Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting

Vincenza Granata, Roberta Fusco, Antonio Avallone, Antonino Cassata, Raffaele Palaia, Paolo Delrio, Roberta Grassi, Fabiana Tatangelo, Giulia Grazzini, Francesco Izzo, Antonella Petrillo, Vincenza Granata, Roberta Fusco, Antonio Avallone, Antonino Cassata, Raffaele Palaia, Paolo Delrio, Roberta Grassi, Fabiana Tatangelo, Giulia Grazzini, Francesco Izzo, Antonella Petrillo

Abstract

Background: MRI is the most reliable imaging modality that allows to assess liver metastases. Our purpose is to compare the per-lesion and per-patient detection rate of gadoxetic acid-(Gd-EOB) enhanced liver MRI and fast MR protocol including Diffusion Weighted Imaging (DWI) and T2-W Fat Suppression sequence in the detection of liver metastasis in pre surgical setting.

Methods: One hundred and eight patients with pathologically proven liver metastases (756 liver metastases) underwent Gd-EOBMRI were enrolled in this study. Three radiologist independently graded the presence of liver lesions on a five-point confidence scale assessed only abbreviated protocol (DWI and sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) fat suppressed sequence) and after an interval of more than 2 weeks the conventional study (all acquired sequences). Per-lesion and per-patient detection rate of metastases were calculated. Weighted к values were used to evaluate inter-reader agreement of the confidence scale regarding the presence of the lesion.

Results: MRI detected 732 liver metastases. All lesions were identified both by conventional study as by abbreviated protocol. In terms of per-lesion detection rate of liver metastasis, all three readers had higher detection rate both with abbreviated protocol and with standard protocol with Gd-EOB (96.8% [732 of 756] vs. 96.5% [730 of 756] for reader 1; 95.8% [725 of 756] vs. 95.2% [720 of 756] for reader 2; 96.5% [730 of 756] vs. 96.5% [730 of 756] for reader 3). Inter-reader agreement of lesions detection rate between the three radiologists was excellent (k range, 0.86-0.98) both for Gd-EOB MRI and for Fast protocol (k range, 0.89-0.99).

Conclusion: Abbreviated protocol showed the same detection rate than conventional study in detection of liver metastases.

Figures

Fig 1. Flow chart of included and…
Fig 1. Flow chart of included and excluded patients.
Fig 2. Woman 54 y with right…
Fig 2. Woman 54 y with right colon cancer.
Pre surgical MRI study: In A (SPACE FS T2-W sequence) white arrow shows parenchymal metastasis and yellow arrow shows subcapsular lesion. Parenchimal lesion is not detected by HAlf fourier Single- shot Turbo spin-Echo (HASTE) T2-W sequence (in B) while subcapsular lesion is detected. In EOB phase contrast study the metastases appear as hypointense lesions with restricted diffusion in DWI sequences and hypointense signal in ADC map (D, E and F).
Fig 3. Man 63 y with rectal…
Fig 3. Man 63 y with rectal cancer.
Pre surgical MRI study: In A (SPACE FS T2-W sequence) arrow shows subcapsular lesion. HASTE T2-W sequence (in B) does not detect the lesion, while is preset an indirect sign (capsular retraction), arrow. In EOB phase contrast study the metastasis appear as hypointense lesion with restricted diffusion in DWI sequences and hypointense signal in ADC map (D, E and F).
Fig 4. Woman 48 y with left…
Fig 4. Woman 48 y with left colon cancer.
Pre surgical MRI study: In A (SPACE FS T2-W sequence) arrow shows subcapsular lesion. HASTE T2-W sequence (in B) does not detect the lesion, arrow. In EOB phase contrast study the metastasis appear as hypointense lesion without restricted diffusion in DWI sequences (D, E and F).

