Abstract
Some liver nodules remain indeterminate despite hepatocyte-specific contrast MRI in patients with colorectal liver metastasis (CRLM). Our objective was to study the natural course and evaluate possible treatment strategies for indeterminate nodules. We retrospectively evaluated patients in whom MRI revealed ‘indeterminate’ or ‘equivocal’ nodules between January 2008 and October 2018. Patients were followed up until October 2019 or until death (median, 18 months; (1–130 months)). The incidence of patients with indeterminate nodules on MRI was 15.4% (60 of 389). The sensitivity and specificity of intraoperative ultrasound for detecting indeterminate nodules were 73.68% and 93.75%, respectively, with a positive predictive value of 96.6%. Over half of the patients followed up had benign nodules (58.8%). By comparing characteristics of patients with benign or malignant nodules in the follow up group, the ratio of positive lymph nodes to total number of lymph nodes resected (pLNR) was significantly greater in patients with malignant nodules (P = 0.006). Intraoperative ultrasound could be considered as an adjunct to MRI in patients with indeterminate nodules owing to its high positive predictive value. The pLNR could be used to help select which patients can undergo conservative therapy, at least in metachronous CRLM.
Highlights
Some liver nodules remain indeterminate despite hepatocyte-specific contrast magnetic resonance imaging (MRI) in patients with colorectal liver metastasis (CRLM)
Computed tomography (CT) is the most common imaging modality to screen patients with CLRM, there is increasing evidence to show that MRI with hepatocyte-specific tissue contrast is better to detect small lesions characterized as indeterminate on CT with a positive predictive value of 91%12
Besides its use for detecting CRLM, gadoxetic acid-enhanced MRI is associated with improving the diagnostic accuracy of hepatocellular carcinoma (HCC) by detecting small HCC lesions and precursors of HCC p rogression[15]
Summary
Some liver nodules remain indeterminate despite hepatocyte-specific contrast MRI in patients with colorectal liver metastasis (CRLM). The sensitivity and specificity of intraoperative ultrasound for detecting indeterminate nodules were 73.68% and 93.75%, respectively, with a positive predictive value of 96.6%. Intraoperative ultrasound could be considered as an adjunct to MRI in patients with indeterminate nodules owing to its high positive predictive value. Resectability of colorectal liver metastasis (CRLM) has changed rapidly. In addition it was found that left-sided primary tumors were associated with improved median OS after resection of C RLM7. The prognostic impact after hepatic resection for CRLM varies based on KRAS status and site of the primary CRC6. With the advent of tissue-specific contrast agents, magnetic resonance imaging (MRI) is increasingly being used to diagnose small lesions that are not characterized on CT. The CT image is may be compromised in patients who have received chemotherapy due to sinusoidal dilatation and injury caused by chemotherapeutic agents, interfering with the attenuation of hepatic p arenchyma[10]
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