title: Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know.
abstract: Surgical resection of colorectal metastatic disease has increased as surgeons have adopted a more aggressive ideology. Current exclusion criteria are patients for whom a negative resection margin is not feasible or a future liver remnant (FLR) of greater than 20% is not achievable. The goal of preoperative imaging is to identify the number and distribution of liver metastases, in addition to establishing their relation to relevant intrahepatic structures. FLR can be calculated utilizing cross-sectional imaging to select out patients at risk for hepatic dysfunction after resection. MRI, specifically with gadoxetic acid contrast, is currently the preferred modality for assessment of hepatic involvement for patients with newly diagnosed colorectal cancer, to include those who have undergone neoadjuvant chemotherapy. Employment of liver-directed therapies has recently expanded and they may provide an alternative to hepatectomy in order to obtain locoregional control in poor surgical candidates or convert patients with initially unresectable disease into surgical candidates.
authors.affiliation: Department of Radiology, Stony Brook University Medical Center, HSC Level 4, Room 120 East Loop Road, Stony Brook, NY, 11794, USA. mikereiter13@yahoo.com.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Reiter
authors.affiliation: Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Hannemann
authors.affiliation: Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA.|Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Schwope
authors.affiliation: Department of Radiology, Brooke Army Medical Center, San Antonio, TX, USA.|Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lisanti
authors.affiliation: Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Learn
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: CT; Colorectal cancer; Hepatic metastases; MRI; Portal vein embolization