Detection of colorectal metastases in patients being treated with chemotherapy utilising SPIO-MRI: a radiological-pathological study.
OBJECTIVE
Chemotherapy commonly causes liver injury through sinusoidal obstructive syndrome and steatosis. Chemotherapy-induced liver injury may make it more difficult to detect metastases secondary to reduced contrast between the injured liver and metastases. The aim of this study was to determine the sensitivity of superparamagnetic iron oxide (SPIO) contrast-enhanced imaging in patients who have undergone chemotherapy prior to liver surgery.


METHODS
Local ethics committee approval was obtained. Thirty-one patients with hepatic metastases completing preoperative chemotherapy were prospectively recruited. Images were reviewed independently by two blinded observers who identified and localized lesions with a four-point confidence scale. The alternative free-response receiver operator characteristic method was used to analyze the results.


RESULTS
The sensitivity in detecting colorectal metastases following chemotherapy was 78% and 76%, respectively, for observers 1 and 2 (95% confidence interval: 71%-85% and 68%-82%). The areas under the alternative free-response receiver operator curves were 0.73 and 0.80 for observers 1 and 2, respectively.


CONCLUSIONS
Compared to previously published work on chemotherapy-naïve patients, it is clear that the sensitivity of SPIO-enhanced magnetic resonance imaging (MRI) in detecting colorectal metastases following chemotherapy is reduced. It is therefore critical that all imaging--pre-, during and postchemotherapy--is reviewed when reporting liver MRI prior to surgery.
Leeds Teaching Hospitals NHS Trust, St James's Institute of Oncology, Radiology Department, Bexley Wing, LS9 7TF Leeds, UK. jonathan.smith@leedsth.nhs.uk
Jonathan T
JT
Smith
Janice
J
Ward
James A
JA
Guthrie
Maria B
MB
Sheridan
Sheila
S
Boyes
Daniel
D
Wilson
Judy I
JI
Wyatt
Darren
D
Treanor
Philip J
PJ
Robinson
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology*; D003287:Contrast Media / Q000494:pharmacology; D005189:False Positive Reactions; D005260:Female; D005290:Ferric Compounds / Q000737:chemistry; D006801:Humans; D008099:Liver / Q000293:injuries / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D015588:Observer Variation; D012372:ROC Curve; D015203:Reproducibility of Results
D000970:Antineoplastic Agents; D003287:Contrast Media; D005290:Ferric Compounds; C000499:ferric oxide