From the Department of Radiology (Y. Nakai, W.G., R.K., O.A.), Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery (Y. Nishioka, J.A., K.H.), and Department of Pathology (H.A., T.U.), Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Radiology. 2020 Dec;297(3):584-594. doi: 10.1148/radiol.2020202367. Epub 2020 Oct 6.
Background Gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI is superior to CT in the detection of colorectal liver metastases (CRLMs) smaller than 10 mm. However, few studies have used MRI findings to predict patients' long-term prognosis. Purpose To investigate the relationship between Gd-EOB-DTPA-enhanced MRI findings in the liver parenchyma peripheral to CRLM and both pathologic vessel invasion and long-term prognosis. Materials and Methods This retrospective study included patients who underwent Gd-EOB-DTPA-enhanced MRI before curative surgery for CRLM, without neoadjuvant chemotherapy, between July 2008 and June 2015. Early enhancement, reduced Gd-EOB-DTPA uptake, and bile duct dilatation peripheral to the CRLM at MRI were evaluated by three abdominal radiologists. All tumor specimens were reevaluated for the presence or absence of portal vein, hepatic vein, and bile duct invasion. Predictors of recurrence-free survival (RFS) and overall survival (OS) after surgery were identified with Cox proportional hazard model with the Bayesian information criterion. Previously reported prognosticators were selected for multivariable analyses. The median follow-up period was 60 months (range, 9-127 months). Results Overall, 106 patients (mean age, 65 years ± 12 [standard deviation]; 68 men) with 148 CRLMs were evaluated. Bile duct dilatation peripheral to the tumor was associated with pathologic portal vein invasion (sensitivity, 12 of 50 [24%]; specificity, 89 of 98 [91%]; = .02), bile duct invasion (sensitivity, eight of 19 [42%]; specificity, 116 of 129 [90%]; = .001), poor RFS ( = .03; hazard ratio [HR] = 2.4 [95% confidence interval {CI}: 1.3, 4.2]), and poor OS ( = .01; HR = 2.4 [95% CI: 1.2, 4.9]). For RFS and OS, early enhancement and reduced Gd-EOB-DTPA uptake peripheral to the CRLM were eliminated by means of variable selection in the multivariable analysis, but the combination of these findings with bile duct dilatation provided a predictor of poor OS ( = .001; HR = 3.3 [95% CI: 1.6, 6.8]). Conclusion MRI signal intensity changes peripheral to the colorectal liver metastasis were predictors of long-term prognosis after curative surgery without neoadjuvant chemotherapy. © RSNA, 2020 See also the editorial by Bashir in this issue.
钆塞酸二钠（Gd-EOB-DTPA）增强 MRI 在检测直径小于 10mm 的结直肠癌肝转移（CRLM）方面优于 CT。然而，很少有研究使用 MRI 结果来预测患者的长期预后。目的：研究 CRLM 周围肝实质的 Gd-EOB-DTPA 增强 MRI 表现与病理血管侵犯和长期预后的关系。材料与方法：本回顾性研究纳入 2008 年 7 月至 2015 年 6 月期间，接受 Gd-EOB-DTPA 增强 MRI 检查后行 CRLM 根治性手术的患者，且未接受新辅助化疗。三位腹部放射科医生评估了 CRLM 周围的早期强化、Gd-EOB-DTPA 摄取减少和胆管扩张。所有肿瘤标本均重新评估门静脉、肝静脉和胆管侵犯情况。采用具有贝叶斯信息准则的 Cox 比例风险模型确定手术切除后无复发生存（RFS）和总生存（OS）的预测因素。选择了以前报道的预后因素进行多变量分析。中位随访时间为 60 个月（范围，9-127 个月）。结果：共有 106 例患者（平均年龄 65 岁±12[标准差]；68 例男性）的 148 个 CRLM 进行了评估。肿瘤周围胆管扩张与病理门静脉侵犯相关（敏感性，50 个中的 12 个[24%]；特异性，98 个中的 89 个[91%]； =.02）、胆管侵犯（敏感性，19 个中的 8 个[42%]；特异性，129 个中的 116 个[90%]； =.001）、RFS 不良（ =.03；风险比[HR]为 2.4[95%置信区间{CI}：1.3，4.2]）和 OS 不良（ =.01；HR 为 2.4[95% CI：1.2，4.9]）。对于 RFS 和 OS，早期强化和 CRLM 周围 Gd-EOB-DTPA 摄取减少在多变量分析中通过变量选择被排除，但将这些发现与胆管扩张相结合可以预测 OS 不良（ =.001；HR 为 3.3[95% CI：1.6，6.8]）。结论：无新辅助化疗的根治性手术后，结直肠癌肝转移周围 MRI 信号强度变化是长期预后的预测因素。
