Abstract
ObjectiveTo assess the added value of arterial enhancement fraction (AEF) color maps for the differentiation of small metastases from hepatic benign lesions.Subjects and MethodsWe retrospectively analyzed 46 patients with colorectal cancer who underwent multiphasic liver CT imaging and had low-attenuating liver lesions smaller than 3 cm (123 total lesions; metastasis: benign = 32:91). AEF color maps of the liver were created from multiphasic liver CT images using dedicated software. Two radiologists independently reviewed multiphasic CT image sets alone and in combination with image sets with AEF color maps using a five-point scale. The additional diagnostic value of the color maps was assessed by means of receiver-operating characteristic (ROC) analysis.ResultsThe area under the ROC curve (Az) increased when multiphasic CT images were combined with AEF color map analysis as compared with evaluation based only on multiphasic CT images (from 0.698 to 0.897 for reader 1, and from 0.825 to 0.945 for reader 2; P < 0.001 and 0.002, respectively). The increase Az was especially significant for lesions less than 1 cm (from 0.702 to 0.888 for reader 1, and from 0.768 to 0.958 for reader 2; P = 0.001 and P = 0.001, respectively). The mean AEF of tumor-adjacent parenchyma (35.07 ± 27.2) was significantly higher than that of tumor-free liver parenchyma (27.3 ± 20.6) (P = 0.04).ConclusionsAEF color mapping can improve the diagnostic performance for small hepatic metastases from colorectal cancer and may allow for the elimination of additional examinations.
Highlights
The liver is the most common site of metastasis from colorectal cancer
The area under the receiver-operating characteristic (ROC) curve (Az) increased when multiphasic Computed tomography (CT) images were combined with arterial enhancement fraction (AEF) color map analysis as compared with evaluation based only on multiphasic CT images
AEF color mapping can improve the diagnostic performance for small hepatic metastases from colorectal cancer and may allow for the elimination of additional examinations
Summary
The liver is the most common site of metastasis from colorectal cancer. Accurate preoperative diagnosis of liver metastases is critical for planning treatment and predicting prognosis [1,2]. Computed tomography (CT) is the primary imaging modality for preoperative evaluation of patients with known or suspected colorectal cancer and can be used to accurately diagnose both the extent of primary colorectal cancer and liver metastasis. Low-attenuation lesions in the liver were detected in 13% to 25.5% of preoperative CT scans, only 2.2% to 14.0% were confirmed as metastases [3,4]. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance image (MRI) and positron emission tomography (PET) can be helpful for the diagnosis of small metastases, [5,6,7] these imaging modalities require additional expense and time and are not available in some facilities or countries
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