Additional value of gadoxetic acid-enhanced MRI to gadolinium-enhanced MRI for the surgical management of colorectal and neuroendocrine liver metastases

Abstract

Objective: To assess the impact of preoperative Gadoxetic Acid-Enhanced MRI (Primovist/Eovist) compared to a standard non-hepatospecific Gadolinium-Enhanced MRI on the surgical management of colorectal and neuroendocrine liver metastasis. Methods: A retrospective analysis of 123 patients who underwent both a Gadoxetic Acid-Enhanced MRI and a non-hepatospecific Gadolinium-Enhanced MRI for evaluation of liver metastasis, within 30 days, from January 2012 to December 2015 at the CHU de Quebec was performed. The number of lesions identified on each MRI was compared. In cases where the number of lesions differed from one imaging modality to another, the surgeons were asked if their surgical plan was modified by the additional findings of the Gadoxetic Acid-Enhanced MRI. Results: Compared to the non-hepatospecific Gadolinium-Enhanced MRI, the Gadoxetic Acid-Enhanced MRI found new lesions in 24 of the 121 patients (19.8%), excluded lesions in 28 patients (23.1%) and identified the same number of lesions in 69 patients (57.0%). Regardless of the size, 95.8% of the patients with a unique liver metastasis seen on the non-hepatospecific Gadolinium-Enhanced MRI had no new lesions on the Gadoxetic Acid-Enhanced MRI. The addition of the Gadoxetic Acid-Enhanced MRI directly altered the surgical management in 28 % of the patients. Conclusion: Despite the additionnal cost associated with a Gadoxetic Acid-Enhanced MRI compared to a standard non-hepatospecific Gadolinium-Enhanced MRI, the use of this contrast agent has a significant impact on the surgical management of patients with liver metastasis more specifically in patients with more than one liver metastasis identified on a standard non-hepatospecific Gadolinium-Enhanced MRI.