European Radiology

, Volume 28, Issue 11, pp 4735–4747 | Cite as

Diagnostic accuracy of CE-CT, MRI and FDG PET/CT for detecting colorectal cancer liver metastases in patients considered eligible for hepatic resection and/or local ablation

  • Kim SivesgaardEmail author
  • Lars P. Larsen
  • Michael Sørensen
  • Stine Kramer
  • Sven Schlander
  • Nerijus Amanavicius
  • Arindam Bharadwaz
  • Dennis Tønner Nielsen
  • Frank Viborg Mortensen
  • Erik Morre Pedersen



To compare the diagnostic performance of contrast-enhanced computed tomography (CE-CT), magnetic resonance imaging (MRI) and combined fluorodeoxyglucose/positron emission tomography/computed tomography (FDG-PET/CT) for detection of colorectal liver metastases (CRLM) in patients eligible for local treatment.

Materials and methods

This health-research ethics-committee-approved prospective consecutive diagnostic accuracy study, with written informed consent, included 80 cases (76 patients, four participating twice) between 29 June 2015 and 7 February 2017. Prior chemotherapy or local treatment did not exclude participation. Combined FDG-PET/CT including CE-CT and MRI was performed within 0–3 days shortly before local treatment. CE-CT and MRI images were read independently by two readers for each modality. The combined FDG-PET/CT images were read independently by two pairs of readers. A composite reference standard was used. Sensitivities, specificities and area under the receiver operating characteristic curves (AUCROC) were calculated and compared.


In total, 260 CRLMs were confirmed. The MRI readers had significantly higher per-lesion sensitivity (85.9% and 83.8%) than both CE-CT readers (69.1% and 62.3%) and both PET/CT reader pairs (72.0% and 72.1%) (p<0.001). There were no significant differences in per-lesion specificity. MRI readers had significantly higher AUCROC (0.92 and 0.88) than both CE-CT readers (0.80 and 0.82) (p≤0.001). AUCROC for MR reader 1 was higher than that of both PET/CT reader pairs (0.83 and 0.84) (p≤0.0001).


MRI performed significantly better than both CE-CT and combined FDG-PET/CT for detection of CRLM in consecutive patients eligible for local treatment irrespective of prior chemotherapy or local treatment.

Key Points

• Patients eligible for local treatment of colorectal liver-metastases require optimal imaging.

• In 80 consecutive patients, MRI had superior per lesion diagnostic performance.

• Findings were independent of prior treatment and type of planned local treatment.

• Equally, MRI had superior diagnostic performance on per segment basis.


Colorectal neoplasms Neoplasm metastasis Magnetic resonance imaging Computed tomography Positron emission tomography computed tomography 



Area under the curve


Colorectal cancer liver metastases


Diffusion-weighted imaging


Fast field echo


Multidisciplinary tumour board


Proton density fat fraction


Receiver operator characteristics


Single shot


Turbo spin echo



This study has received funding by Dansk Kræftforsknings Fond, Riisfort Fonden, Beckett-Fonden and Direktør Emil C Hertz og hustru Inger Hertz’ Fond.

Compliance with ethical standards


The scientific guarantor of this publication is Erik Morre Pedersen, MD, PhD, DMSc.

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

Associate Professor Niels Trolle Andersen, Department of Public Health – Department of Biostatistics, Aarhus University, kindly provided statistical advice regarding the use of the mixed effect logistic regression model.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• diagnostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Kim Sivesgaard
    • 1
    Email author
  • Lars P. Larsen
    • 1
  • Michael Sørensen
    • 2
  • Stine Kramer
    • 3
  • Sven Schlander
    • 1
  • Nerijus Amanavicius
    • 1
  • Arindam Bharadwaz
    • 1
  • Dennis Tønner Nielsen
    • 1
  • Frank Viborg Mortensen
    • 4
  • Erik Morre Pedersen
    • 1
  1. 1.Department of RadiologyAarhus University HospitalAarhusDenmark
  2. 2.Department of Hepatology & GastroenterologyAarhus University HospitalAarhusDenmark
  3. 3.Department of Nuclear Medicine & PET-CentreAarhus University HospitalAarhusDenmark
  4. 4.Department of Surgery (section for upper gastrointestinal and hepato-pancreato-biliary surgery)Aarhus University HospitalAarhusDenmark

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