title: Prospective diagnostic test accuracy comparison of computed tomography during arterial portography and Primovist magnetic resonance imaging in the pre-operative assessment of colorectal cancer liver metastases.
abstract: OBJECTIVE
  To assess and compare the accuracy and inter-observer agreement for the detection of liver lesions using Primovist magnetic resonance imaging (pMRI) and computed tomography during arterial portography (CTAP).
  
  
  METHODS
  Patients evaluated at St George Hospital Liver Unit for colorectal liver metastases (CRCLM) underwent CTAP as part of standard staging. pMRI was added to the pre-operative assessment. Two radiologists reported CTAP and two reported pMRI. The sensitivity and specificity of CTAP and pMRI were calculated using histopathology as the gold standard.
  
  
  RESULTS
  Complete data were available for 62 patients corresponding to 219 lesions confirmed on histopathology. Agreement on the detection of lesions between the two radiologists that reported pMRI was higher than for CTAP (Kappa = 0.80 versus 0.74). Specificity of lesion detection for pMRI was 0.88 and 0.83 for CTAP (P = 0.112). Sensitivity for pMRI was 0.83 and 0.81 for CTAP. For patients who had chemotherapy before evaluation, pMRI had a significantly higher specificity than CTAP (0.79 versus 0.63, P = 0.011).
  
  
  CONCLUSIONS
  pMRI is less invasive, has a good inter-observer agreement, has comparable sensitivity and specificity to CTAP in the pre-chemotherapy population and demonstrates better specificity in patients assessed post-chemotherapy. pMRI is a valid alternative to CTAP in the assessment of CRCLM.
authors.affiliation: Department of Surgery, St George Hospital, Sydney, NSW, Australia.
authors.forename: Jai S
authors.initials: JS
authors.lastname: Bagia
authors.affiliation: Department of Radiology, St George Hospital, Sydney, NSW, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Chai
authors.affiliation: Department of Radiology, St George Hospital, Sydney, NSW, Australia.
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.affiliation: Department of Radiology, St George Hospital, Sydney, NSW, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chu
authors.affiliation: Department of Radiology, St George Hospital, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Rouse
authors.affiliation: Department of Histopathology, Douglas Hanly Moir Pathology, Sydney, NSW, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sinclair
authors.affiliation: Department of Anatomical Pathology, South Eastern Area Laboratory Services (SEALS), Sydney, NSW, Australia.
authors.forename: Leon
authors.initials: L
authors.lastname: Vonthethoff
authors.affiliation: School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Armando
authors.initials: A
authors.lastname: Teixeira-Pinto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011172:Portography / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*