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Wale A, Harris H, Brown G. Diagnostic Certainty in Characterizing Liver Lesions in Rectal Cancer: Abbreviated Liver MRI versus CT. Ann Surg Oncol 2025; 32:2435-2445. [PMID: 39836274 PMCID: PMC11882682 DOI: 10.1245/s10434-024-16468-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 10/23/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND Early diagnosis of metastases is crucial but routine staging with contrast-enhanced multidetector computed tomography (ceMDCT) is suboptimal. A total of 20% will have indeterminate or too small to characterize (TSTC) liver lesions on CT, requiring formal characterization by magnetic resonance imaging (MRI). This UK cross-sectional study reports our experience undertaking routine abbreviated liver MRI (MRI). PATIENTS AND METHODS A total of 99 patients with rectal cancer had ceMDCT, abbreviated liver MRI, and rectal MRI at diagnosis. Liver imaging was scored for liver metastases, benign or indeterminate/TSTC lesions on a per patient basis. Primary rectal cancer was risk scored on MRI. RESULTS A total of 42/99 (42%) had liver lesion(s) on ceMDCT versus 55/99 (56%) by MRI, and 46/99 (46%) had high-risk rectal cancer. ceMDCT showed 5 patients with liver metastases, 14 with benign lesions, and 23 with indeterminate/TSTC lesions. MRI showed 6 with liver metastases, 45 with benign lesions, and 4 with indeterminate/TSTC lesions. All liver metastases were in high-risk rectal cancer, OR 17.18 (p = 0.06), with 12.5% conversion rate of TSTC lesions to metastases in high-risk rectal cancer and 0% in low-risk rectal cancer. Diagnostic certainty of the liver findings was achieved in 93% of patients by MRI compared with 45% by ceMDCT (p < 0.0001). DISCUSSION Abbreviated liver MRI diagnosed fewer indeterminate/TSTC lesions and provided greater diagnostic certainty than ceMDCT, p < 0.0001. High-risk rectal cancer is associated with a higher conversation rate of TSTC lesions to metastases than low-risk rectal cancers. Risk stratified; routine abbreviated liver MRI sequences should be investigated as part of the patient pathway for high-risk rectal cancer.
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Affiliation(s)
- Anita Wale
- Department of Radiology, St George's Hospital NHS Foundation Trust, Cardiovascular and Genomics Research Institute, St George's University of London, London, UK
| | - Heather Harris
- Department of Radiology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, UK
| | - Gina Brown
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Wale A, Brown G. ASO Author Reflections: Diagnostic Certainty in Characterizing Liver Lesions in Rectal Cancer: Abbreviated Liver MRI Versus CT. Ann Surg Oncol 2025; 32:2481-2482. [PMID: 39821543 PMCID: PMC11882672 DOI: 10.1245/s10434-024-16605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 11/12/2024] [Indexed: 01/19/2025]
Affiliation(s)
- Anita Wale
- Department of Radiology, St George's Hospital NHS Foundation Trust, London, UK
- Cardiovascular and Genomics Research Institute, St George's, University of London, London, UK
| | - Gina Brown
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Zhang L, Bai L. Diagnostic performance of contrast-enhanced CT combined with contrast-enhanced MRI for colorectal liver metastases: a case-control study. BMC Gastroenterol 2025; 25:188. [PMID: 40114056 PMCID: PMC11924653 DOI: 10.1186/s12876-025-03785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 03/13/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND Colorectal liver metastases (CRLM) are a major determinant of prognosis in colorectal cancer (CRC) patients. Their early and accurate detection is essential for appropriate therapeutic planning and improving survival outcomes. PURPOSE To evaluate the diagnostic capabilities of contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) in detecting colorectal liver metastases. MATERIALS AND METHODS We employed a case-control design to compare patients with histologically confirmed liver metastases against a control group without the condition. A total of 85 patients in each group were selected and retrospectively matched based on relevant factors. All subjects underwent both contrast-enhanced CT and MRI. The diagnostic performance of these imaging modalities was assessed by analysing sensitivity, specificity, positive and negative predictive values, and radiologists' diagnostic confidence. Kappa statistics were used to evaluate inter-observer agreement. All MRI scans were performed using a 3-Tesla (3-T) MRI scanner to ensure high-quality imaging and detailed lesion characterization. And all the scans were reviewed by two radiologists. RESULTS The combination of contrast-enhanced CT and MRI demonstrated a statistically significant improvement in sensitivity (90.6% for MRI alone vs. 96.5% for combined modalities) and specificity (95.3% for MRI alone vs. 98.3% for combined modalities). Positive and negative predictive values were similarly enhanced. Radiologists' diagnostic confidence was higher with combined imaging, achieving a 'very high' confidence level in 78.8% of cases compared with 64.7% for MRI alone. The inter-observer agreement reached 'almost perfect' status with the combined approach. CONCLUSION The integration of contrast-enhanced CT with MRI significantly enhanced the diagnostic accuracy for colorectal liver metastases, representing a valuable tool for the preoperative evaluation of patients with CRC. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Luxian Zhang
- Department of Radiology, Zhongshan Hospital Xiamen University, 201 Hubin South Road, Siming District, Xiamen City, Fujian Province, 361004, China
| | - Luna Bai
- Department of Radiology, Zhongshan Hospital Xiamen University, 201 Hubin South Road, Siming District, Xiamen City, Fujian Province, 361004, China.
