Magnetic Resonance Imaging of Liver Metastases

  • G. F. Pistolesi
  • R. Caudana
  • G. Morana
Part of the Medical Radiology book series (MEDRAD)


The presence of liver metastases has a remarkable impact on the survival rate. Such an event is relatively frequent: for instance, hepatic secondaries are found in approximately 40% of patients with colorectal cancer (Ferrucci 1994). In the diagnostic approach to liver metastases, the imaging plays a fundamental role in selecting those patients who can benefit from surgical resection. This treatment, performed with the correct indication, drastically improves the survival rate: 5-year survival rate of 20%–40% for metastases from colorectal carcinoma (Butler et al. 1986; Hughes et el. 1988; Ferrucci and Stark 1990; Fegiz et al. 1991; Scheeleet al. 1991; Nakamura et al. 1992) with a risk of morbidity and mortality of 2%–7% (Holm et al. 1989; Scheele et al. 1991; Vetto et al. 1990). Conversely, in untreated colorectal hepatic metastases, the mean survival rate is drastically reduced (Wagner et al. 1984): 21 months for solitary lesions with a 5-year survival of 16% (Greenway 1988), 15 months for multiple metastases confined within a single liver lobe and 10 months for diffuse involvement of the liver.


Liver Metastasis Weighted Image Hepatic Tissue Focal Nodular Hyperplasia Spin Echo 
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  1. Ackermann (1974) The blood supply of experimental liver metastases. IV. Changes in vascularity with increasing tumor growth. Surgery 75:589–596Google Scholar
  2. Arrive’ L, Lewin M, Wendum D, et a1 (1996) LI’sions hépatiques hyperintenses sur les séquences d’IRM pondérées en Ti. Feuillets de Radiologie 36:205–21.1Google Scholar
  3. Baker ME, Pelley R (1995) Hepatic metastases: basic principles and implications for radiologists. Radiology 197:329–337PubMedGoogle Scholar
  4. Brasch RC (1992) New directions in the development of MR imaging contrast media. Radiology 183:1–11PubMedGoogle Scholar
  5. Bruneton JN, Raffaelli CH, Maestro C, et al (1998) Pathologie tumorale du foie chez le patient porteur d’un cancer. Feuillets de Radiologie 38:91–96Google Scholar
  6. Butler J, Attiyen FF, Daly JM (1986) Hepatic resection for metastases of the colon and rectum. Surg Gynecol O ostet 162:109–113Google Scholar
  7. Caudana R, Morana G, Pirovano G, et al (1996) Focal malignant hepatic lesions: MR imaging enhanced with gadolinium benzyolxipropionictetra-acetate (BOPTA). Preliminary results of phase II clinical application. Radiology 199:513–520PubMedGoogle Scholar
  8. Crooks LE (1991) Some consideration for MR imaging of the liver. Radiology 180:615–616PubMedGoogle Scholar
  9. Fegiz G, Ramacciato G, Gennari L, et a1 (1991) Hepatic resection for colorectal metastases: the Italian multicenter experience. J Surg Oncol 2(S):144–154CrossRefGoogle Scholar
  10. Ferrucci JT (1994) Liver tumor imaging. Current concepts. Radiol Clin North Am 32:39–54PubMedGoogle Scholar
  11. Ferrucci Jt, Stark DD (1990) Liver Imaging. Current trends and new technique. Andover Medical Publisher Inc.Google Scholar
  12. Foley WD, Kneeland JB, Cates JD, et al (1987) Contrast optimization for the detection of focal hepatic lesions by MR imaging at 1.5 T. AJR 149:1155–1160PubMedGoogle Scholar
  13. Fretz CJ, Stark DD, Metz CE, et al (1990) Detection of hepatic metastases: comparison of contrast-enhanced CT, unenhanced MR imaging, and iron-oxide enhanced MR imaging. AIR 155:763–770Google Scholar
