European Radiology

, Volume 28, Issue 10, pp 4234–4242 | Cite as

Clinical impact of preoperative liver MRI in the evaluation of synchronous liver metastasis of colon cancer

  • Cherry Kim
  • So Yeon KimEmail author
  • Min-Ju Kim
  • Yong Sik Yoon
  • Chan Wook Kim
  • Jae Hoon Lee
  • Kyu-pyo Kim
  • Seung Soo Lee
  • Seong Ho Park
  • Moon-Gyu Lee



To investigate whether additional MRI including gadoxetic acid enhancement is associated with survival rate (SR) in patients with synchronous liver metastasis of colon cancer (sCLM), compared with patients assessed only with CT.


Fifty-two patients underwent only CT (CT group) and 65 underwent additional MRI (CT+MRI group) for preoperative work-up of sCLM. In the CT+MRI group, the discrepancy between CT and MRI was analyzed. The 5-year SR was compared between the groups, and affecting factors were investigated. The inverse probability treatment weighting analysis (IPTW) adjusted by propensity scores was performed.


In the CT+MRI group, 44 (67.7%) showed a discrepancy in the number of sCLMs between CT and MRI. MRI detected 39 additional sCLMs initially missed on CT in 26 patients. The number of detected sCLMs was better correlated with the pathologic findings in the CT+MRI group than in the CT group (p = 0.008). The estimated 5-year SR in the CT+MRI group was 70.8%, while that in the CT group was 48.1%. On adjusted multivariate analyses after the IPTW, the CT+MRI group showed a significantly lower risk of overall mortality than the CT group.


Additional preoperative evaluation by MRI allowed us to more precisely detect sCLM and was associated with a better SR.

Key Points

• CT+MRI group showed significantly higher 5-year survival rates than CT group.

• CT+MRI group was an independent prognostic factor of overall mortality.

• MRI facilitates more accurate detection and better lesion characterization.

• MRI selected better candidates for curative treatment.

• The benefits of MRI were reflected by better survival.


Colonic neoplasms Neoplasm metastasis Liver Magnetic resonance imaging Multidetector computed tomography 



Carcinoembryonic antigen


Inverse probability of treatment weighting


Propensity score


Radiofrequency ablation


Synchronous liver metastasis of colon cancer



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is So Yeon Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• case-control study

