Colorectal liver metastases: disappearing lesions in the era of Eovist hepatobiliary magnetic resonance imaging - PubMed (original) (raw)

Colorectal liver metastases: disappearing lesions in the era of Eovist hepatobiliary magnetic resonance imaging

Joseph W Owen et al. HPB (Oxford). 2016 Mar.

Abstract

Background: Hepatobiliary contrast enhanced MRI is known to be the most sensitive imaging modality for detection of colorectal hepatic metastasis. To date no study has investigated the rate of disappearing lesions with gadoxetic acid MR (Eovist/Primovist), or characterized the pathologic response of lesions which disappear on gadoxetic acid MR.

Methods: Retrospective review of hepatic resections for colorectal metastases between 01/2008 and 01/2014 was performed to evaluated the rate of disappearance of lesions on gadoxetic acid MR and the rate of complete pathologic response in the lesions that disappear. "Disappearing lesions" were lesions on baseline imaging that were not identifiable on pre-operative Eovist MRI. Complete pathologic response was defined as no viable tumor on pathology or by lack of recurrence within 1 year.

Results: In 23 patients, 200 colorectal metastases were identified on baseline imaging. On pre-operative Eovist MR 77 of the 200 lesions (38.5%) were "disappearing" lesions. At surgical pathology or 1 year follow-up imaging, 42 of 77 lesions (55%) demonstrated viable tumor (21) or recurrence (21). Thirty of 77 lesions (39%) were nonviable at pathology (10) or without evidence of recurrence at 1 year (20). 5 lesions were indeterminate.

Discussion: Despite disappearance on Eovist MR imaging (the most sensitive available imaging modality), 38.5% of all colorectal metastases disappeared and of those, 55% were viable.

Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

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Figures

Figure 1

Figure 1

Coronal hepatobiliary 20 min delay MR image at baseline (a) demonstrating colorectal metastases in the liver (arrows). Coronal hepatobiliary 20 min delay MR image at pre-surgical staging (b) demonstrating no lesion at the site of metastases on the prior exam (arrowheads).

Figure 2

Figure 2

Arterial phase: hepatic artery and early portal vein enhancement (A). Portal Phase: peak portal vein enhancement (B). Transitional phase: early parenchymal uptake (C). Transitional 5 min phase: gradual blood pool clearance (D). Hepatobiliary 20 min phase: blood pool clearance with peak normal liver parenchymal enhancement. Note the colorectal metastasis (arrow) and the arterial shunting (arrowhead).

Figure 3

Figure 3

Mosaic plot – Contingency analysis demonstrates that the odds for ≥ 1 disappearing lesions with in the “Synchronous” group is 11.25 times greater than in the “Metachronous” group (odds ratio – 11.25; p = 0.0064).

Figure 4

Figure 4

Diagram demonstrating the treatment and viability of disappearing lesions.

Figure 5

Figure 5

Kaplan Meier Survival Curve – Disease free survival was shorter for patients with “Lesion Left Behind” (Yellow) than for patients with all lesions resected (Blue) with p=0.005.

Figure 6

Figure 6

Baseline contrast enhanced CT image showing extensive colorectal metastatic disease (arrows) in the liver (A). Presurgical staging MR image with Gadoxetate Disodium in the hepatobiliary 20 min phase (B) showing resolution of previously seen lesions (arrowheads), and presurgical staging PET/CT (C) showing no increased FDG-uptake in the region of previously seen lesions (open arrowheads).

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