References

    1. Granata V, Fusco R, Avallone A, Catalano O, Piccirillo M, Palaia R, et al. A radiologist’s point of view in the presurgical and intraoperative setting of colorectal liver metastases. Future Oncol. 2018. September;14(21):2189–2206. 10.2217/fon-2018-0080
    1. Granata V, Fusco R, de Lutio di Castelguidone E, Avallone A, Palaia R, Delrio P, et al. Diagnostic performance of gadoxetic acid-enhanced liver MRI versus multidetector CT in the assessment of colorectal liver metastases compared to hepatic resection. BMC Gastroenterol. 2019. July 24;19(1):129 10.1186/s12876-019-1036-7
    1. Izzo F, Granata V, Grassi R, Fusco R, Palaia R, Delrio P, et al. Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update. Oncologist. 2019. October;24(10): e990–e1005. 10.1634/theoncologist.2018-0337
    1. Granata V, Fusco R, Venanzio Setola S, Mattace Raso M, Avallone A, De Stefano A, et al. Liver radiologic findings of chemotherapy-induced toxicity in liver colorectal metastases patients. Eur Rev Med Pharmacol Sci. 2019. November;23(22):9697–9706. 10.26355/eurrev_201911_19531
    1. Granata V, Fusco R, Setola SV, Castelguidone ELD, Camera L, Tafuto S, et al. The multidisciplinary team for gastroenteropancreatic neuroendocrine tumours: the radiologist’s challenge. Radiol Oncol. 2019. October 25;53(4):373–387. 10.2478/raon-2019-0040
    1. Granata V, Catalano O, Fusco R, Tatangelo F, Rega D, Nasti G, et al. The target sign in colorectal liver metastases: an atypical Gd-EOB-DTPA “uptake” on the hepatobiliary phase of MR imaging. Abdom Imaging 2015; 40:2364–71. 10.1007/s00261-015-0488-7
    1. Granata V, Fusco R, Maio F, Avallone A, Nasti G, Palaia R, et al. Qualitative assessment of EOB-GD-DTPA and Gd-BT-DO3A MR contrast studies in HCC patients and colorectal liver metastases. Infect Agent Cancer. 2019. November 27;14:40 10.1186/s13027-019-0264-3
    1. Granata V, Fusco R, Catalano O, Avallone A, Palaia R, Botti G, et al. Diagnostic accuracy of magnetic resonance, computed tomography and contrast enhanced ultrasound in radiological multimodality assessment of peribiliary liver metastases. PLoS One 2017; 12:e0179951 10.1371/journal.pone.0179951
    1. Granata V, Fusco R, Catalano O, et al. Early assessment of colorectal cancer patients with liver metastases treated with antiangiogenic drugs: the role of intravoxel incoherent motion in diffusion-weighted imaging. PLoS One 2015; 10:e0142876 10.1371/journal.pone.0142876
    1. Granata V, Fusco R, Filice S, Incollingo P, Belli A, Izzo F, et al. Comment on "State of the art in magnetic resonance imaging of hepatocellular carcinoma": the role of DWI. Radiol Oncol. 2019. July 13;53(3):369–370. 10.2478/raon-2019-0031
    1. Granata V, Fusco R, Reginelli A, Delrio P, Selvaggi F, Grassi R, et al. Diffusion kurtosis imaging in patients with locally advanced rectal cancer: current status and future perspectives. J Int Med Res. 2019. June;47(6):2351–2360. 10.1177/0300060519827168
    1. Chen ZG, Xu L, Zhang SW, Huang Y, Pan RH. Lesion discrimination with breath-hold hepatic diffusion-weighted imaging: a meta-analysis. World J Gastroenterol. 2015. February 7;21(5):1621–7. 10.3748/wjg.v21.i5.1621
    1. Xiong H, Zeng YL. Standard-b-Value Versus Low-b-Value Diffusion-Weighted Imaging in Hepatic Lesion Discrimination: A Meta-analysis. J Comput Assist Tomogr. 2016. May-Jun;40(3):498–504. 10.1097/RCT.0000000000000377
    1. Wei C, Tan J, Xu L, Juan L, Zhang SW, Wang L, et al. Differential diagnosis between hepatic metastases and benign focal lesions using DWI with parallel acquisition technique: a meta-analysis. Tumour Biol. 2015. February;36(2):983–90. 10.1007/s13277-014-2663-9
    1. Kim SS, Kim SH, Song KD, Choi SY, Heo NH. Value of gadoxetic acid-enhanced MRI and diffusion-weighted imaging in the differentiation of hypervascular hyperplastic nodule from small (<3 cm) hypervascular hepatocellular carcinoma in patients with alcoholic liver cirrhosis: A retrospective case-control study. J Magn Reson Imaging. 2019. May 6 10.1002/jmri.26768
