Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2021; 13(12): 1936-1955
Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.1936
Imaging evaluation of the liver in oncology patients: A comparison of techniques
Patrícia S Freitas, Catarina Janicas, José Veiga, António P Matos, Vasco Herédia, Miguel Ramalho
Patrícia S Freitas, José Veiga, Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon 1150-199, Portugal
Catarina Janicas, Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon 1449-005, Portugal
António P Matos, Vasco Herédia, Miguel Ramalho, Department of Radiology, Hospital Garcia de Orta, EPE, Almada 2805-267, Portugal
António P Matos, Department of Radiology, Hospital CUF Tejo, Lisbon 1350-352, Portugal
Vasco Herédia, Department of Radiology, Hospital Espírito Santo de Évora-EPE, Évora 7000-811, Portugal
Miguel Ramalho, Department of Radiology, Hospital da Luz, Lisbon 1500-650, Portugal
Author contributions: Freitas PS wrote the manuscript, and contributed to conception and design; Freitas PS, Janicas C, Veiga J, Matos AP, Herédia V, and Ramalho M worked with literature review, editing, figure collection, annotation, and captioning, and contributed to revision related to the important intellectual content of the manuscript, and revision and final approval of the version of the article to be published.
Conflict-of-interest statement: The authors declare no conflict of interests 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:
Corresponding author: Miguel Ramalho, MD, Assistant Professor, Department of Radiology, Hospital Garcia de Orta, EPE, Av. Torrado da Silva, Almada 2805-267, Portugal.
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: May 13, 2021
Revised: May 26, 2021
Accepted: November 28, 2021
Article in press: November 28, 2021
Published online: December 27, 2021

The liver is commonly affected by metastatic disease. Therefore, it is essential to detect and characterize liver metastases, assuming that patient management and prognosis rely on it. The imaging techniques that allow non-invasive assessment of liver metastases include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, and PET/MRI. In this paper, we review the imaging findings of liver metastases, focusing on each imaging modality’s advantages and potential limitations. We also assess the importance of different imaging modalities for the management, follow-up, and therapy response of liver metastases. To date, both CT and MRI are the most appropriate imaging methods for initial lesion detection, follow-up, and assessment of treatment response. Multiparametric MRI is frequently used as a problem-solving technique for liver lesions and has evolved substantially over the past decade, including hardware and software developments and specific intravenous contrast agents. Several studies have shown that MRI performs better in small-sized metastases and moderate to severe liver steatosis cases. Although state-of-the-art MRI shows a greater sensitivity for detecting and characterizing liver metastases, CT remains the chosen method. We also present the controversial subject of the "economic implication" to use CT over MRI.

Keywords: Liver metastases, Magnetic resonance imaging, Computed tomography, Oncology, Ultrasound, Follow-up

Core Tip: Several imaging methods are clinically available to evaluate and characterize liver metastases. Both computed tomography and magnetic resonance imaging (MRI) are currently the techniques that show the highest diagnostic performance and are also the most suitable for assessing therapy response and follow-up. Several studies have shown that MRI has a higher sensitivity for detecting and characterizing liver metastases; therefore, it may be the ideal imaging method for treatment planning before and after neoadjuvant chemotherapy. The traditional paradigm for ordering imaging studies emphasizes diagnostic accuracy, which is why we believe that MRI should be favored when available, the first-line imaging for detecting liver metastases, and pre- and post-treatment follow-up.