  14. Gandon Y, Heautot JF, Brunet F, et al (1991) Super-paramagnetic iron oxide: clinical time response study. Eur J Radiol 12:195–200PubMedCrossRefGoogle Scholar
  15. Greenway B (1988) Hepatic metastases from colorectal cancer: resection or not? Br J Surg 75:513–519PubMedCrossRefGoogle Scholar
  16. Grellet J, Bellin MF, Dion E, et al (1993) Techniques d’IRM appliquées au diagnostic des tumeurs hepatiques. I Radiol 74:67–76Google Scholar
  17. Hagspiel KD, Neidl KFW, Eichenberger AC, et al (1995) Detection of liver metastases: comparison of superparamagnetic iron-oxide enhanced and unenhanced MR imaging at 1.5 T with dynamic CT, intra-operative US, and percutaneous US. Radiology 196:471–478PubMedGoogle Scholar
  18. Hamm B, Fischer E, Taupitz M (1990) Differentiation of hepatic hemangiomas from metastases by dynamically contrast enhanced MR Imaging. J Comput Assist Tomogr 14:205–216PubMedCrossRefGoogle Scholar
  19. Hamm B, Vogl TJ, Branding GM, et al (1992) Focal liver lesions: MR imaging with Mn-DPDP. Initial clinical results in 40 Patients. Radiology 182:167–174PubMedGoogle Scholar
  20. Hamm B, Thoeni RFL, Gould RG, et al (1994) Focal liver lesions: characterization with unenhanced and dynamic contrast enhanced MR Imaging. Radiology 190:417–423PubMedGoogle Scholar
  21. Hamm B, Starks T. Muhler A, et al (1995) Phase I clinical evaluation of Gd-EOB-DTPA as a hepatobiliary MR contrast agent: safety, pharmacokinetics, and MR imaging. Radiology 195:785–792PubMedGoogle Scholar
  22. Hamm B, Mahfouz AE, Taupitz M, et al (1997) Liver metastases: improved detection with dynamic gadolinium-enhanced MR imaging? Radiology 202:677–682PubMedGoogle Scholar
  23. Hendrick RE (1988) Contrast and noise. In: Stark DD, Bradley WG (eds) Magnetic Resonance Imaging. The C.V. Mosby Company, St Louis, pp 66–83Google Scholar
  24. Holm A, Bradley E, Aldrete J (1989) Hepatic resection of metastases from colorectal carcinoma: morbidity, mortality, and pattern recurrence. Ann Surg 209:428–434PubMedCrossRefGoogle Scholar
  25. Hughes KS, Rosenstein RB, Songhorabody F, et al (1988) Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Dis Colon Rectum 31:1–4PubMedCrossRefGoogle Scholar
  26. Ichikawa T, Haradome H, Hachiya J, et al (1998) Diffusion-weighted MR Imaging with a single shot echoplanar se-quence: detection and characterization of focal hepatic lesions. AIR 170:397–402Google Scholar
  27. Jones EC, Chezmar JR, Nelson RC, et al (1992) The frequency and significance of small (<15 mm) hepatic lesions detected by CT. AIR 158:535–539Google Scholar
  28. Jung G, Krahe T, Kugel H, et al (1997) Prospective comparison of fast SE and GRASE sequences and Echo Planar imaging with conventional SE sequences in the detection of focal liver lesions at 1.0 T. I Comput Assist Tomogr 21:341–347CrossRefGoogle Scholar
  29. Kan Z, Ivancev K, Lunderquist A, et al (1993) In vivo microscopy of hepatic tumors in animal models: a dynamic investigation of blood supply to hepatic metastases. Radiology 187:621–626PubMedGoogle Scholar
  30. Karhunen PJ (1986) Benign hepatic tumors and tumor-like conditions in men. J Clin Pathol 39:183–188PubMedCrossRefGoogle Scholar
  31. Katsuyoshi I, Kazumitsu H, Takeshi F, et al (1996) Liver neoplasms. Diagnostic pitfalls in cross-sectional imaging. RadioGraphics 16:273–293Google Scholar
  32. Kopp AF, Laniado M, Dammann F (1997) MR Imaging of the liver with Resovist: safety, efficacy, and pharmacodynamic properties. Radiology 204:749–756PubMedGoogle Scholar
