Detection of liver metastases from colorectal carcinoma: Is there a place for routine computed tomography arteriography?

Background. A prospective evaluation of the liver by preoperative ultrasonography, conventional computed tomography (CT), and continuous CT angiography (CCTA) was performed in 60 patients with primary or secondary colorectal carcinoma. Methods. The standards of reference were palpation of the liver...

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Bibliographic Details
Published in:Surgery 1996-05, Vol.119 (5), p.511-516
Main Authors: van Ooijen, Bart, Oudkerd, Matthijs, Schmitz, Paul I.M., Wiggers, Theo
Format: Article
Language:English
Subjects:
Angiography
Biological and medical sciences
Carcinoma - diagnostic imaging
Carcinoma - pathology
Carcinoma - secondary
Colorectal Neoplasms - diagnostic imaging
Colorectal Neoplasms - pathology
Digestive system
Evaluation Studies as Topic
False Positive Reactions
Female
Humans
Investigative techniques, diagnostic techniques (general aspects)
Liver - diagnostic imaging
Liver Neoplasms - diagnostic imaging
Liver Neoplasms - pathology
Liver Neoplasms - secondary
Male
Medical sciences
Palpation
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Sensitivity and Specificity
Tomography, X-Ray Computed
Ultrasonography
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Summary:Background. A prospective evaluation of the liver by preoperative ultrasonography, conventional computed tomography (CT), and continuous CT angiography (CCTA) was performed in 60 patients with primary or secondary colorectal carcinoma. Methods. The standards of reference were palpation of the liver and intraoperative ultrasonography. The imaging techniques were assessed independently of each other. Results. In 37 patients 105 liver metastases were identified; 23 patients had no metastases. CCTA had a high sensitivity of 94% (99 lesions identified) in contrast to ultrasonography (48%) and conventional CT (52%). The superiority of CCTA was also manifest in lesions less than 1 cm in diameter. However, the high sensitivity was accompanied by a high false-positive rate, particularly because of variations in the perfusion of normal liver parenchyma. Overall, CCTA had the highest accuracy (74%) compared with ultrasonography and CT (both 57%). The data indicate that preoperative ultrasonography and conventional CT have low sensitivity in the detection of liver metastases. Conclusions. Although CCTA seems to be superior to other preoperative imaging techniques, the too low specificity will hamper its routine application in patients with hepatic metastases from colorectal carcinoma.
ISSN:0039-6060
1532-7361
DOI:10.1016/S0039-6060(96)80259-5