Presurgical comparative imaging evaluation in patients with colorectal cancer liver metastasis (PROMETEO Study)

Abstract

e15010 Background: The aim of the study was to define the specific diagnostic accuracy of different imaging techniques in patients (pts) with resectable colorectal cancer liver metastasis (CLMs). Methods: Consecutive pts with, potentially resectable CLMs afferent to the Multidisciplinary Liver Team of Bologna Sant’Orsola Malpighi Hospital performed, in the 3 weeks prior to liver surgery, computed tomography scan (CT), magnetic resonance diffusion-weighted (MR-DW), and liver contrast-enhanced ultrasonography (CEUS1). Liver contrast-enhanced ultrasonography was also performed intra-operatively (CEUS2). All the imaging exams were performed according to the standard operative procedures. Results: From December 2007 to December 2008, twenty-nine out of 50 pts enrolled in the PROMETEO study underwent liver resection. The pt characteristics were: 18 (62%) males, 11 (38%) females; 18 (62%) synchronous metastasis, 11 (38%) metachronous metastasis; 15 (51.7%) neoadjuvant chemotherapy; 7 (24.1%) previous liver surgery; 3 (10.3%) previous loco-regional treatment. Ninety-three liver lesions were resected; the median number lesions per patient was 2 (range 1- 10). All lesions were studied with CT and CEUS1, 90 (96.8%) with CEUS2, 83 (89.2%) with PET and 85 (91.4%) with MR-DW. Five lesions at pathological examination were non-metastasis (1 hamartoma, 1 steatosis, 1 giant-cell reaction, 2 necrosis). Only 3 lesions were not detected by all imaging techniques (in one pt. previously treated with chemotherapy and radiofrequency). Conclusions: These results show that CT, CEUS1 and MR-DW have a good accuracy in the detection of liver metastasis in patients who are candidates for resection. CEUS2 presents the best pathological predictive value. [Table: see text] No significant financial relationships to disclose.