Regular Articles
Ferumoxide-enhanced magnetic resonance imaging techniques in pre-operative assessment for colorectal liver metastases

https://doi.org/10.1053/ejso.2001.1251Get rights and content

Abstract

Aim: The objective was to evaluate whether contrast-enhanced magnetic resonance imaging (MRI) techniques used in a pre-operative assessment protocol for colorectal liver metastases are as accurate as spiral computer tomography during arterial portography (CTAP). Pre-operative accuracy and clinical consequences of MRI are described and compared with CTAP. Moreover, post-operative survival rate and tumour recurrence were studied. Methods: The study group comprised 84 patients which were possible candidates for a partial hepatectomy for colorectal liver metastases. Patients were pre-operatively evaluated by CT of the abdomen, CT of the thorax and spiral CTAP and ferumoxide-enhanced MRI was performed in routine way for all patients. Following this selection, 35 patients underwent a partial hepatectomy with curative intent. All patients were retrospectively evaluated. Results: Ferumoxide-enhanced MRI proved to be at least as accurate as spiral CTAP in 81% of patients. In nine patients (11%) spiral CTAP revealed more intrahepatic lesions than MRI; in only two patients (2%) did these foundings influenced the clinical decision. These patients were considered to have irresectable disease. In seven patients (8%) MRI detected more lesions than spiral CTAP and influenced the clinical decision in three patients (4%) and these did not undergo a laparotomy. The actuarial 3 year overall survival of operated patients was 41% and the actuarial 3 year disease-free survival was 19%. Conclusion: Evaluation of the clinical impact of a pre-operative assessment protocol extended with ferumoxide MRI techniques demonstrated that this non-invasive MRI technique is safe and at least as accurate as spiral CTAP. This MRI technique results in comparable clinical decisions and outcome after hepatectomy. We suggest that the performance of routine contrast-enhanced MRI should instead be used in the pre-operative evaluation of colorectal liver metastases.

References (35)

  • B van Ooijen et al.

    Hepatic resections for colorectal metastases in the Netherlands. A multi-institutional study

    Cancer

    (1992)
  • B Nordlinger et al.

    Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie

    Cancer

    (1996)
  • CB Wood et al.

    A retrospective study of the natural history of patients with liver metastases from colorectal cancer

    Clin Oncol

    (1976)
  • M Oudkerk et al.

    Liver metastases from colorectal carcinoma: detection with continuous CT angiography

    Radiology

    (1992)
  • P Soyer et al.

    Hepatic metastases from colorectal cancer: detection and false-positive findings with helical CT during arterial portography

    Radiology

    (1994)
  • P Soyer et al.

    CT during arterial portography for the preoperative evaluation of hepatic tumors: how, when, and why?

    Am J Roentgenol

    (1994)
  • DA Bluemke et al.

    Nontumorous low-attenuation defects in the liver on helical CT during arterial portography: frequency, location, and appearance

    Am J Roentgenol

    (1995)
  • Cited by (33)

    • The impact of staging laparoscopy prior to hepatic resection for colorectal metastases

      2007, European Journal of Surgical Oncology
      Citation Excerpt :

      The value of these resections is dependant on accurate perioperative imaging to ensure isolated hepatic disease as well as the absence of peritoneal and extrahepatic nodal disease as patients with unresectable extrahepatic disease do not benefit from a liver resection.9 Cross-sectional CT, MRI and very recently PET scanning have been used in the preoperative staging prior to a planed liver resection for colorectal metastatic disease.10–12 However, despite advances in cross-sectional imaging up to 20% of patients with colorectal hepatic metastases have undiagnosed extrahepatic disease and are therefore unsuitable for resection.13

    • Surgical therapy for colorectal metastases to the liver

      2007, Journal of Gastrointestinal Surgery
    • Preoperative Imaging for Metastasectomy

      2007, Surgical Oncology Clinics of North America
      Citation Excerpt :

      CTAP is an invasive procedure requiring arterial catheterization of the superior mesenteric artery or the splenic artery. Multiple studies have shown a similar sensitivity and superior specificity of MRI over CTAP [47,54,55]. A recent small trial of mostly colorectal and breast cancer patients has shown superiority of Gd-MR arterial portography over CTAP in liver lesion sensitivity and specificity [56].

    • Radiological staging of colorectal liver metastases

      2007, Surgical Oncology
      Citation Excerpt :

      Sensitivities with SPIO-enhanced scan have been reported at 95% [37–39]. Limitations of SPIO such as Endorem (Guerbet) include a long infusion time (30 min), which prolongs study time and may be associated with significant side effects, such as low back pain and hypotension that has been reported in 10–15% of patients [38–43]. Mangafodipir trisodium (MnDPDP, TeslaScan, GE Healthcare) is a hepatocytes specific, positive contrast agent, taken up by hepatocytes after intravenous administration and the normal liver parenchyma shows increased signal on T1-weighted images while metastases are hypointense.

    View all citing articles on Scopus
    f1

    Correspondence to: J. R. M. van der Sijp, MD, PhD, VU Medical Centre, Department of Surgery, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Tel: +31-20-4444-535; Fax: +31-20-4444-512; E-mail: [email protected]

    View full text