Purpose of Review
Colorectal liver metastases affect about half of the patients with colorectal cancer and have an impact on prognosis. Resection of liver metastases, even after downstaging with chemotherapy, improves patient survival. Several imaging modalities are available for initial detection and follow-up of liver metastases. Our purpose is to review the advantages and disadvantages of each modality and to determine which is the optimal way to evaluate colorectal liver metastases in each phase of the patient’s journey.
The available evidence derives mostly from comparative studies and meta-analysis, with only few available randomized trials. MRI with DWI sequences and liver-specific contrast agents appears to be the most accurate modality for the detection of liver metastases.
Different imaging modalities can be used successfully for the detection and follow-up of colorectal liver metastases, depending on the stage of the disease and patient characteristics. A stepwise approach is recommended, instead of using all modalities in each patient.
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Ferlay J, Colombet M, Soerjomataram I, Dyba T, Randi G, Bettio M, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer. 2018;103:356–87.
van der Pool AEM, Damhuis RA, IJzermans JNM, de Wilt JHW, Eggermont AMM, Kranse R, et al. Trends in incidence, treatment and survival of patients with stage IV colorectal cancer: a population-based series. Color Dis. 2012;14:56–61.
Taylor A, Primrose LW, Kelsh MF, Alexander D, Choti M, Poston G, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol. 2012;283.
Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier A-M. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg. 2006;244:254–9.
Kelly C, Cassidy J. Chemotherapy in metastatic colorectal cancer. Surg Oncol. 2007;16:65–70.
Tirumani SH, Kim KW, Nishino M, Howard SA, Krajewski KM, Jagannathan JP, et al. Update on the role of imaging in management of metastatic colorectal cancer. RadioGraphics. 2014;34:1908–28.
Westwood M, Joore M, Grutters J, et al. Contrast-enhanced ultrasound using SonoVue® (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver met. Heal Technol Assess. 2013. https://doi.org/10.3310/hta17160.
Claudon M, Dietrich C, Choi B, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – update 2012. Ultraschall der Medizin - Eur J Ultrasound. 2012;34:11–29.
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 31:1739–1749. **useful meta-analysis comparing liver-specific MRI and CT.
Sica GT, Ji H, Ros PR. CT and MR imaging of hepatic metastases. Am J Roentgenol. 2000;174:691–8.
Schima W. Liver metastases of colorectal cancer: US, CT or MR? Cancer Imaging. 2005;5:S149–56.
Soyer P, Poccard M, Boudiaf M, Abitbol M, Hamzi L, Panis Y, et al. Detection of hypovascular hepatic metastases at triple-phase helical CT: sensitivity of phases and comparison with surgical and histopathologic findings. Radiology. 2004;231:413–20.
Wicherts DA, de Haas RJ, van Kessel CS, Bisschops RHC, Takahara T, van Hillegersberg R, et al. Incremental value of arterial and equilibrium phase compared to hepatic venous phase CT in the preoperative staging of colorectal liver metastases: an evaluation with different reference standards. Eur J Radiol. 2011;77:305–11.
Fowler KJ, Saad NE, Linehan D. Imaging approach to hepatocellular carcinoma, cholangiocarcinoma, and metastatic colorectal cancer. Surg Oncol Clin N Am. 2015;24:19–40.
Zamboni GA, Gourtsoyianni S, Sourlas E, Raptopoulos VD. Value of customized scan timing determined by tracking liver enhancement in oncology patients. J Comput Assist Tomogr. 2009;33:253–8.
Brodoefel H, Tognolini A, Zamboni GA, Gourtsoyianni S, Claussen CD, Raptopoulos V. Standardisation of liver MDCT by tracking liver parenchyma enhancement to trigger imaging. Eur Radiol. 2012;22:812–20.
Löwenthal D, Zeile M, Lim WY, Wybranski C, Fischbach F, Wieners G, et al. Detection and characterisation of focal liver lesions in colorectal carcinoma patients: comparison of diffusion-weighted and Gd-EOB-DTPA enhanced MR imaging. Eur Radiol. 2011;21:832–40.
Koh D-M, Collins DJ, Wallace T, Chau I, Riddell AM. Combining diffusion-weighted MRI with Gd-EOB-DTPA-enhanced MRI improves the detection of colorectal liver metastases. Br J Radiol. 2012;85:980–9.
