ROC comparison of standard enhanced MRI with and without an hepatocyte-specific gadoxetic acid (Primovist) phase in the detection of colorectal liver metastases

Congress:

ECR 2011

Poster Number:

C-1550

Type:

Scientific Paper

Keywords:

Contrast agents, MR, Contrast agent-intravenous, Diagnostic procedure, Imaging sequences, Metastases, Tissue characterisation, Liver

Authors:

V. O. Chan¹, J. Ryan², J. F. Gerstenmaier¹, C. Hegarty¹, C. Cantwell¹, E. J. Heffernan¹, R. Gibney¹, S. Skehan¹, D. E. Malone¹; ¹Dublin/IE, ²Sydney/AU

DOI:

10.1594/ecr2011/C-1550

DOI-Link:

https://dx.doi.org/10.1594/ecr2011/C-1550

Fig. 1: Large low signal intensity CRLM in segment 7/8 on the T1W in phase sequence.

Fig. 2: Segment 7/8 CRLM does not demonstrate signal drop out on the T1W out of phase...

Fig. 3: The T2W short TE (TE 72) sequence demonstrates the CRLM with heterogenous...

Fig. 4: The T2W long TE (TE 389) sequence shows central necrosis of the CRLM and no...

Purpose

To determine whether hepatic MRI using "standard plus Primovist protocol" sequences improve diagnostic performance over "standard protocol" sequences alone in lesion detection and declaring liver segments free of disease during the pre-resection work-up of patients with colorectal liver metastases.

Methods and Materials

Retrospective study on consecutive patients with colorectal liver metastases (CRLM) over an 18-month period (July 2006 - December 2007). To assess tumour burden, each patient underwent MDCT thorax/abdomen/pelvis, PET/CT and liver MRI. This study looks at the liver MR imaging only which consisted of unenhanced sequences (T1W IP/OP, T1W 3D GRE + FS, dual echo T2W, T2W + FS) (Figures 1 - 5), dynamic T1W 3D GRE + FS multiphase gadolinium-enhanced sequences at 20s/60s/120s (Figures6 - 9) and 20 mins delayed T1W 3D GRE +...

Results

A total of 52 confirmed CRLM in 17 patients were included in the study. CRLM size ranged from 0.3 - 9 cm (mean 2.7 cm). CRLM in all hepatic segments were represented. Eight patients had a solitary CRLM, while 9 patients had 4 - 6 CRLM. Individual sensitivity, specificity and AUC values for each of the 6 readers for both the "standard protocol" sequences and "standard + Primovist protocol" sequences are shown in figures 1 and 2, respectively. IndividualROC curves for each of the 6...

Conclusion

The relative roles of MDCT, PET/CT and MRI in pre-resectional imaging of CRLM patients are evolving with significant impact both on lesion detection and on resection planning [3]. Despite the early high impact of PET/CT, many patients with hepatic CRLM now referred for assessment of resectibility have received "down-staging" advanced chemotherapy which, in our experience, may reduce metabolic activity and conspicuity of small metastases on PET/CT [4]. In addition, chemotherapy causes hepatic steatosis and decreases the sensitivity of contrast-enhanced MDCT. It seems likely that MRI...

References

1. Eng J. ROC analysis: web-based calculator for ROC curves. Baltimore: Johns Hopkins University [updated 2006 May 17; cited 2009 Dec 5]. 2. Dorfman DD, Berbaum KS, Metz CE. Receiver operating characteristic rating analysis: Generalization to the population of readers and patients with the jackknifemethod. Investigative Radiology 1992;27:723-731. 3. Niekel MC, Bipat S, Stoker J. Imaging for colorectal liver metastases - a meta-analysis. Annals of Oncology 2010;21(S1):37. 4. Chan VO, McDermott S, Das JP, TA Bangash, Latif A, Geoghegan J, Collins CD, Skehan SJ, Malone...

Personal Information

VO Chan, J Gerstenmaier, S McDermott, C Hegarty: Specialist Registrars in the training programme of the Faculty of Radiologists, RCSI, Dublin. J Ryan: Senior Lecturer/Course Director (GEM), Medical Radiation Science, Brain and Mind Institute, University of Sydney, Australia. S Kearney: Final year medical student in University College Dublin. CP Cantwell, E Heffernan: Consultant Radiologists, St. Vincent's University Hospital and Junior Clinical Lecturers, University College Dublin. RG Gibney, SJ Skehan: Consultant Radiologists, St. Vincent's University Hospital and Senior Clinical Lecturers, University College Dublin. DE Malone: Consultant...