Preoperative CT versus diffusion weighted magnetic resonance imaging of the liver in patients with rectal cancer; a prospective randomized trial

Michael P Achiam, Vibeke B Løgager, Bjørn Skjoldbye, Jakob M Møller, Torben Lorenzen, Vera L Rasmussen, Henrik S Thomsen, Talie H Mollerup, Cecilie Okholm, Jacob Rosenberg, Michael P Achiam, Vibeke B Løgager, Bjørn Skjoldbye, Jakob M Møller, Torben Lorenzen, Vera L Rasmussen, Henrik S Thomsen, Talie H Mollerup, Cecilie Okholm, Jacob Rosenberg

Abstract

Introduction. Colorectal cancer is one of the most frequent cancers in the world and liver metastases are seen in up to 19% of patients with colorectal cancers. Detection of liver metastases is not only vital for sufficient treatment and survival, but also for a better estimation of prognosis. The aim of this study was to evaluate the feasibility of diffusion weighted MRI of the liver as part of a combined MR evaluation of patients with rectal cancers and compare it with the standard preoperative evaluation of the liver with CT. Methods. Consecutive patients diagnosed with rectal cancers were asked to participate in the study. Preoperative CT and diffusion weighted MR (DWMR) were compared to contrast enhanced laparoscopic ultrasound (CELUS). Results. A total of 35 patients were included, 15 patients in Group-1 having the standard CT evaluation of the liver and 20 patients in Group-2 having the standard CT evaluation of the liver and DWMR of the liver. Compared with CELUS, the per-patient sensitivity/specificity was 50/100% for CT, and for DWMR: 100/94% and 100/100% for Reader 1 and 2, respectively. The per-lesion sensitivity of CT and DWMR were 17% and 89%, respectively compared with CELUS. Furthermore, one patient had non-resectable metastases after DWMR despite being diagnosed with resectable metastases after CT. Another patient was diagnosed with multiple liver metastases during CELUS, despite a negative CT-scan. Discussion. DWMR is feasible for preoperative evaluation of liver metastases. The current standard preoperative evaluation with CT-scan results in disadvantages like missed metastases and futile operations. We recommend that patients with rectal cancer, who are scheduled for MR of the rectum, should have a DWMR of the liver performed at the same time.

Keywords: Computed tomography; Contrast enhanced ultrasound; Diffusion weighted magnetic resonance; Magnetic resonance imaging; Metastasis rectal cancer.

Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1. Flowchart of patients included.
Figure 1. Flowchart of patients included.
DWMR, Diffusion weighted magnetic resonance; CELUS, Contrast enhanced laparoscopic ultrasound.
Figure 2. Missed liver metastasis on CT…
Figure 2. Missed liver metastasis on CT and diffusion weighted MR.
(A) Initial CT, (B) Diffusion weighted MR, (C) subsequent CT after 5 months of neoadjuvant therapy. Broken arrow: Metastasis missed on primary CT and diffusion weighted MR.
Figure 3. Missed liver metastasis segment 7…
Figure 3. Missed liver metastasis segment 7 & 8 on CT and diffusion weighted MR.
(A) Initial CT, (B) Diffusion weighted MR, (C) CT in venous phase. White arrow: Segment 4 metastasis. Black arrow: Two metastases missed on primary CT.
Figure 4. Missed metastasis on initial CT…
Figure 4. Missed metastasis on initial CT and diffusion weighted MR.
(A) Initial CT, (B) Diffusion weighted MR, (C) CT in venous phase after 3 months of neoadjuvant therapy. Black arrow: Metastasis missed on primary CT.

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