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Yohanathan L, Chopra A, Simo K, Clancy TE, Khithani A, Anaya DA, Maegawa FA, Sheikh M, Raoof M, Jacobs M, Aleassa E, Boff M, Ferguson B, Tan-Tam C, Winslow E, Qadan M, D’Angelica MI. Assessment and treatment considerations for patients with colorectal liver metastases: AHPBA consensus guideline and update for surgeons. HPB (Oxford) 2025; 27:263-278. [PMID: 39828468 DOI: 10.1016/j.hpb.2024.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/20/2024] [Accepted: 12/09/2024] [Indexed: 01/22/2025]
Abstract
BACKGROUND Colorectal cancer most commonly metastasizes to the liver. While various treatment strategies have been developed, surgical management of these patients has vital implications on the prognosis and survival of this group of patients. There remains a need for a consensus guideline regarding the surgical evaluation and management of patients with colorectal liver metastases (CRLM). METHODS This review article is a consensus guideline established by the members of the AHPBA Professional Standards Committee, as an amalgamation of existent literature and a guide to surgeons managing this complex disease. RESULTS These guidelines reports the benefits and shortcomings of various diagnostic modalities including imaging and next-generation sequencing in the management of patients with CRLM. While surgery has established survival benefits in patients with resectable disease, this report notes the importance of treatment sequencing with non-surgical modalities as well as between colon and liver resection. Finally, the guidelines address the various treatment modalities for patients with unresectable disease, that may have significant impact on survival. CONCLUSION CRLM is a complex diagnosis which warrants multidisciplinary approach with early surgical involvement in both assessment and management of the disease, to optimize patient outcomes and survival.
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Liu J, Ye L, Miao G, Rao S, Zeng M, Liu L. Non-enhanced abbreviated MRI as a periodic surveillance protocol for colorectal liver metastases compared with contrast-enhanced CT: a prospective observational study. Int J Surg 2025; 111:2495-2504. [PMID: 39878067 DOI: 10.1097/js9.0000000000002252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 12/07/2024] [Indexed: 01/31/2025]
Abstract
BACKGROUND Adopting an appropriate noninvasive radiological method is crucial for periodic surveillance of liver metastases in colorectal cancer (CRC) patients after surgery, which is closely related to clinical management and prognosis. This study aimed to prospectively enroll stage II-III CRC patients for the surveillance of liver metastases and compare the diagnostic performance of contrast-enhanced CT (CE-CT) and non-enhanced abbreviated MRI (NE-AMRI) during this process. METHODS 587 CRC patients undergoing radical resection of the primary tumor were evaluated by 1 to 3 rounds of surveillance tests, consisting of abdominal CE-CT and contrast-enhanced MRI (CE-MRI) within 7 days at 6-month intervals. Subsequently, images of NE-AMRI were extracted from the CE-MRI examination, and paired CE-CT and NE-AMRI analysis were performed. The lesion-based detection rates between two protocols were compared, and a subgroup analysis was performed in lesions with a size of ≤10 mm. The patient-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the areas under the curves (AUCs) of CE-CT and NE-AMRI in each round were evaluated. Finally, the relationship between the diagnostic accuracy of two protocols and characteristics of patients was explored. RESULTS The lesion-based detection rates of NE-AMRI in three rounds were all significantly higher than those of CE-CT ( P < 0.001, P < 0.001, P = 0.003, respectively). In the subgroup analysis of lesions ≤ 10 mm, NE-AMRI also performed better than CE-CT ( P < 0.001, P = 0.002, P = 0.005, respectively). The patient-based sensitivities, specificities, NPVs, and PPVs of NE-AMRI were higher than those of CE-CT in three rounds of surveillance. The AUCs for NE-AMRI were all significantly better than those for CE-CT in each round ( P = 0.015, P = 0.045, P = 0.009, respectively). Furthermore, patient BMI and fatty liver disease had impacts on the diagnostic accuracy of the CE-CT protocol, but not on the NE-AMRI protocol. CONCLUSION NE-AMRI may be a promising periodic surveillance tool for CRC patients after surgery to increase diagnostic accuracy of liver metastases, developing personalized clinical management and improving prognosis, simultaneously avoiding side effects associated with ionizing radiation and contrast agents.