  33. Larson RE, Semelka RC, Bagley AS, et al (1994) Hyper-vascular malignant liver lesions: comparison of various MR imaging pulse sequences and dynamic CT. Radiology 192:393–399PubMedGoogle Scholar
  34. Lauffer RB (1996) MRI contrast agents: basic principles. In: Edelmann RR, Zlatkin MB, Hesselink JR (eds) Clinical Magnetic Resonance Imaging, 2nded.,vol 1,W.B. Saunders, Philadelphia, pp 177–191Google Scholar
  35. Lim KO, Stark DD, Leese PT, et a1 (1991) Hepatobiliary MR imaging: first human experience with Mn-DPDP. Radiology 178:79–82PubMedGoogle Scholar
  36. Lin G, Lunderquist A, Hagerstrandt I, et al(1984) Postmortem examination of the blood supply and vascular pattern of small liver metastases in man. Surgery 96:517–526PubMedGoogle Scholar
  37. Low RN, Francis IR, Sigeti JS, et al (1993) Abdominal MR imaging: comparison of T2-weighted fast and conventional Spin-Echo, and contrast-enhanced fast ultiplanar spoiled gradient-recalled Imaging. Radiology 186:803-811PubMedGoogle Scholar
  38. Machi J, Isomoto H, Kurohiji T, et a1 (1991) Accuracy of intraoperative ultrasound in diagnosing liver metastases from colorectal cancer: evaluation with post-operative follow-up results. World J Surg 15:551–557PubMedCrossRefGoogle Scholar
  39. Mahfouz AE, Hamm B, Wolf KJ (1994) Peripheral wash-out: a sign of malignancy on dynamic gadolinium enhanced MR images of focal liver lesions. Radiology 190: 49–52PubMedGoogle Scholar
  40. Mahfouz AE, Hamm B, Mathieu D (1996) Imaging of metastases to the liver. Eur Radiol 6:607–614PubMedCrossRefGoogle Scholar
  41. Mirowitz SA, Lee JKT, Gutierrez E, et al (1991) Dynamic Gadolinium-enhanced rapid acquisition spin-echo MR imaging of the liver. Radiology 179:371–376PubMedGoogle Scholar
  42. Mitchell DG (1994) Focal hepatic lesions: the continuing search for the optimal MR imaging pulse sequences. Radiology 193:17–18PubMedGoogle Scholar
  43. Mitchell DG, Saini S, Weinreb J, et al (1994) Hepatic metastases and cavernous hemangiomas: distinction with standard-and triple-dose gadoteridol-enhanced MR imaging. Radiology 193:49–57PubMedGoogle Scholar
  44. Nakamura S, Yokoi Y, Suzuki S, et al (1992) Results of extensive surgery for liver metastases in colorectal carcinoma. Br J Surg 79:35–38PubMedCrossRefGoogle Scholar
  45. Outwater EK, Tomaszewski E, Daly JM, et al (1991) Hepatic colorectal metastases: correlation of MR imaging and pathologic appearance. Radiology 180:327–332PubMedGoogle Scholar
  46. Outwater EK, Mitchell DG, Vinitski S (1994) Abdominal MR imaging: evaluation of a fast spin echo sequence. Radiology 190:425–429PubMedGoogle Scholar
  47. Reimer P, Rummeny EJ, Shamsi K, et al (1996) Phase II clinical evaluation of Gd-EOB-DTPA: dose, safety, aspects, and pulse sequence. Radiology 199:177–183PubMedGoogle Scholar
  48. Reinig JW, Dwyer AJ, Miller DL, et al (1989) Liver metastases: detection with MR Imaging at 0.5 and 1.5 T. Radiology 170:149–153PubMedGoogle Scholar
  49. Ros PR, Freeny PC, Harms SE, et al (1995) Hepatic MR imaging with ferumoxide: a multicentric clinical trial of the safety and efficacy in the detection of focal hepatic lesions. Radiology 196:481–488PubMedGoogle Scholar
  50. Rummeny EJ, Wernecke K, Saini S, et al (1992) Comparison between high field strenght MR imaging and CT for screening of hepatic metastases: a receiver operating characteristic analysis. Radiology 182:879–886PubMedGoogle Scholar
  51. Rydberg JN, Lomas DJ, Coakley KJ, et al (1995) Comparison of breath-hold fast spin-echo pulse sequences for T2-weighted MR imaging of liver lesions. Radiology 194:431437Google Scholar