• performed at one institution


  1. 1.
    Leporrier J, Maurel J, Chiche L, Bara S, Segol P, Launoy G (2006) A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer. Br J Surg 93:465–474CrossRefGoogle Scholar
  2. 2.
    Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier AM (2006) Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 244:254–259CrossRefGoogle Scholar
  3. 3.
    Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318 discussion 318-321CrossRefGoogle Scholar
  4. 4.
    Iwatsuki S, Dvorchik I, Madariaga JR et al (1999) Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg 189:291–299CrossRefGoogle Scholar
  5. 5.
    National Comprehensive Cancer Network (2015) Clinical practice guidelines in oncology, colon cancer, Version 3. Accessed 14 Mar 2018
  6. 6.
    Van Cutsem E, Cervantes A, Nordlinger B, Arnold D, Group EGW (2014) Metastatic colorectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 25:iii1–iii9CrossRefGoogle Scholar
  7. 7.
    Chen L, Zhang J, Zhang L et al (2012) Meta-analysis of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging for the detection of liver metastases. PLoS One 7:e48681CrossRefGoogle Scholar
  8. 8.
    Bipat S, van Leeuwen MS, Comans EF et al (2005) Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis. Radiology 237:123–131CrossRefGoogle Scholar
  9. 9.
    Vreugdenburg TD, Ma N, Duncan JK, Riitano D, Cameron AL, Maddern GJ (2016) Comparative diagnostic accuracy of hepatocyte-specific gadoxetic acid (Gd-EOB-DTPA) enhanced MR imaging and contrast enhanced CT for the detection of liver metastases: a systematic review and meta-analysis. Int J Colorectal Dis 31:1739–1749CrossRefGoogle Scholar
  10. 10.
    Niekel MC, Bipat S, Stoker J (2010) Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology 257:674–684CrossRefGoogle Scholar
  11. 11.
    Seo HJ, Kim MJ, Lee JD, Chung WS, Kim YE (2011) Gadoxetate disodium-enhanced magnetic resonance imaging versus contrast-enhanced 18F-fluorodeoxyglucose positron emission tomography/computed tomography for the detection of colorectal liver metastases. Invest Radiol 46:548–555CrossRefGoogle Scholar
  12. 12.
    Kim HJ, Lee SS, Byun JH et al (2015) Incremental value of liver MR imaging in patients with potentially curable colorectal hepatic metastasis detected at CT: a prospective comparison of diffusion-weighted imaging, gadoxetic acid-enhanced MR imaging, and a combination of both MR techniques. Radiology 274:712–722CrossRefGoogle Scholar
  13. 13.
    Sofue K, Tsurusaki M, Tokue H, Arai Y, Sugimura K (2011) Gd-EOB-DTPA-enhanced 3.0 T MR imaging: quantitative and qualitative comparison of hepatocyte-phase images obtained 10 min and 20 min after injection for the detection of liver metastases from colorectal carcinoma. Eur Radiol 21:2336–2343CrossRefGoogle Scholar
  14. 14.
    Tsurusaki M, Sofue K, Murakami T (2016) Current evidence for the diagnostic value of gadoxetic acid-enhanced magnetic resonance imaging for liver metastasis. Hepatol Res 46:853–861CrossRefGoogle Scholar
  15. 15.
    Cho JY, Lee YJ, Han HS et al (2015) Role of gadoxetic acid-enhanced magnetic resonance imaging in the preoperative evaluation of small hepatic lesions in patients with colorectal cancer. World J Surg 39:1161–1166CrossRefGoogle Scholar
  16. 16.
    Kim HD, Lim YS, Han S et al (2015) Evaluation of early-stage hepatocellular carcinoma by magnetic resonance imaging with gadoxetic acid detects additional lesions and increases overall survival. Gastroenterology 148:1371–1382CrossRefGoogle Scholar
  17. 17.
    Jeon SK, Lee JM, Joo I et al (2018) Magnetic resonance with diffusion-weighted imaging improves assessment of focal liver lesions in patients with potentially resectable pancreatic cancer on CT. Eur Radiol. CrossRefGoogle Scholar
  18. 18.
    Mekenkamp LJ, Koopman M, Teerenstra S et al (2010) Clinicopathological features and outcome in advanced colorectal cancer patients with synchronous vs metachronous metastases. Br J Cancer 103:159–164CrossRefGoogle Scholar
  19. 19.
    Siriwardena AK, Mason JM, Mullamitha S, Hancock HC, Jegatheeswaran S (2014) Management of colorectal cancer presenting with synchronous liver metastases. Nat Rev Clin Oncol 11:446–459CrossRefGoogle Scholar
  20. 20.
    Zech CJ, Korpraphong P, Huppertz A et al (2014) Randomized multicentre trial of gadoxetic acid-enhanced MRI versus conventional MRI or CT in the staging of colorectal cancer liver metastases. Br J Surg 101:613–621CrossRefGoogle Scholar
  21. 21.
    Tanaka M, Kishi Y, Esaki M et al (2016) Feasibility of routine application of gadoxetic acid-enhanced MRI in combination with diffusion-weighted MRI for the preoperative evaluation of colorectal liver metastases. Ann Surg Oncol 23:3991–3998CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Cherry Kim
    • 1
    • 2
  • So Yeon Kim
    • 1
    Email author
  • Min-Ju Kim
    • 3
  • Yong Sik Yoon
    • 4
  • Chan Wook Kim
    • 4
  • Jae Hoon Lee
    • 4
  • Kyu-pyo Kim
    • 5
  • Seung Soo Lee
    • 1
  • Seong Ho Park
    • 1
  • Moon-Gyu Lee
    • 1
  1. 1.Department of Radiology and the Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  2. 2.Department of RadiologyAnsan Hospital, Korea University College of MedicineAnsan-siKorea
  3. 3.Department of Clinical Epidemiology and BiostatisticsAsan Medical Center, University of Ulsan College of MedicineSeoulKorea
  4. 4.Department of SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoulKorea
  5. 5.Department of OncologyAsan Medical Center, University of Ulsan College of MedicineSeoulKorea

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