Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2023; 29(36): 5180-5197
Published online Sep 28, 2023. doi: 10.3748/wjg.v29.i36.5180
Liver metastases: The role of magnetic resonance imaging
Cesare Maino, Federica Vernuccio, Roberto Cannella, Francesco Cortese, Paolo Niccolò Franco, Clara Gaetani, Valentina Giannini, Riccardo Inchingolo, Davide Ippolito, Arianna Defeudis, Giulia Pilato, Davide Tore, Riccardo Faletti, Marco Gatti
Cesare Maino, Paolo Niccolò Franco, Davide Ippolito, Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
Federica Vernuccio, University Hospital of Padova, Institute of Radiology, Padova 35128, Italy
Roberto Cannella, Giulia Pilato, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo 90127, Italy
Francesco Cortese, Riccardo Inchingolo, Unit of Interventional Radiology, F Miulli Hospital, Acquaviva delle Fonti 70021, Italy
Clara Gaetani, Valentina Giannini, Arianna Defeudis, Davide Tore, Riccardo Faletti, Marco Gatti, Department of Surgical Sciences, University of Turin, Turin 10126, Italy
Davide Ippolito, School of Medicine, University of Milano Bicocca, Milano 20100, Italy
Author contributions: All Authors equally contributed to this paper with the conception and design of the study, literature review and analysis, drafting and critical revision, and editing; All authors gave final approval of the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Gatti, MD, Assistant Professor, Doctor, Department of Surgical Sciences, University of Turin, Via Genova 3, Turin 10126, Italy. marcogatti17@gmail.com
Received: July 30, 2023
Peer-review started: July 30, 2023
First decision: August 15, 2023
Revised: August 28, 2023
Accepted: September 11, 2023
Article in press: September 11, 2023
Published online: September 28, 2023
Processing time: 52 Days and 5 Hours
Abstract

The liver is one of the organs most commonly involved in metastatic disease, especially due to its unique vascularization. It’s well known that liver metastases represent the most common hepatic malignant tumors. From a practical point of view, it’s of utmost importance to evaluate the presence of liver metastases when staging oncologic patients, to select the best treatment possible, and finally to predict the overall prognosis. In the past few years, imaging techniques have gained a central role in identifying liver metastases, thanks to ultrasonography, contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI). All these techniques, especially CT and MRI, can be considered the non-invasive reference standard techniques for the assessment of liver involvement by metastases. On the other hand, the liver can be affected by different focal lesions, sometimes benign, and sometimes malignant. On these bases, radiologists should face the differential diagnosis between benign and secondary lesions to correctly allocate patients to the best management. Considering the above-mentioned principles, it’s extremely important to underline and refresh the broad spectrum of liver metastases features that can occur in everyday clinical practice. This review aims to summarize the most common imaging features of liver metastases, with a special focus on typical and atypical appearance, by using MRI.

Keywords: Liver metastases; Magnetic resonance imaging; Gadolinium; Gd-EOB-DTPA; Gadoxetate disodium; Liver specific contrast agents; Hepatobiliary contrast agents

Core Tip: To better detect liver metastases, magnetic resonance imaging (MRI) protocol should be correctly performed, using extra-cellular or hepatobiliary contrast agents. Even if conventional non-enhanced techniques can help depict focal liver lesions, contras-enhanced sequences are mandatory, to evaluate their behavior in comparison to the healthy liver parenchyma. These aspects allow to determine liver and hepatic lesions’ vascularization over time and increase radiologists’ diagnostic values. The typical appearance of liver metastases can be easily recognized as hypovascular lesions. However, some primary tumors can produce liver metastases with atypical appearances, such as hypervascular ones, or within calcification, mucin, or other proteins. The multiparametric nature of MRI, combined with the administration of contrast agents, can strongly increase radiologists' confidence in the final diagnosis.