  52. Saini S (1992) Contrast-enhanced MR imaging of the liver. Radiology 182:12–14PubMedGoogle Scholar
  53. Saini S, Nelson RC (1995) Technique for MR imaging of the liver. Radiology 197:575–577PubMedGoogle Scholar
  54. Saini S, Reimer P, Hahn PF, et al (1994) Echo-planar MR imaging of the liver in patients with focal hepatic lesions: quantitative analysis of images made with various sequences. AIR 163:1389–1393Google Scholar
  55. Scheele J, Stangl R, Altendorf-Hofmann A, et al (1991) Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 110:13–29PubMedGoogle Scholar
  56. Schulz W, Borchard F (1992) Größe der Lebermetastasen bei geringer metasrasenzahl. Eine quantitative studie an postmortalen lebern. Röfo Fortschr Geb Roentgenstr Neuen Bildgeb Verfahr 156:320–424CrossRefGoogle Scholar
  57. Schumann-Gianpieri G (1993) Liver contrast media for magnetic resonance imaging: interrelations between pharmacokinetics and imaging. Invest Radiol 28:753–756CrossRefGoogle Scholar
  58. Schwartz LH, Seltzer SE, Tempany CMC, et al (1993) Prospective comparison of T2-weighted fast spin-echo, with and without fat suppression, and conventional spin-echo pulse sequences in the upper abdomen. Radiology 189:411–416PubMedGoogle Scholar
  59. Semelka RC, Kelekis NL (1997) Liver. In: Semelka RC, Ascher SM, Reinhold C (eds) MRI of the abdomen and pelvis. Wiley-Liss, New York, pp 19–135Google Scholar
  60. Semelka RC, Mitchell DG (1996) Liver and biliary system. In: Edelman RR, Zlatkin MB, Hesselink JR (eds) Clinical magnetic resonance imaging, Vol 2. WB Saunders, Philadelphia, pp 1466–1512Google Scholar
  61. Semelka RC, Simm FC, Recht M, et al (1991) T1-weighted sequences for MR imaging of the liver: comparison of three techniques for single-breath, whole-volume acquisition at 1.0 and 1.5 T. Radiology 180:629–635PubMedGoogle Scholar
  62. Semelka RC, Shoenut JP, Kroeker MA, et al (1992) Focal liver disease: comparison of dynamic contrast-enhanced CT and T2-weighted fat-suppressed, FLASH, and dynamic gadolinium-enhanced MR imaging at 1.5 T. Radiology 184:687–694PubMedGoogle Scholar
  63. Semelka RC, Cumming MJ, Shoenut JP, et al (1993a) Islet cell tumors: comparison of dynamic contrast enhanced CT and MR imaging with dynamic gadolinium enhancement and fat suppression. Radiology 186:799–802Google Scholar
  64. Semelka RC, Hricak H, Bis KG, Werthmuller C, et al (1993b) Liver lesion detection: comparison between excitation-spoiling fat suppression and regular spin-echo at 1.5 T Abdom Imaging 18:56–60CrossRefGoogle Scholar
  65. Semelka RC, Bagley AS, Brown ED, et al (1994) Malignant lesions of the liver identified on T1 - but not T2 - weighted MR images at 1.5 T. JMRI 4:315–318PubMedCrossRefGoogle Scholar
  66. Seneterre E, Taourel P. Bouvier Y, et al (1996) Detection of hepatic metastases: ferumoxide-enhanced MR imaging versus unenhanced MR imaging and CT during arterial portography. Radiology 200:785–792PubMedGoogle Scholar
  67. Siewert B, Muller MF, Foley M, et al (1994) Fast MF. Imaging of the liver: quantitative comparison of the techniques. Radiology 193:37–42PubMedGoogle Scholar
  68. Soyer P, Levesque M, Elias D, et al (1992) Detectioi of liver metastases from colorectal cancer: comparison of intra-operative US and CT during arterial portography. Radio1-ogy 183:541–544Google Scholar
  69. Soyer P, Levesque M, Caudron C, et al (1993) MR] of liver metastases from colorectal cancer vs CT during arterial portography. I Comput Assist Tomogr 17:67–74CrossRefGoogle Scholar
