Masahiro Tanaka1,2, Yoji Kishi3, Minoru Esaki1, Satoshi Nara1, Mototaka Miyake4, Nobuyoshi Hiraoka5, Masato Nagino2, Kazuaki Shimada1. 1. Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan. 2. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 3. Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan. yokishi@ncc.go.jp. 4. Division of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan. 5. Division of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan.
Abstract
BACKGROUND: Gadoxetic acid-enhanced magnetic resonance imaging (MRI) in combination with diffusion-weighted MRI (Gd-EOB-MRI/DWI) has become popular for evaluating colorectal liver metastases (CRLM). This retrospective observational study aimed to determine whether this procedure should be indicated prior to hepatectomy in all patients with CRLM. METHODS: A retrospective survey of relevant data of patients who had undergone hepatectomy for CRLM from 2008 to 2014 was performed. The rates of detection by contrast-enhanced computed tomography (CE-CT) and Gd-EOB-MRI/DWI were evaluated. In addition, relapse-free and overall survivals after primary hepatectomy were compared between patients who had undergone only CE-CT versus those who had undergone both CE-CT and Gd-EOB-MRI/DWI. RESULTS: In all, 419 pathologically confirmed CRLM were resected in 202 hepatectomies in 177 patients. The sensitivity of detection of CRLM was 77 % for CE-CT and 93 % for Gd-EOB-MRI/DWI (P < 0.01). The sensitivity of detection of 1-5, 6-10, and 11-15 mm CRLM by CE-CT was 9.6 % (5/52), 47 % (26/55), and 76 % (57/75), respectively, whereas that by Gd-EOB-MRI/DWI was 54 % (28/52), 91 % (50/55), and 99 % (74/75), respectively; these differences are significant (P < 0.01 for all three groups). Relapse-free (P = 0.99) and overall survival (P = 0.79) did not differ significantly between 37 patients evaluated preoperatively by only CE-CT and 168 patients evaluated by both CE-CT and Gd-EOB-MRI/DWI. CONCLUSION: Gd-EOB-MRI/DWI detects small CRLM (≤15 mm) with higher sensitivity than CE-CT. However, whether Gd-EOB-MRI/DWI should be a routine component of preoperative evaluation remains unclear in terms of survival benefit.
BACKGROUND:Gadoxetic acid-enhanced magnetic resonance imaging (MRI) in combination with diffusion-weighted MRI (Gd-EOB-MRI/DWI) has become popular for evaluating colorectal liver metastases (CRLM). This retrospective observational study aimed to determine whether this procedure should be indicated prior to hepatectomy in all patients with CRLM. METHODS: A retrospective survey of relevant data of patients who had undergone hepatectomy for CRLM from 2008 to 2014 was performed. The rates of detection by contrast-enhanced computed tomography (CE-CT) and Gd-EOB-MRI/DWI were evaluated. In addition, relapse-free and overall survivals after primary hepatectomy were compared between patients who had undergone only CE-CT versus those who had undergone both CE-CT and Gd-EOB-MRI/DWI. RESULTS: In all, 419 pathologically confirmed CRLM were resected in 202 hepatectomies in 177 patients. The sensitivity of detection of CRLM was 77 % for CE-CT and 93 % for Gd-EOB-MRI/DWI (P < 0.01). The sensitivity of detection of 1-5, 6-10, and 11-15 mm CRLM by CE-CT was 9.6 % (5/52), 47 % (26/55), and 76 % (57/75), respectively, whereas that by Gd-EOB-MRI/DWI was 54 % (28/52), 91 % (50/55), and 99 % (74/75), respectively; these differences are significant (P < 0.01 for all three groups). Relapse-free (P = 0.99) and overall survival (P = 0.79) did not differ significantly between 37 patients evaluated preoperatively by only CE-CT and 168 patients evaluated by both CE-CT and Gd-EOB-MRI/DWI. CONCLUSION:Gd-EOB-MRI/DWI detects small CRLM (≤15 mm) with higher sensitivity than CE-CT. However, whether Gd-EOB-MRI/DWI should be a routine component of preoperative evaluation remains unclear in terms of survival benefit.