ABSTRACT
OBJECTIVE: To compare the diagnostic value of gadoxetic acid-enhanced MRI at 3.0 T with 64-row MDCT in the detection of colorectal liver metastases in diffuse fatty infiltration of the liver after neoadjuvant chemotherapy. METHODS: Twenty-three patients with colorectal liver metastases and at moderate to severe steatosis (25-90%) underwent prospectively preoperative tri-phasic MDCT (Somatom Sensation 64, Siemens) and gadoxetic acid-enhanced MRI (3-T Magnetom Trio, Siemens). All patients underwent surgical resection of liver metastases. Intraoperative ultrasound (IOUS) was carried out, which served as the standard of reference, together with histopathology. RESULTS: Overall, 68 metastases (range, 0.4-6 cm; 31/68 metastases [46%] ≤ 1 cm) were found at histology. MDCT detected 49/68 lesions (72%), and MRI 66/68 (97%, p < 0.001). For lesions ≤ 1 cm, MDCT detected only 13/31 (41.9%) and MRI 29/31 (93%, p < 0.001). Eight false-positive lesions were detected by MDCT, seven small lesions by MRI. There was no statistically significant difference between the two modalities in the detection of lesions > 1 cm (p = 0.250). IOUS detected all metastases and revealed two false-positive diagnoses. CONCLUSION: Gadoxetic acid-enhanced 3.0 T MRI is superior to 64-row MDCT in detecting colorectal liver metastases ≤ 1 cm during preoperative staging in patients with liver steatosis. A combination of MRI and IOUS may further improve the outcome of surgical treatment.
Subject(s)
Colorectal Neoplasms/secondary , Fatty Liver/complications , Gadolinium DTPA , Image Enhancement/methods , Magnetic Resonance Imaging/methods , Monitoring, Intraoperative/methods , Multidetector Computed Tomography/methods , Aged , Aged, 80 and over , Biopsy/methods , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/surgery , Contrast Media , Diagnosis, Differential , Fatty Liver/diagnosis , Female , Follow-Up Studies , Hepatectomy , Humans , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Time FactorsABSTRACT
A profound knowledge of the various benign focal hepatic lesions and selection of the most suitable radiological examination modality is essential for achieving an accurate characterization of a hepatic lesion and in turn will determine the further patient management. This will avoid unnecessary agitation to both patient and the referring clinician and limits time-consuming, costly and risky biopsies to an absolute minimum. The following article will discuss the typical and atypical appearances of the most frequent and clinically relevant benign focal hepatic lesions with ultrasound, computed tomography and magnetic resonance imaging.
Subject(s)
Image Enhancement/methods , Image Processing, Computer-Assisted/methods , Liver Diseases/diagnosis , Liver Neoplasms/diagnosis , Liver/pathology , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Ultrasonography/methods , Adenoma, Liver Cell/diagnosis , Adenoma, Liver Cell/pathology , Cholangiopancreatography, Magnetic Resonance/methods , Contrast Media/administration & dosage , Cysts/diagnosis , Cysts/pathology , Diagnosis, Differential , Diffusion Magnetic Resonance Imaging/methods , Focal Nodular Hyperplasia/diagnosis , Focal Nodular Hyperplasia/pathology , Hamartoma/diagnosis , Hamartoma/pathology , Hemangioma/diagnosis , Hemangioma/pathology , Humans , Liver Diseases/pathology , Liver Neoplasms/pathology , Sensitivity and SpecificityABSTRACT
Radiology has gained an exceptional position in medicine because a correct diagnosis is the most crucial issue in determining an accurate and personalized therapeutic strategy. This has a direct influence not only on the individual patient but also on the socio-economic aspects of healthcare services in terms of shortening the time interval to establish a diagnosis and to avoid risk-associated invasive diagnostic methods or long-term, cost-intensive follow-up. Magnetic resonance imaging (MRI) is an excellent example of this which due to continuous technological developments and emerging techniques allows a non-invasive diagnosis of the different hepatic diseases. In this article, we illustrate the direct correlation between the recent technical advances in MRI, such as 3.0 T, diffusion-weighted imaging, perfusion imaging, spectroscopy, texture analysis and MR elastography and obtaining a confident non-invasive diagnosis of focal and diffuse liver diseases.