  70. Stark DD, Wittenberg J, Rodney JB, et al (1987) Hepatic metastases: randomized, controlled comparison of detection. with MR Imaging and CT. Radiology 165:399–40ißPubMedGoogle Scholar
  71. Steele G Jr, Bleday R, Mayer R, et al (1991) A prospective evaluation of hepatic resection for colorectal ca:-cinorna metastases to the liver: Gastrointestinal Tumor Study Group protocol 6584.1 Clin Oncol 9:1105–1112Google Scholar
  72. Strotzer M, Gmeinwieser J, Schmidt J, et al (1997) Diagnosis of liver metastases from colorectal carcinoma. Comparison of spiral-CTAP combined with intra-venous contrast-enhanced spiral-CT and SPIO-enhanced MR co nbined with plain MR imaging. Acta Radiol 38:986–992PubMedGoogle Scholar
  73. Sugarbaker PH (1990) Surgical decision making for large bowel cancer metastatic to the liver. Radiology 174:621–626PubMedGoogle Scholar
  74. Taupitz M, Speidel A, Hamm B, et al (1995) T2-weighted breath-hold MR Imaging of the liver at 1.5 T: results with a three-dimensional steady-state free precession sequence in 87 patients. Radiology 194:439–446PubMedGoogle Scholar
  75. van Beers B, Demeure R, Pringot, et al (1990) Dynamiz spin-echo imaging with Gd-DTPA: value in the differentiation of hepatic tumors. AJR 154:515–519PubMedGoogle Scholar
  76. Vassiliades VG, Foley WD, Alarcon J, et al (1991) Hepatic me - tastases: CT versus MR imaging at 1.5 T. Gastrointest Radiol 16:159–163PubMedCrossRefGoogle Scholar
  77. Vetto JT, Hughes KS, Rosenstein R, et al (1990) Morbidity and. mortality of hepatic resection for metastatic colorectal carcinoma. Dis Colon Rectum 33:408–413PubMedCrossRefGoogle Scholar
  78. Vogl TJ, Pegios W, Mcmahon C, et al (1992) Gadotenate dimeglumine. A new contrast agent for MR imaging: preliminary evaluation in healthy volunteers. AIR 158:887-892Google Scholar
  79. Wagner IS, Adson MA, Van Heerden JA, et al (1984) The natural history of hepatic metastases from colorectal cancer. Ann Surg 199:502–508PubMedCrossRefGoogle Scholar
  80. Wang C, Ahlstrom H, Ekholm S, et al (1998) Diagnostic efficacy of Mn-DPDP in MR imaging of the liver. A pha,,e III multicentre study. Acta Radiol 38:643–649Google Scholar
  81. Weisskoff RM, Edelman RR (1996) Basic principles of MRI. In: Edelman RR, Zlatkin MB, Hesselink JR (eds) Cli iicalmagnetic resonance imaging, Vol 1. WB Saunders, Philadelphia, pp 3–51Google Scholar
  82. Weissleder R, Stark DD, Engelstad B, et al (1989) Superparamagnetic iron oxide pharmacokinetics and toxicity. AJR 152:167–173PubMedGoogle Scholar
  83. Wernecke K, Rummeny E, Bongartz G, et al (1991) Detection of hepatic masses in patients with carcinoma: comparative sensitivities of sonography, CT, and MR imaging. AJR 157:731–739PubMedGoogle Scholar
  84. Withney WS, Herfkens RJ, Jeffrey RB, et al (1993) Dynamic breath-hold multiplanar spoiled gradient-recalled MRimaging with gadolinium enhancement for differentiating hepatic hemangiomas from malignancies at 1.5 T. Radiology 189:863–870Google Scholar
  85. Wittenberg J, Stark DD, Forman PF, et al (1988) Differentiation of hepatic metastases from hepatic hemangiomas and cysts by using MR imaging. AJR 151:79–84PubMedGoogle Scholar
  86. Zerhouni EA, Rutter C, Hamilton SR, et al (1996) CT and MR imaging in the staging of colorectal carcinoma: report of the Radiology Diagnostic Oncology Group II. Radiology 200:443–451PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1999

Authors and Affiliations

  • G. F. Pistolesi
    • 1
  • R. Caudana
    • 1
  • G. Morana
    • 1
  1. 1.Department of RadiologyUniversity of Verona, Borgo Roma HospitalVeronaItaly

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