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Affiliation(s)
- Jingjing Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Lechi Ye
- Departments of General Surgery and Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai China
| | - Gengyun Miao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengxiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Liheng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
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Mohammed H, Mohamed H, Mohamed N, Sharma R, Sagar J. Early Rectal Cancer: Advances in Diagnosis and Management Strategies. Cancers (Basel) 2025; 17:588. [PMID: 40002183 PMCID: PMC11853685 DOI: 10.3390/cancers17040588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 02/07/2025] [Accepted: 02/08/2025] [Indexed: 02/27/2025] Open
Abstract
Colorectal cancer (CRC) is the second most prevalent cause of cancer-related death and the third most common cancer globally. Early-stage rectal cancer is defined by lesions confined to the bowel wall, without extension beyond the submucosa in T1 or the muscularis propria in T2, with no indication of lymph node involvement or distant metastasis. The gold standard for managing rectal cancer is total mesorectal excision (TME); however, it is linked to considerable morbidities and impaired quality of life. There is a growing interest in local resection and non-operative treatment of early RC for organ preservation. Local resection options include three types of transanal endoscopic surgery (TES): transanal endoscopic microsurgery (TEM), transanal endoscopic operations (TEO), and transanal minimally invasive surgery (TAMIS), while endoscopic resection includes endoscopic mucosal resection (EMR), underwater endoscopic mucosal resection (UEMR), and endoscopic submucosal dissection (ESD). Although the oncological outcome of local resection of early rectal cancer is debated in the current literature, some studies have shown comparable outcomes with radical surgery in selected patients. The use of adjuvant and neoadjuvant chemoradiotherapy in early rectal cancer management is also controversial in the literature, but a number of studies have reported promising outcomes. This review focuses on the available literature regarding diagnosis, staging, and management strategies of early rectal cancer and provides possible recommendations.
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Affiliation(s)
- Huda Mohammed
- Surgery Department, Colorectal Surgery, Luton and Dunstable Hospital, Luton LU4 0DZ, UK; (H.M.); (N.M.); (R.S.)
| | - Hadeel Mohamed
- Faculty of Medicine, University of Khartoum, Khartoum 11115, Sudan;
| | - Nusyba Mohamed
- Surgery Department, Colorectal Surgery, Luton and Dunstable Hospital, Luton LU4 0DZ, UK; (H.M.); (N.M.); (R.S.)
| | - Rajat Sharma
- Surgery Department, Colorectal Surgery, Luton and Dunstable Hospital, Luton LU4 0DZ, UK; (H.M.); (N.M.); (R.S.)
| | - Jayesh Sagar
- Surgery Department, Colorectal Surgery, Luton and Dunstable Hospital, Luton LU4 0DZ, UK; (H.M.); (N.M.); (R.S.)
