Tani Keigo, Shindoh Junichi, Akamatsu Nobuhisa, Arita Junichi, Kaneko Junichi, Sakamoto Yoshihiro, Hasegawa Kiyoshi, Kokudo Norihiro
Hepato-biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Hepatobiliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
J Surg Oncol. 2018 Feb;117(2):191-197. doi: 10.1002/jso.24805. Epub 2017 Sep 6.
To clarify the detectability of gadolinium ethoxybenzyl diethylene-triamine pantaacetic acid enhanced magnetic resonance imaging (EOB-MRI) and contrast-enhanced intraoperative-ultrasonography (CE-IOUS) for residual disease in disappearing colorectal liver metastases (DLMs) and to seek a better management for DLMs.
Eighty-two patients who underwent hepatectomy after chemotherapy for colorectal liver metastases were retrospectively reviewed. Lesions which disappear on post-chemotherapy contrast-enhance CT were defined as DLMs. All the patients underwent EOB-MRI and CE-IOUS. With pathologic evaluation for resected specimens and clinical observation of anatomically corresponding site for non-resected lesions, detectability of residual disease in DLMs were estimated between these two imaging modalities.
Twenty (18%) patients presented with 111 DLMs, and EOB-MRI and CE-IOUS identified 64 (57.6%) and 62 (55.9%), respectively. Residual disease was pathologically confirmed for 69.2% in resected specimens and clinically estimated in 33.3% for non-resected DLMs. EOB-MRI showed a higher accuracy of prediction of residual disease compared with CE-IOUS (0.90 vs 0.70). Of the 11 non-resected lesions which were undetected with CE-IOUS and regrew after surgery, 9 (81.8%) were detected on EOB-MRI.
EOB-MRI may be superior to CE-IOUS in detecting residual tumors for DLMs. Maximum attempt of resection would be needed for visualized lesions in EOB-MRI.
明确乙氧基苄基二乙烯三胺五乙酸钆增强磁共振成像（EOB-MRI）及术中超声造影（CE-IOUS）对消失性结直肠癌肝转移（DLMs）中残留病灶的检测能力，并探寻对DLMs更好的治疗管理方法。
回顾性分析82例接受化疗后结直肠癌肝转移肝切除术的患者。化疗后对比增强CT上消失的病灶定义为DLMs。所有患者均接受EOB-MRI及CE-IOUS检查。通过对切除标本进行病理评估以及对未切除病灶的相应解剖部位进行临床观察，评估这两种成像方式对DLMs中残留病灶的检测能力。
20例（18%）患者出现111个DLMs，EOB-MRI和CE-IOUS分别识别出64个（57.6%）和62个（55.9%）。切除标本中69.2%的残留病灶经病理证实，未切除的DLMs中有33.3%经临床评估。与CE-IOUS相比，EOB-MRI对残留病灶的预测准确性更高（0.90对0.70）。在CE-IOUS未检测到且术后复发的11个未切除病灶中，9个（81.8%）在EOB-MRI上被检测到。
在检测DLMs中的残留肿瘤方面，EOB-MRI可能优于CE-IOUS。对于EOB-MRI中可视化的病灶，需要最大程度地尝试切除。
