title: Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy.
abstract: OBJECTIVE
  To compare the diagnostic accuracy and sensitivity of Gd-EOB-DTPA MRI and diffusion-weighted (DWI) imaging alone and in combination for detecting colorectal liver metastases in patients who had undergone preoperative chemotherapy.
  
  
  METHODS
  Thirty-two consecutive patients with a total of 166 liver lesions were retrospectively enrolled. Of the lesions, 144 (86.8 %) were metastatic at pathology. Three image sets (1, Gd-EOB-DTPA; 2, DWI; 3, combined Gd-EOB-DTPA and DWI) were independently reviewed by two observers. Statistical analysis was performed on a per-lesion basis.
  
  
  RESULTS
  Evaluation of image set 1 correctly identified 127/166 lesions (accuracy 76.5 %; 95 % CI 69.3-82.7) and 106/144 metastases (sensitivity 73.6 %, 95 % CI 65.6-80.6). Evaluation of image set 2 correctly identified 108/166 (accuracy 65.1 %, 95 % CI 57.3-72.3) and 87/144 metastases (sensitivity of 60.4 %, 95 % CI 51.9-68.5). Evaluation of image set 3 correctly identified 148/166 (accuracy 89.2 %, 95 % CI 83.4-93.4) and 131/144 metastases (sensitivity 91 %, 95 % CI 85.1-95.1). Differences were statistically significant (P < 0.001). Notably, similar results were obtained analysing only small lesions (<1 cm).
  
  
  CONCLUSIONS
  The combination of DWI with Gd-EOB-DTPA-enhanced MRI imaging significantly increases the diagnostic accuracy and sensitivity in patients with colorectal liver metastases treated with preoperative chemotherapy, and it is particularly effective in the detection of small lesions.
authors.affiliation: Department of Radiology, Mauriziano Hospital, Torino, Italy. macera.annalisa@gmail.com
authors.forename: Annalisa
authors.initials: A
authors.lastname: Macera
authors.forename: Chiara
authors.initials: C
authors.lastname: Lario
authors.forename: Massimo
authors.initials: M
authors.lastname: Petracchini
authors.forename: Teresa
authors.initials: T
authors.lastname: Gallo
authors.forename: Daniele
authors.initials: D
authors.lastname: Regge
authors.forename: Irene
authors.initials: I
authors.lastname: Floriani
authors.forename: Dario
authors.initials: D
authors.lastname: Ribero
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Capussotti
authors.forename: Stefano
authors.initials: S
authors.lastname: Cirillo
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy / Q000473:pathology* / Q000556:secondary*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology*; D003287:Contrast Media; D004358:Drug Therapy; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000556:secondary*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D000970:Antineoplastic Agents; D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA