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Use of liver magnetic resonance imaging after standard staging abdominopelvic computed tomography to evaluate newly diagnosed colorectal cancer patients

 Kichang Han  ;  Seong Ho Park  ;  Kyung Won Kim  ;  Hyoung Jung Kim  ;  Seung Soo Lee  ;  Jin Cheon Kim  ;  Chang Sik Yu  ;  Seok-Byung Lim  ;  Yo-Sub Joo  ;  Ah Young Kim  ;  Hyun Kwon Ha 
 ANNALS OF SURGERY, Vol.261(3) : 480-486, 2015 
Journal Title
Issue Date
Colorectal Neoplasms/diagnostic imaging ; Colorectal Neoplasms/pathology* ; Contrast Media ; Female ; Humans ; Liver Neoplasms/diagnostic imaging ; Liver Neoplasms/secondary* ; Magnetic Resonance Imaging/methods* ; Male ; Middle Aged ; Neoplasm Staging ; Tomography, X-Ray Computed/methods*
colon cancer ; liver ; magnetic resonance ; metastasis ; MRI ; rectal cancer ; staging
OBJECTIVE: To investigate the impact of liver magnetic resonance imaging (MRI) in staging evaluation of newly diagnosed colorectal cancer patients.

BACKGROUND: No clear guidelines regarding how to use liver MRI in evaluating newly diagnosed colorectal cancer.

METHODS: We included 863 adults who had newly diagnosed colorectal cancer without concomitant malignancies and received portal-phase contrast-enhanced abdominopelvic computed tomography (CT). Patients who had diminutive indeterminate hypoattenuating ["too-small-to-characterize" (TSTC)] hepatic lesions without other suspicious/indeterminate findings (TSTC-liver-on-CT), metastasis-negative hepatic findings (negative-liver-on-CT), and hepatic lesions suspicious or indeterminate for metastasis excluding TSTC lesions as seen on CT were identified. Per-patient rate of hepatic metastasis unsuspected by CT and the diagnostic yield of liver MRI for such lesions were assessed.

RESULTS: There were 261 TSTC-liver-on-CT patients, 464 negative-liver-on-CT patients, and 138 patients with suspicious hepatic findings on CT. Among TSTC-liver-on-CT patients, the rate of hepatic metastasis was 2.2% (5/230, excluding patients without follow-up) and the yield of liver MRI was 3% (3/96). Negative-liver-on-CT patients gave the MRI yield of 0% (0/94). Among negative-liver-on-CT patients, the rate of hepatic metastasis discovered within 6 months of curative surgery was 1.1% (4/350, excluding patients without follow-up) when the liver was cleared by negative CT alone and 2% (2/88, excluding patients without follow-up) when cleared also by negative MRI (P = 0.347). Among the patients who had suspicious hepatic findings on CT, the MRI yield was 25% (19/77).

CONCLUSIONS: The diagnostic yield of liver MRI for hepatic metastasis was very low in newly diagnosed colorectal cancer patients who showed TSTC hepatic lesions or metastasis-negative hepatic findings on CT. Staging liver MRI is likely unnecessary for them.
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Yonsei Authors
Han, Ki Chang(한기창) ORCID logo
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