Merkle EM, Zech CJ, Bartolozzi C, et al (2016) Consensus report from the 7th international forum for liver magnetic resonance imaging. Eur Radiol 26:674–682. *consensus report by an international panel of experts in liver imaging.
Vilgrain V, Esvan M, Ronot M, Caumont-Prim A, Aubé C, Chatellier G. A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. Eur Radiol. 2016;26:4595–615.
Zech CJ, Korpraphong P, Huppertz A, Denecke T, Kim M-J, Tanomkiat W, et al. Randomized multicentre trial of gadoxetic acid-enhanced MRI versus conventional MRI or CT in the staging of colorectal cancer liver metastases. Br J Surg. 2014;101:613–21.
Zech CJ, Justo N, Lang A, Ba-Ssalamah A, Kim M-J, Rinde H, et al. Cost evaluation of gadoxetic acid-enhanced magnetic resonance imaging in the diagnosis of colorectal-cancer metastasis in the liver: results from the VALUE trial. Eur Radiol. 2016;26:4121–30.
Han K, Park SH, Kim KW, Kim HJ, Lee SS, Kim JC, et al. Use of liver magnetic resonance imaging after standard staging abdominopelvic computed tomography to evaluate newly diagnosed colorectal cancer patients. Ann Surg. 2015;261:480–6.
Il KS, Kim D-W, Cho JY, Park J, Lee KH, Son IT, et al. Is MRI of the liver needed during routine preoperative workup for colorectal cancer? Dis colon rectum. 2017;60:936–44.
Ruers TJM, Wiering B, van der Sijp JRM, Roumen RM, de Jong KP, Comans EFI, et al. Improved selection of patients for hepatic surgery of colorectal liver metastases with 18F-FDG PET: a randomized study. J Nucl Med. 2009;50:1036–41.
Moulton C-A, Gu C-S, Law CH, et al. Effect of PET before liver resection on surgical management for colorectal adenocarcinoma metastases. JAMA. 2014;311:1863.
Maffione AM, Lopci E, Bluemel C, Giammarile F, Herrmann K, Rubello D. Diagnostic accuracy and impact on management of 18F-FDG PET and PET/CT in colorectal liver metastasis: a meta-analysis and systematic review. Eur J Nucl Med Mol Imaging. 2015;42:152–63.
Gavra M, Syed R, Fraioli F, Afaq A, Bomanji J. PET/MRI in the upper abdomen. Semin Nucl Med. 2015;45:282–92.
Beiderwellen K, Geraldo L, Ruhlmann V, Heusch P, Gomez B, Nensa F, et al. Accuracy of [18F]FDG PET/MRI for the detection of liver metastases. PLoS One. 2015;10:e0137285.
Karaosmanoglu AD, Onur MR, Ozmen MN, Akata D, Karcaaltincaba M. Magnetic resonance imaging of liver metastasis. Semin Ultrasound, CT MRI. 2016;37:533–48.
Van Cutsem E, Cervantes A, Adam R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016;27:1386–422.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Rectal Cancer V.2.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed May 15th,2019. To view the most recent and c.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colon Cancer V.1.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. Accessed May 15th,2019. To view the most recent and co.
Adam R, De Gramont A, Figueras J, et al. The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist. 2012;17:1225–39.
Robinson PJA. The effects of cancer chemotherapy on liver imaging. Eur Radiol. 2009;19:1752–62.
Spolverato G, Vitale A, Ejaz A, Cosgrove D, Cowzer D, Cillo U, et al. Hepatic resection for disappearing liver metastasis: a cost-utility analysis. J Gastrointest Surg. 2015;19:1668–75.
van Kessel CS, Buckens CFM, van den Bosch MAAJ, van Leeuwen MS, van Hillegersberg R, Verkooijen HM. Preoperative imaging of colorectal liver metastases after neoadjuvant chemotherapy: a meta-analysis. Ann Surg Oncol. 2012;19:2805–13.
Jhaveri K, Cleary S, Audet P, Balaa F, Bhayana D, Burak K, et al. Consensus statements from a multidisciplinary expert panel on the utilization and application of a liver-specific MRI contrast agent (gadoxetic acid). Am J Roentgenol. 2015;204:498–509.