    1. Colagrande S, Castellani A, Nardi C, Lorini C, Calistri L, Filippone A. The role of diffusion-weighted imaging in the detection of hepatic metastases from colorectal cancer: A comparison with unenhanced and Gd-EOB-DTPA enhanced MRI. Eur J Radiol. 2016. May;85(5):1027–34. 10.1016/j.ejrad.2016.02.011
    1. Granata V, Cascella M, Fusco R, dell’Aprovitola N, Catalano O, Filice S, et al. Immediate Adverse Reactions to Gadolinium-Based MR Contrast Media: A Retrospective Analysis on 10,608 Examinations. Biomed Res Int. 2016;2016:3918292 10.1155/2016/3918292
    1. Dahlström N, Persson A, Albiin N, Smedby O, Brismar TB. Contrast-enhanced magnetic resonance cholangiography with Gd-BOPTA and Gd-EOB-DTPA in healthy subjects. Acta Radiol. 2007. May;48(4):362–8. 10.1080/02841850701196922
    1. Brismar TB, Dahlstrom N, Edsborg N, Persson A, Smedby O, Albiin N. Liver vessel enhancement by Gd-BOPTA and Gd-EOB-DTPA: A comparison in healthy volunteers. Acta Radiol. 2009. September;50(7):709–15. 10.1080/02841850903055603
    1. Soyer P, Dohan A, Patkar D, Gottschalk A. Observational study on the safety profile of gadoterate meglumine in 35,499 patients: The SECURE study. J Magn Reson Imaging. 2017. April;45(4):988–997. 10.1002/jmri.25486
    1. Carr TF. Pathophysiology of Immediate Reactions to Injectable Gadolinium-based Contrast Agents. Top Magn Reson Imaging. 2016. December;25(6):265–268. 10.1097/RMR.0000000000000108
    1. de Kerviler E, Maravilla K, Meder JF, Naggara O, Dubourdieu C, Jullien V, et al. Adverse Reactions to Gadoterate Meglumine: Review of Over 25 Years of Clinical Use and More Than 50 Million Doses. Invest Radiol. 2016September;51(9):544–51. 10.1097/RLI.0000000000000276
    1. Martí-Bonmatí L, Martí-Bonmatí E. Retention of gadolinium compounds used in magnetic resonance imaging: a critical review and the recommendations of regulatory agencies. Radiologia. 2017. Nov-Dec;59(6):469–477. 10.1016/j.rx.2017.09.007
    1. Runge VM. Critical Questions Regarding Gadolinium Deposition in the Brain and Body After Injections of the Gadolinium-Based Contrast Agents, Safety, and Clinical Recommendations in Consideration of the EMA’s Pharmacovigilance and Risk Assessment Committee Recommendation for Suspension of the Marketing Authorizations for 4 Linear Agents. Invest Radiol. 2017. June;52(6):317–323. 10.1097/RLI.0000000000000374
    1. Abraham JL, Thakral C. Tissue distribution and kinetics of gadolinium and nephrogenic systemic fibrosis. Eur J Radiol. 2008. May;66(2):200–7. 10.1016/j.ejrad.2008.01.026
    1. Milon A, Wahab CA, Kermarrec E, Bekhouche A, Taourel P, Thomassin-Naggara I. Breast MRI: Is Faster Better? AJR Am J Roentgenol. 2019. December 11:1–14. 10.2214/AJR.19.21924
    1. van Zelst JCM, Vreemann S, Witt HJ, Gubern-Merida A, Dorrius MD, Duvivier K, et al. Multireader Study on the Diagnostic Accuracy of Ultrafast Breast Magnetic Resonance Imaging for Breast Cancer Screening. Invest Radiol. 2018. October;53(10):579–586. 10.1097/RLI.0000000000000494
    1. Tokuda O, Harada Y, Matsunaga N. MRI of soft-tissue tumors: fast STIR sequence as substitute for T1-weighted fat-suppressed contrast-enhanced spin-echo sequence. AJR Am J Roentgenol. 2009; 193:1607–1614. 10.2214/AJR.09.2675
    1. Tokuda O, Hayashi N, Matsunaga N. MRI of bone tumors: Fast STIR imaging as a substitute for T1-weighted contrast-enhanced fat-suppressed spin-echo imaging. J Magn Reson Imaging. 2004; 19:475–481. 10.1002/jmri.20031
    1. Eberhardt SC, Johnson JA, Parsons RB. Oncology imaging in the abdomen and pelvis: where cancer hides. Abdom Imaging. 2013; 38:647–671. 10.1007/s00261-012-9941-z
    1. Low RN, Gurney J. Diffusion-weighted MRI (DWI) in the oncology patient: value of breathhold DWI compared to unenhanced and gadolinium-enhanced MRI. J Magn Reson Imaging. 2007; 25:848–858. 10.1002/jmri.20864
