Diagnostic accuracy of CE-CT, MRI and FDG PET/CT for detecting colorectal cancer liver metastases in patients considered eligible for hepatic resection and/or local ablation
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To compare the diagnostic performance of contrast-enhanced computed tomography (CE-CT), magnetic resonance imaging (MRI) and combined fluorodeoxyglucose/positron emission tomography/computed tomography (FDG-PET/CT) for detection of colorectal liver metastases (CRLM) in patients eligible for local treatment.
Materials and methods
This health-research ethics-committee-approved prospective consecutive diagnostic accuracy study, with written informed consent, included 80 cases (76 patients, four participating twice) between 29 June 2015 and 7 February 2017. Prior chemotherapy or local treatment did not exclude participation. Combined FDG-PET/CT including CE-CT and MRI was performed within 0–3 days shortly before local treatment. CE-CT and MRI images were read independently by two readers for each modality. The combined FDG-PET/CT images were read independently by two pairs of readers. A composite reference standard was used. Sensitivities, specificities and area under the receiver operating characteristic curves (AUCROC) were calculated and compared.
In total, 260 CRLMs were confirmed. The MRI readers had significantly higher per-lesion sensitivity (85.9% and 83.8%) than both CE-CT readers (69.1% and 62.3%) and both PET/CT reader pairs (72.0% and 72.1%) (p<0.001). There were no significant differences in per-lesion specificity. MRI readers had significantly higher AUCROC (0.92 and 0.88) than both CE-CT readers (0.80 and 0.82) (p≤0.001). AUCROC for MR reader 1 was higher than that of both PET/CT reader pairs (0.83 and 0.84) (p≤0.0001).
MRI performed significantly better than both CE-CT and combined FDG-PET/CT for detection of CRLM in consecutive patients eligible for local treatment irrespective of prior chemotherapy or local treatment.
• Patients eligible for local treatment of colorectal liver-metastases require optimal imaging.
• In 80 consecutive patients, MRI had superior per lesion diagnostic performance.
• Findings were independent of prior treatment and type of planned local treatment.
• Equally, MRI had superior diagnostic performance on per segment basis.
KeywordsColorectal neoplasms Neoplasm metastasis Magnetic resonance imaging Computed tomography Positron emission tomography computed tomography
Area under the curve
Colorectal cancer liver metastases
Fast field echo
Multidisciplinary tumour board
Proton density fat fraction
Receiver operator characteristics
Turbo spin echo
This study has received funding by Dansk Kræftforsknings Fond, Riisfort Fonden, Beckett-Fonden and Direktør Emil C Hertz og hustru Inger Hertz’ Fond.
Compliance with ethical standards
The scientific guarantor of this publication is Erik Morre Pedersen, MD, PhD, DMSc.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
Associate Professor Niels Trolle Andersen, Department of Public Health – Department of Biostatistics, Aarhus University, kindly provided statistical advice regarding the use of the mixed effect logistic regression model.
Written informed consent was obtained from all patients in this study.
Institutional Review Board approval was obtained.
• diagnostic study
• performed at one institution
- 6.Berger-Kulemann V, Schima W, Baroud S et al (2012) Gadoxetic acid-enhanced 3.0 T MR imaging versus multidetector-row CT in the detection of colorectal metastases in fatty liver using intraoperative ultrasound and histopathology as a standard of reference. Eur J Surg Oncol 38:670–676CrossRefGoogle Scholar
- 8.Kim HJ, Lee SS, Byun JH et al (2015) Incremental Value of Liver MR Imaging in Patients with Potentially Curable Colorectal Hepatic Metastasis Detected at CT: A Prospective Comparison of Diffusion-weighted Imaging, Gadoxetic Acid-enhanced MR Imaging, and a Combination of Both MR Techniques. Radiology 274:712–722CrossRefGoogle Scholar
- 11.Jhaveri KS, Fischer SE, Hosseini-Nik H et al (2017) Prospective comparison of gadoxetic acid-enhanced liver MRI and contrast-enhanced CT with histopathological correlation for preoperative detection of colorectal liver metastases following chemotherapy and potential impact on surgical plan. HPB (Oxford) 19:992–1000CrossRefGoogle Scholar
- 15.Adam R, De Gramont A, Figueras J et al (2012) The oncosurgery approach to managing liver metastases from colorectal cancer: a multidisciplinary international consensus. Oncologist, In, pp 1225–1239Google Scholar
- 16.Larsen PN, Lysholt C (2011) Kliniske retningslinier for behandling af Kolo-Rektale Levermetastaser (KRLM). Dansk Lever-Galdevejscancer Gruppe. Available via http://gicancer.dk/. Accessed 14 Nov 2017.