced liver MRI and fast MR protocol including Diffusion Weighted Imaging (DWI) and T2-W Fat Suppression sequence in the detection of liver metastasis in pre surgical setting.MethodsOne hundred and eight patients with pathologically proven liver metastases (756 liver metastases) underwent Gd-EOBMRI were enrolled in this study. Three radiologist independently graded the presence of liver lesions on a five-point confidence scale assessed only abbreviated protocol (DWI and sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) fat suppressed sequence) and after an interval of more than 2 weeks the conventional study (all acquired sequences). Per-lesion and per-patient detection rate of metastases were calculated. Weighted к values were used to evaluate inter-reader agreement of the confidence scale regarding the presence of the lesion.ResultsMRI detected 732 liver metastases. All lesions were identified both by conventional study as by abbreviated protocol. In terms of per-lesion detection rate of liver metastasis, all three readers had higher detection rate both with abbreviated protocol and with standard protocol with Gd-EOB (96.8% [732 of 756] vs. 96.5% [730 of 756] for reader 1; 95.8% [725 of 756] vs. 95.2% [720 of 756] for reader 2; 96.5% [730 of 756] vs. 96.5% [730 of 756] for reader 3). Inter-reader agreement of lesions detection rate between the three radiologists was excellent (k range, 0.86–0.98) both for Gd-EOB MRI and for Fast protocol (k range, 0.89–0.99).ConclusionAbbreviated protocol showed the same detection rate than conventional study in detection of liver metastases.
Highlights
Imaging is an important tool in the management of patients with liver metastases by helping enumerate the number and sites of lesions, assessing the resectability, evaluating the response to treatment, and detecting drug toxicities [1,2,3,4]
Contrast medium is a useful tool in the characterizing setting, in pre surgical setting after conversion treatment, the radiologist’s role is identifying residual metastases in order to assess the resectability
The utility of Magnetic Resonance imaging (MRI) for detection and characterization of focal liver lesions is well established [1,2,3,4,5,6], its high cost and longer examination time compared with multidetector computed tomography (MDCT) or ultrasound may limit its widespread use for staging in patients with colorectal cancer (CRC)
Summary
Imaging is an important tool in the management of patients with liver metastases by helping enumerate the number and sites of lesions, assessing the resectability, evaluating the response to treatment (systemic or ablative therapies), and detecting drug toxicities [1,2,3,4]. Functional data, extracted by diffusion weighted imaging (DWI) and dynamic contrast-enhanced (DCE)MRI, allow a proper detection and characterization of focal liver lesions [5,6,7,8]. Our purpose is to compare the per-lesion and per-patient detection rate of gadoxetic acid-(Gd-EOB) enhanced liver MRI and fast MR protocol including Diffusion Weighted Imaging (DWI) and T2-W Fat Suppression sequence in the detection of liver metastasis in pre surgical setting
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