Beckers RCJ, Lambregts DMJ, Lahaye MJ, Rao S-X, Kleinen K, Grootscholten C, Beets GL, Beets-Tan RGH, Maas M (2018) Advanced imaging to predict response to chemotherapy in colorectal liver metastases – a systematic review. HPB 20:120–127. **review of the advanced modalities for predicting response to treatment.
Koh D-M, Scurr E, Collins D, Kanber B, Norman A, Leach MO, et al. Predicting response of colorectal hepatic metastasis: value of pretreatment apparent diffusion coefficients. Am J Roentgenol. 2007;188:1001–8.
Liang H-Y, Huang Y-Q, Yang Z-X, Ying-Ding ZM-S, Rao S-X. Potential of MR histogram analyses for prediction of response to chemotherapy in patients with colorectal hepatic metastases. Eur Radiol. 2016;26:2009–18.
Heijmen L, ter Voert EEGW, Oyen WJG, Punt CJA, van Spronsen DJ, Heerschap A, et al. Multimodality imaging to predict response to systemic treatment in patients with advanced colorectal cancer. PLoS One. 2015;10:e0120823.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.
Wolchok JD, Hoos A, O’Day S, et al. Guidelines for the evaluation of immune therapy activity in solid tumors: immune-related response criteria. Clin Cancer Res. 2009;15:7412–20.
Nishino M, Hatabu H, Hodi FS. Imaging of cancer immunotherapy: current approaches and future directions. Radiology. 2019;290:9–22.
Lubner MG, Smith AD, Sandrasegaran K, Sahani DV, Pickhardt PJ. CT texture analysis: definitions, applications, biologic correlates, and challenges. RadioGraphics. 2017;37:1483–503.
Lubner MG, Stabo N, Lubner SJ, del Rio AM, Song C, Halberg RB, et al. CT textural analysis of hepatic metastatic colorectal cancer: pre-treatment tumor heterogeneity correlates with pathology and clinical outcomes. Abdom Imaging. 2015;40:2331–7.
Beckers RCJ, Lambregts DMJ, Schnerr RS, Maas M, Rao SX, Kessels AGH, et al. Whole liver CT texture analysis to predict the development of colorectal liver metastases—a multicentre study. Eur J Radiol. 2017;92:64–71.
Lee SJ, Zea R, Kim DH, Lubner MG, Deming DA, Pickhardt PJ. CT texture features of liver parenchyma for predicting development of metastatic disease and overall survival in patients with colorectal cancer. Eur Radiol. 2018;28:1520–8.
Rao S-X, Lambregts DM, Schnerr RS, et al. CT texture analysis in colorectal liver metastases: a better way than size and volume measurements to assess response to chemotherapy? United Eur Gastroenterol J. 2016;4:257–63.
Zhang H, Li W, Hu F, Sun Y, Hu T, Tong T. MR texture analysis: potential imaging biomarker for predicting the chemotherapeutic response of patients with colorectal liver metastases. Abdom Radiol. 2019;44:65–71.
ESR. Magnetic resonance fingerprinting - a promising new approach to obtain standardized imaging biomarkers from MRI. Insights Imaging. 2015;6:163–5.
Ma D, Gulani V, Seiberlich N, Liu K, Sunshine JL, Duerk JL, et al. Magnetic resonance fingerprinting. Nature. 2013;495:187–92.
Chen Y, Jiang Y, Pahwa S, Ma D, Lu L, Twieg MD, et al. MR fingerprinting for rapid quantitative abdominal imaging. Radiology. 2016;279:278–86.
Vialle R, Boucebci S, Richer J-P, Velasco S, Herpe G, Vesselle G, et al. Preoperative detection of hepatic metastases from colorectal cancer: prospective comparison of contrast-enhanced ultrasound and multidetector-row computed tomography (MDCT). Diagn Interv Imaging. 2016;97:851–5.
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Zamboni, G., Mazzaro, A. & Mansueto, G. How to Best Image Colorectal Liver Metastases. Curr Colorectal Cancer Rep (2020). https://doi.org/10.1007/s11888-019-00447-x
- Colon cancer
- Liver metastases
- Liver resection
- Chemotherapy follow-up