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
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 will earn the role of the final pre-resection arbiter of tumour burden and metastasis location.
In this study,
there was no improvement in diagnostic performance for "standard + Primovist protocol" sequences over "standard protocol" MRI sequences in both lesion detection and declaring segments free of disease in CRLM patients.
Therefore,
current evidence does not mandate the routine use of gadoxetic acid-enhanced hepatic MRI in the pre-resectional imaging of CRLM patients,
particularly in view of the increased cost and time compared to gadolinium-enhanced hepatic MRI.
Further research is warranted but it is reasonable for radiologists who subjectively find the hepatocyte-specific sequence helpful to use gadoxetic acid-enhanced hepatic MRI