Gadoxetic acid-enhanced 3.0 T MR imaging versus multidetector-row CT in the detection of colorectal metastases in fatty liver using intraoperative ultrasound and histopathology as a standard of reference.
OBJECTIVE
To compare the diagnostic value of gadoxetic acid-enhanced MRI at 3.0 T with 64-row MDCT in the detection of colorectal liver metastases in diffuse fatty infiltration of the liver after neoadjuvant chemotherapy.


METHODS
Twenty-three patients with colorectal liver metastases and at moderate to severe steatosis (25-90%) underwent prospectively preoperative tri-phasic MDCT (Somatom Sensation 64, Siemens) and gadoxetic acid-enhanced MRI (3-T Magnetom Trio, Siemens). All patients underwent surgical resection of liver metastases. Intraoperative ultrasound (IOUS) was carried out, which served as the standard of reference, together with histopathology.


RESULTS
Overall, 68 metastases (range, 0.4-6 cm; 31/68 metastases [46%] ≤ 1 cm) were found at histology. MDCT detected 49/68 lesions (72%), and MRI 66/68 (97%, p < 0.001). For lesions ≤ 1 cm, MDCT detected only 13/31 (41.9%) and MRI 29/31 (93%, p < 0.001). Eight false-positive lesions were detected by MDCT, seven small lesions by MRI. There was no statistically significant difference between the two modalities in the detection of lesions > 1 cm (p = 0.250). IOUS detected all metastases and revealed two false-positive diagnoses.


CONCLUSIONS
Gadoxetic acid-enhanced 3.0 T MRI is superior to 64-row MDCT in detecting colorectal liver metastases ≤ 1 cm during preoperative staging in patients with liver steatosis. A combination of MRI and IOUS may further improve the outcome of surgical treatment.
Department of Radiology, Medical University of Vienna, AKH, Waehringer Guertel 18-20, 1090 Vienna, Austria. vanessa.berger-kulemann@meduniwien.ac.at
V
V
Berger-Kulemann
W
W
Schima
S
S
Baroud
C
C
Koelblinger
K
K
Kaczirek
T
T
Gruenberger
M
M
Schindl
J
J
Maresch
M
M
Weber
A
A
Ba-Ssalamah
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D003287:Contrast Media; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006498:Hepatectomy; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D061330:Multidetector Computed Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors
D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA