van Etten B, van der Sijp J, Kruyt R, Oudkerk M, van der Holt B, Wiggers Th
Department of Surgical Oncology, University Hospital Rotterdam-Daniel den Hoed Cancer Centre, The Netherlands.
Eur J Surg Oncol. 2002 Sep;28(6):645-51. doi: 10.1053/ejso.2001.1251.
The objective was to evaluate whether contrast-enhanced magnetic resonance imaging (MRI) techniques used in a pre-operative assessment protocol for colorectal liver metastases are as accurate as spiral computer tomography during arterial portography (CTAP). Pre-operative accuracy and clinical consequences of MRI are described and compared with CTAP. Moreover, post-operative survival rate and tumour recurrence were studied.
The study group comprised 84 patients which were possible candidates for a partial hepatectomy for colorectal liver metastases. Patients were pre-operatively evaluated by CT of the abdomen, CT of the thorax and spiral CTAP and ferumoxide-enhanced MRI was performed in routine way for all patients. Following this selection, 35 patients underwent a partial hepatectomy with curative intent. All patients were retrospectively evaluated.
Ferumoxide-enhanced MRI proved to be at least as accurate as spiral CTAP in 81% of patients. In nine patients (11%) spiral CTAP revealed more intrahepatic lesions than MRI; in only two patients (2%) did these foundings influenced the clinical decision. These patients were considered to have irresectable disease. In seven patients (8%) MRI detected more lesions than spiral CTAP and influenced the clinical decision in three patients (4%) and these did not undergo a laparotomy. The actuarial 3 year overall survival of operated patients was 41% and the actuarial 3 year disease-free survival was 19%.
Evaluation of the clinical impact of a pre-operative assessment protocol extended with ferumoxide MRI techniques demonstrated that this non-invasive MRI technique is safe and at least as accurate as spiral CTAP. This MRI technique results in comparable clinical decisions and outcome after hepatectomy. We suggest that the performance of routine contrast-enhanced MRI should instead be used in the pre-operative evaluation of colorectal liver metastases.
评估在结直肠癌肝转移术前评估方案中使用的对比增强磁共振成像（MRI）技术是否与动脉门静脉造影（CTAP）期间的螺旋计算机断层扫描一样准确。描述MRI的术前准确性和临床后果，并与CTAP进行比较。此外，还研究了术后生存率和肿瘤复发情况。
研究组包括84例可能适合进行结直肠癌肝转移部分肝切除术的患者。患者术前接受腹部CT、胸部CT和螺旋CTAP评估，并对所有患者常规进行铁氧化物增强MRI检查。经过这种筛选，35例患者接受了根治性部分肝切除术。对所有患者进行回顾性评估。
铁氧化物增强MRI在81%的患者中被证明至少与螺旋CTAP一样准确。在9例患者（11%）中，螺旋CTAP显示的肝内病变比MRI多；只有2例患者（2%）这些发现影响了临床决策。这些患者被认为患有不可切除的疾病。在7例患者（8%）中，MRI检测到的病变比螺旋CTAP多，并在3例患者（4%）中影响了临床决策，这些患者未接受剖腹手术。手术患者的3年总生存率为41%，3年无病生存率为19%。
对采用铁氧化物MRI技术扩展的术前评估方案的临床影响进行评估表明，这种非侵入性MRI技术是安全的，至少与螺旋CTAP一样准确。这种MRI技术在肝切除术后导致类似的临床决策和结果。我们建议在结直肠癌肝转移的术前评估中应采用常规对比增强MRI检查。
