Liver magnetic resonance imaging (MRI) in potentially resectable colorectal liver metastases.

Abstract

Background: Liver MRI is increasingly used to evaluate potentially resectable colorectal liver metastases (CLM). Benefits include: identifying additional CLM, clarifying the nature of equivocal lesions and acquiring greater anatomical detail. This information has the potential to spare patients from futile surgery, or conversely ensure that all sites of CLM are resected. We evaluated local use of liver MRI and impact on patient management. Methods: We retrospectively identified patients who had MRI for potential CLM between Jan 1 2009 and June 30 2012 and/or resection of CLM between 1 January 2009 and 31 December 2012 at Eastern Health and Epworth Eastern, Box Hill, Melbourne, Australia. Histories were audited for staging investigations (CT, PET, MRI, US), details of the primary tumor (synchronous vs metachronous, histology) and use of chemotherapy. Reasons for not proceeding to liver surgery were recorded, including influence of MRI results. For patients undergoing surgery, MRI findings were correlated with operative/histology findings. Results: Ninety-nine patients were identified with potential CLM, 74 had pre-operative liver MRI. Liver MRI excluded CLM in 8/74 (11%) patients and deemed 18/74 (24%) to be inoperable. Ten patients declined or had comorbidities that contra-indicated surgery. Of the 62 patients who proceeded to surgery, 37/62 (60%) had had pre-operative liver MRI. Five patients did not proceed to liver resection (4 had unresectable disease at laparotomy, 1 had no identifiable lesion after neo-adjuvant chemotherapy). Fifty-seven patients proceeded to liver resection. Forty-seven percent had received pre-operative chemotherapy. Conclusions: Liver MRI is a useful tool in the evaluation of potential CLM. In this retrospective cohort, 35% (26/74) of the subset of patients who had pre-operative liver MRI did not proceed to surgery based purely on MRI findings.