Department of Surgery, University Medical Centre Utrecht, The Netherlands.
Dig Surg. 2011;28(1):36-43. doi: 10.1159/000322390. Epub 2011 Feb 4.
To determine the best imaging modality for preoperative detection, characterization and measurement of colorectal liver metastases (CRLM) after neoadjuvant chemotherapy (NAC).
A total of 79 lesions in 15 patients with CRLM were included. Following NAC, all patients received multislice liver CT (MSCT) and magnetic resonance imaging (MRI) that were scored by two observers for lesion number, type, diameter (mm) and segmental location. Intraoperative findings, histopathology and follow-up imaging were used as reference standard for surgically treated patients; non-surgical candidates underwent follow-up imaging.
Lesion detection rate was similar for MSCT and MRI (76 and 80%, respectively, p = 0.648). Lesion characterization was significantly superior (p = 0.021) at MRI (89%, κ 0.747, p = 0.001) compared to MSCT (77%, κ 0.235, p = 0.005). Interobserver variability for diameter measurement was not significant at MRI (p = 0.909 [95% CI -1.245 to 1.395]), but significant at MSCT (p = 0.028 [95% CI -3.349 to -2.007]). Differences in diameter measurement were independent of observer (p = 0.131), and no statistical effect from imaging modality on diameter measurement was observed (p = 0.095).
MRI is superior to MSCT in preoperative characterization and measurement of CRLM after NAC. Lesion detection rates for both modalities are comparable.
确定新辅助化疗（NAC）后术前检测、特征描述和结直肠癌肝转移（CRLM）测量的最佳成像方式。
共纳入 15 例 CRLM 患者的 79 个病灶。NAC 后，所有患者均接受多层螺旋 CT（MSCT）和磁共振成像（MRI）检查，由两位观察者对病灶数量、类型、直径（mm）和节段位置进行评分。对接受手术治疗的患者，以术中所见、组织病理学和随访影像学检查作为参考标准；不适合手术的患者则进行随访影像学检查。
MSCT 和 MRI 的病灶检出率相似（分别为 76%和 80%，p = 0.648）。MRI 的病灶特征描述明显更优（p = 0.021）（89%，κ = 0.747，p = 0.001），而 MSCT 为 77%（κ = 0.235，p = 0.005）。MRI 上直径测量的观察者间变异性无统计学意义（p = 0.909 [95%CI -1.245 至 1.395]），但在 MSCT 上有统计学意义（p = 0.028 [95%CI -3.349 至 -2.007]）。直径测量的差异与观察者无关（p = 0.131），且未观察到成像方式对直径测量的统计学影响（p = 0.095）。
MRI 在 NAC 后 CRLM 的术前特征描述和测量方面优于 MSCT。两种方法的病灶检出率相当。