    1. Mao Y, Chen B, Wang H, Zhang Y, Yi X, Liao W, et al. Diagnostic performance of magnetic resonance imaging for colorectal liver metastasis: A systematic review and meta-analysis. Sci Rep. 2020. February 6;10(1):1969 10.1038/s41598-020-58855-1
    1. Cheung HMC, Karanicolas PJ, Coburn N, Seth V, Law C, Milot L. Delayed tumour enhancement on gadoxetate-enhanced MRI is associated with overall survival in patients with colorectal liver metastases. Eur Radiol. 2019;29(2):1032–1038. 10.1007/s00330-018-5618-5
    1. Kim YK, Kim YK, Park HJ, Park MJ, Lee WJ, Choi D. Noncontrast MRI with diffusion-weighted imaging as the sole imaging modality for detecting liver malignancy in patients with high risk for hepatocellular carcinoma. Magn Reson Imaging. 2014;32(6):610–618. 10.1016/j.mri.2013.12.021
    1. Han S, Choi JI, Park MY, Choi MH, Rha SE, Lee YJ. The Diagnostic Performance of Liver MRI without Intravenous Contrast for Detecting Hepatocellular Carcinoma: A Case-Controlled Feasibility Study. Korean J Radiol. 2018. Jul-Aug;19(4):568–577. 10.3348/kjr.2018.19.4.568
    1. Chan MV, McDonald SJ, Ong YY, Mastrocostas K, Ho E, Huo YR, et al. HCC screening: assessment of an abbreviated non-contrast MRI protocol. Eur Radiol Exp. 2019. December 18;3(1):49 10.1186/s41747-019-0126-1
    1. Lee JY, Huo EJ, Weinstein S, Santos C, Monto A, Corvera CU, et al. Evaluation of an abbreviated screening MRI protocol for patients at risk for hepatocellular carcinoma. Abdom Radiol (NY). 2018. July;43(7):1627–1633. 10.1007/s00261-017-1339-5
    1. Khatri G, Pedrosa I, Ananthakrishnan L, de Leon AD, Fetzer DT, Leyendecker J, et al. Abbreviated-protocol screening MRI vs. complete-protocol diagnostic MRI for detection of hepatocellular carcinoma in patients with cirrhosis: An equivalence study using LI-RADS v2018. J Magn Reson Imaging. 2020. February;51(2):415–425. 10.1002/jmri.26835
    1. Marks RM, Ryan A, Heba ER, Tang A, Wolfson TJ, Gamst AC, et al. Diagnostic per-patient accuracy of an abbreviated hepatobiliary phase gadoxetic acid-enhanced MRI for hepatocellular carcinoma surveillance. AJR Am J Roentgenol. 2015. March;204(3):527–35. 10.2214/AJR.14.12986
    1. Besa C, Lewis S, Pandharipande PV, Chhatwal J, Kamath A, Cooper N, et al. Hepatocellular carcinoma detection: diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid. Abdom Radiol (NY). 2017. January;42(1):179–190. 10.1007/s00261-016-0841-5 Erratum in: Abdom Radiol (NY). 2017 Jul 28.
    1. Tillman BG, Gorman JD, Hru JM, Lee MH, King MC, Sirlin CB, et al. Diagnostic per-lesion performance of a simulated gadoxetate disodium-enhanced abbreviated MRI protocol for hepatocellular carcinoma screening. Clin Radiol. 2018. May;73(5):485–493. 10.1016/j.crad.2017.11.013
    1. Suh CH, Kim KW, Park SH, Kim SY, Woo DC, Shin S, et al. Performing Gadoxetic Acid-Enhanced MRI After CT for Guiding Curative Treatment of Early-Stage Hepatocellular Carcinoma: A Cost-Effectiveness Analysis. AJR Am J Roentgenol. 2018. February;210(2): W63–W69. 10.2214/AJR.17.18300
    1. Nishie A, Goshima S, Haradome H, Hatano E, Imai Y, Kudo M, et al. Cost-effectiveness of EOB-MRI for Hepatocellular Carcinoma in Japan. Clin Ther. 2017. April;39(4):738–750.e4. 10.1016/j.clinthera.2017.03.006
    1. Lee JM, Kim MJ, Phongkitkarun S, Sobhonslidsuk A, Holtorf AP, Rinde H, et al. Health economic evaluation of Gd-EOB-DTPA MRI vs ECCM-MRI and multi-detector computed tomography in patients with suspected hepatocellular carcinoma in Thailand and South Korea. J Med Econ. 2016. August;19(8):759–68. 10.3111/13696998.2016.1171230
    1. Zech CJ, Justo N, Lang A, Ba-Ssalamah A, Kim MJ, Rinde H, et al. Cost evaluation of gadoxetic acid-enhanced magnetic resonance imaging in the diagnosis of colorectal-cancer metastasis in the liver: Results from the VALUE Trial. Eur Radiol. 2016. November;26(11):4121–4130. 10.1007/s00330-016-4271-0
    1. Mitin T, Enestvedt CK, Thomas CR Jr. Management of oligometastatic rectal cancer: is liver first?. J Gastrointest Oncol. 2015;6(2):201–207. 10.3978/j.issn.2078-6891.2014.086

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