title: Feasibility of Routine Application of Gadoxetic Acid-Enhanced MRI in Combination with Diffusion-Weighted MRI for the Preoperative Evaluation of Colorectal Liver Metastases.
abstract: Gadoxetic acid-enhanced magnetic resonance imaging (MRI) in combination with diffusion-weighted MRI (Gd-EOB-MRI/DWI) has become popular for evaluating colorectal liver metastases (CRLM). This retrospective observational study aimed to determine whether this procedure should be indicated prior to hepatectomy in all patients with CRLM.
  
  
  
  A retrospective survey of relevant data of patients who had undergone hepatectomy for CRLM from 2008 to 2014 was performed. The rates of detection by contrast-enhanced computed tomography (CE-CT) and Gd-EOB-MRI/DWI were evaluated. In addition, relapse-free and overall survivals after primary hepatectomy were compared between patients who had undergone only CE-CT versus those who had undergone both CE-CT and Gd-EOB-MRI/DWI.
  
  
  
  In all, 419 pathologically confirmed CRLM were resected in 202 hepatectomies in 177 patients. The sensitivity of detection of CRLM was 77 % for CE-CT and 93 % for Gd-EOB-MRI/DWI (P < 0.01). The sensitivity of detection of 1-5, 6-10, and 11-15 mm CRLM by CE-CT was 9.6 % (5/52), 47 % (26/55), and 76 % (57/75), respectively, whereas that by Gd-EOB-MRI/DWI was 54 % (28/52), 91 % (50/55), and 99 % (74/75), respectively; these differences are significant (P < 0.01 for all three groups). Relapse-free (P = 0.99) and overall survival (P = 0.79) did not differ significantly between 37 patients evaluated preoperatively by only CE-CT and 168 patients evaluated by both CE-CT and Gd-EOB-MRI/DWI.
  
  
  
  Gd-EOB-MRI/DWI detects small CRLM (≤15 mm) with higher sensitivity than CE-CT. However, whether Gd-EOB-MRI/DWI should be a routine component of preoperative evaluation remains unclear in terms of survival benefit.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.|Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan. yokishi@ncc.go.jp.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Kishi
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Esaki
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nara
authors.affiliation: Division of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Mototaka
authors.initials: M
authors.lastname: Miyake
authors.affiliation: Division of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Hiraoka
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D057234:Preoperative Period; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA