Hosseini-Nik Hooman, Fischer Sandra E, Moulton Carol-Anne E, Karbhase Gautam, Menezes Ravi J, Gallinger Steven, Jhaveri Kartik S
Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada.
Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada.
Abdom Radiol (NY). 2016 Feb;41(2):231-8. doi: 10.1007/s00261-015-0572-z.
To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate colorectal liver metastasis (CRLM) with complete pathologic response from those with incomplete response in patients treated with preoperative chemotherapy.
Gadoxetic acid-enhanced liver MRI and DWI were performed after completion of preoperative chemotherapy in patients with CRLM scheduled for liver resection. Metastases were classified as those with complete pathologic response (CR-CRLM) or incomplete response (IR-CRLM) according to postsurgical histopathology. Quantitative analysis was performed on non-contrast-enhanced images and hepatobiliary phase images following gadoxetic acid administration. Apparent diffusion coefficient values (ADC), normalized relative enhancement (NRE), and relative signal intensity difference (RSID) along with their diagnostic measures for detection of CR-CRLM were calculated for all lesions.
In 23 patients, 10 CR-CRLM and 35 IR-CRLM (mean diameter, 21.2 mm) were evaluated. In CR-CRLM, ADC was significantly higher after exclusion of the outliers (p = 0.030); and RSID was significantly lower (p = 0.008). Combined indices range of ADC = 1.25-1.9 × 10(-3) mm(2)/s, NRE = 0-35% and RSID <120 had 60% sensitivity and 100% specificity for detection of CR-CRLM.
DWI and gadoxetic acid-enhanced MRI appear promising for the detection of CRLM with complete response to preoperative chemotherapy. This could have significant implications for liver resection planning after preoperative chemotherapy.
评估弥散加权成像（DWI）和钆塞酸增强磁共振成像（MRI）在鉴别接受术前化疗的患者中，具有完全病理缓解和不完全缓解的结直肠癌肝转移（CRLM）方面的诊断性能。
对计划进行肝切除的CRLM患者在术前化疗完成后进行钆塞酸增强肝脏MRI和DWI检查。根据术后组织病理学将转移灶分为完全病理缓解（CR-CRLM）或不完全缓解（IR-CRLM）。对钆塞酸给药后的非增强图像和肝胆期图像进行定量分析。计算所有病灶的表观扩散系数值（ADC）、归一化相对增强（NRE）和相对信号强度差异（RSID）及其检测CR-CRLM的诊断指标。
对23例患者中的10个CR-CRLM和35个IR-CRLM（平均直径21.2mm）进行了评估。在CR-CRLM中，排除异常值后ADC显著更高（p = 0.030）；RSID显著更低（p = 0.008）。ADC = 1.25 - 1.9×10⁻³mm²/s、NRE = 0 - 35%且RSID < 120的联合指标对检测CR-CRLM具有60%的敏感性和100%的特异性。
DWI和钆塞酸增强MRI在检测对术前化疗有完全反应的CRLM方面似乎很有前景。这可能对术前化疗后的肝切除规划具有重要意义。
