Impact of baseline gadoxetic acid-enhanced liver magnetic resonance and diffusion-weighted imaging in resectable colorectal liver metastases: A prospective, monocentric study

Liver magnetic resonance imaging (MRI) utilizing hepatocyte-specific contrast agent and diffusion-weighted imaging (DWI) is currently used to properly stage colorectal liver metastases (CRLM) in patients candidate to liver surgery. However, the added value of liver MRI in choosing the treatment stra...

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Published in:Surgical oncology 2022-09, Vol.44, p.101836-101836, Article 101836
Main Authors: Moretto, Roberto, Borelli, Beatrice, Boraschi, Piero, Roffi, Nicolò, Donati, Francescamaria, Antoniotti, Carlotta, Della Pina, Clotilde, Colombatto, Piero, Balestri, Riccardo, Signori, Stefano, Gigoni, Roberto, Guidoccio, Federica, Volterrani, Duccio, Masi, Gianluca, Cremolini, Chiara, Urbani, Lucio
Format: Article
Language:English
Subjects:
Chemotherapy
Computed tomography
Contrast agents
Diffusion
Hepatectomy
Hepato-specific contrast-enhanced magnetic resonance imaging
Hypotheses
Liver
Magnetic resonance imaging
Medical imaging
Metastases
Metastasis
Multidisciplinary teams
Nuclear medicine
Null hypothesis
Oxaliplatin
Patients
Perioperative chemotherapy
Resectable colorectal liver metastases
Resonance
Surgery
Tumors
Veins & arteries
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Summary:Liver magnetic resonance imaging (MRI) utilizing hepatocyte-specific contrast agent and diffusion-weighted imaging (DWI) is currently used to properly stage colorectal liver metastases (CRLM) in patients candidate to liver surgery. However, the added value of liver MRI in choosing the treatment strategy in resectable CRLM over computed tomography (CT)-scan is not clear. This is a prospective monocentric collection of consecutive cases of patients with CRLM conceived with the aim to assess the added value of liver MRI in changing the initial treatment strategy planned according to CT-scan. Potential changes in the initially planned strategy were defined as: - from upfront surgery to perioperative chemotherapy (fluoropyrimidine and oxaliplatin) - from upfront surgery to first-line systemic therapy (doublet or triplet plus a biological agent) - from perioperative chemotherapy to first-line systemic therapy. Hypothesising that MRI may induce a change in the choice of the treatment strategy in the 20% of cases (alternative hypothesis), against a null hypothesis of 5%, with one-tailed alpha and beta errors of 0.05 and 0.20 respectively, 27 patients were needed. The added value of liver MRI would have been considered clinically meaningful if at least 4 changes in the treatment strategy were observed. Among 27 enrolled patients, upfront surgery and perioperative chemotherapy strategies were chosen in 17 (63%) and 10 (37%) cases, respectively, based on CT-scan. After liver MRI, additional liver lesions were found in 8 patients (30%) and the initial strategy was changed in 7 patients (26%) (4 initially deemed candidate to upfront surgery and 3 initially sent to perioperative chemotherapy) that were treated with first-line systemic therapy. Our results support the indication of the current guidelines on the routine use of liver MRI in the initial workup of patients with resectable CRLM with an MRI-driven changes of initial treatment plan in a relevant percentage of cases. •Initial hepatocyte-specific contrast-enhanced MRI and DWI may detect additional liver lesions than CTscan.•MRI causes change of the therapeutic plan established with CTscan alone in a relevant group of patients with resectable CRLM.•Liver MRI should be routinely used in the initial workup of patients with resectable CRLM.
ISSN:0960-7404
1879-3320
DOI:10.1016/j.suronc.2022.101836