Diffusion-weighted imaging and loco-regional N staging of patients with colorectal liver metastases

Computed tomography (CT), magnetic resonance imaging (MRI), and 18-fluorideoxyglucose positron emission tomography (18FDG-PET) are historically the most accurate imaging techniques for diagnosing liver metastases. Recently, the combination of diffusion-weighted imaging and hepatospecific contrast media, such as gadoxetic acid in MRI, have been demonstrated to have the highest diagnostic accuracy, sensitivity, and specificity for detecting liver metastases. Various recent meta-analyses have confirmed the diagnostic superiority of this combination (diffusion-weighted imaging and gadoxetic acid-enhanced MRI), especially in terms of per lesion sensitivity, as compared with CT and 18FDG-PET, even for smaller lesions (≤1 cm). However, none of the oncological guidelines have suggested the use of MRI as a first-line technique for liver metastasis detection during the staging process of oncological patients. This review analyzes the history of the principal imaging techniques for the diagnosis of liver metastases, in particular of colorectal liver metastases, focusing on the most accurate method (diffusion-weighted imaging combined with gadoxetic acid-enhanced MRI), possible reasons for the lack of its diffusion in the guidelines, and possible future scenarios.

Download Full-text

Gadoxetic acid-enhanced MRI and diffusion-weighted imaging for the detection of colorectal liver metastases after neoadjuvant chemotherapy

European Radiology ◽

10.1007/s00330-015-3615-5 ◽

2015 ◽

Vol 25 (8) ◽

pp. 2428-2436 ◽

Cited By ~ 18

Author(s):

Mi Hye Yu ◽

Jeong Min Lee ◽

Bo Yun Hur ◽

Tae-You Kim ◽

Seung-Yong Jeong ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Liver Metastases ◽

Diffusion Weighted Imaging ◽

Colorectal Liver Metastases ◽

Gadoxetic Acid ◽

Enhanced Mri ◽

Diffusion Weighted ◽

And Diffusion

Download Full-text

3T diffusion-weighted MRI in the response assessment of colorectal liver metastases after chemotherapy: Correlation between ADC value and histological tumour regression grading

European Journal of Radiology ◽

10.1016/j.ejrad.2017.03.020 ◽

2017 ◽

Vol 91 ◽

pp. 57-65 ◽

Cited By ~ 8

Author(s):

Francescamaria Donati ◽

Piero Boraschi ◽

Federica Pacciardi ◽

Rosa Cervelli ◽

Maura Castagna ◽

...

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Response Assessment ◽

Tumour Regression ◽

Diffusion Weighted Mri ◽

Adc Value ◽

Regression Grading ◽

Diffusion Weighted

Download Full-text

The role of quantitative diffusion-weighted imaging in characterization of hypovascular liver lesions: A prospective comparison of intravoxel incoherent motion derived parameters and apparent diffusion coefficient

PLoS ONE ◽

10.1371/journal.pone.0247301 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247301

Author(s):

Jelena Djokić Kovač ◽

Marko Daković ◽

Aleksandra Janković ◽

Milica Mitrović ◽

Vladimir Dugalić ◽

...

Keyword(s):

Diffusion Coefficient ◽

Apparent Diffusion Coefficient ◽

Liver Metastases ◽

Diffusion Weighted Imaging ◽

Intraclass Correlation ◽

Intravoxel Incoherent Motion ◽

Liver Lesions ◽

Diffusion Weighted ◽

Significant Difference ◽

Apparent Diffusion

Background The utility of intravoxel incoherent motion (IVIM) related parameters in differentiation of hypovascular liver lesions is still unknown. Purpose The purpose of this study was to evaluate the value of IVIM related parameters in comparison to apparent diffusion coefficient (ADC) for differentiation among intrahepatic mass-forming cholangiocarcinoma (IMC), and hypovascular liver metastases (HLM). Methods Seventy-four prospectively enrolled patients (21 IMC, and 53 HLM) underwent 1.5T magnetic resonance examination with IVIM diffusion-weighted imaging using seven b values (0–800 s/mm2). Two independent readers performed quantitative analysis of IVIM-related parameters and ADC. Interobserver reliability was tested using a intraclass correlation coefficient. ADC, true diffusion coefficient (D), perfusion-related diffusion coefficient (D*), and perfusion fraction (ƒ) were compared among the lesions using Kruskal-Wallis H test. The diagnostic accuracy of each parameter was assessed by receiver operating characteristic (ROC) curve analysis. Results The interobserver agreement was good for ADC (0.802), and excellent for D, D*, and ƒ (0.911, 0.927, and 0.942, respectively). ADC, and D values were significantly different among IMC and HLM (both p < 0.05), while there was no significant difference among these lesions for ƒ and D* (p = 0.101, and p = 0.612, respectively). ROC analysis showed higher diagnostic performance of D in comparison to ADC (AUC = 0.879 vs 0.821). Conclusion IVIM-derived parameters in particular D, in addition to ADC, could help in differentiation between most common hypovascular malignant liver lesions, intrahepatic mass—forming cholangiocarcinoma and hypovascular liver metastases.

Download Full-text