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Castagnoli F, Withey SJ, Konidari M, Chau I, Riddell A, Shur J, Messiou C, Koh DM. Clinical performance of a simulated abbreviated liver magnetic resonance imaging in combination with contrast-enhanced computed tomography for the baseline evaluation of the liver in patients with colorectal cancer. Clin Radiol 2025; 80:106743. [PMID: 39631364 DOI: 10.1016/j.crad.2024.106743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 10/19/2024] [Accepted: 10/23/2024] [Indexed: 12/07/2024]
Abstract
AIM To assess the diagnostic accuracy and inter-reader agreement of a simulated abbreviated gadoxetate liver magnetic resonance imaging (MRI) protocol together with contrast-enhanced computed tomography (CE-CT) against a standard gadoxetate MRI for the detection of colorectal liver metastases at baseline. MATERIALS AND METHODS Three readers independently evaluated two sets of images per patient, recording number and location of metastases and benign lesions. Set 1 comprised T1w, T2w, DWI, multiphase CE-T1w, and hepatobiliary phase (HBP) images (standard). Set 2 included T2w, HBP, DWI (from Set 1) and CE-CT (simulated abbreviated). Diagnostic performance was compared using McNemar's test. The level of agreement between sets 1 and 2 was determined with Cohen kappa. For agreement in the number of benign lesions and metastases, we applied intraclass correlation coefficient (ICC). RESULTS Seventy-five patients (245 metastases, 122 benign lesions) were evaluated. There was no significant difference in diagnostic accuracy between set 1 and 2 for each reader (mean P = 0.74). The total number of metastases and benign lesions showed high agreement between reading set 1 and 2 (κ = 0.81, 0.78). The total number of metastases showed substantial agreement between readers for set 1 and 2 (ICC = 0.99, 0.99). Good agreement was seen for metastatic segmental involvement (κ = 0.84-0.99). CONCLUSION At baseline, using a simulated abbreviated liver MRI together with CE-CT showed excellent agreement with standard MRI protocol for liver metastasis detection.
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Affiliation(s)
- F Castagnoli
- Department of Radiology, Royal Marsden Hospital, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
| | - S J Withey
- Department of Radiology, Royal Marsden Hospital, London, UK
| | - M Konidari
- Department of Radiology, Royal Marsden Hospital, London, UK
| | - I Chau
- Department of Medicine, Royal Marsden Hospital, London, UK
| | - A Riddell
- Department of Radiology, Royal Marsden Hospital, London, UK
| | - J Shur
- Department of Radiology, Royal Marsden Hospital, London, UK
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - D M Koh
- Department of Radiology, Royal Marsden Hospital, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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Takayama M, Ito K, Karako K, Mihara Y, Sasaki S, Ichida A, Takamoto T, Akamatsu N, Kawaguchi Y, Hasegawa K. An artificial intelligence-based recognition model of colorectal liver metastases in intraoperative ultrasonography with improved accuracy through algorithm integration. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2025; 32:58-68. [PMID: 39547943 PMCID: PMC11780306 DOI: 10.1002/jhbp.12089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2024]
Abstract
BACKGROUND/PURPOSE Contrast-enhanced intraoperative ultrasonography (CE-IOUS) is crucial for detecting colorectal liver metastases (CLM) during surgery. Although artificial intelligence shows potential in diagnostic systems, its application in CE-IOUS is limited. METHODS This study aimed to develop an automatic tumor detection model using Mask region-based convolutional neural network (Mask R-CNN) for CE-IOUS images. CE-IOUS videos of the CLM from 121 patients were collected, generating ground truth data. A total of 2659 images were obtained. Two models were developed: the basic recognition model (BRM), which was trained on CE-mode images, and the subtraction model (SM), which used images created by a subtraction algorithm that highlighted the differences in pixel values between the basic-mode and CE-mode images. The subtraction algorithm focuses on echogenicity differences. These two models were combined into a combination model (CM), which assessed outcomes using the prediction probabilities from both models. RESULTS The optimal epochs were determined by the maximum area under the curve (AUC), and the thresholds were calculated accordingly. BRM, SM, and CM achieved 89.4%, 86.6%, and 96.5% accuracy, respectively. CM outperformed the individual models, achieving an AUC of 0.99. CONCLUSIONS A novel automated recognition model was developed for accurate CLM detection in CE-IOUS by integrating image- and algorithm-based models.
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Affiliation(s)
- Maho Takayama
- Hepato‐Biliary‐Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kyoji Ito
- Hepato‐Biliary‐Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kenji Karako
- Hepato‐Biliary‐Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yuichiro Mihara
- Hepato‐Biliary‐Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Shu Sasaki
- Hepato‐Biliary‐Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Akihiko Ichida
- Hepato‐Biliary‐Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Takeshi Takamoto
- Hepato‐Biliary‐Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Nobuhisa Akamatsu
- Hepato‐Biliary‐Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Yoshikuni Kawaguchi
- Hepato‐Biliary‐Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Kiyoshi Hasegawa
- Hepato‐Biliary‐Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
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Jooste V, Lepage C, Manfredi S, Bouvier AM. Trends in incidence of infrequent and frequent synchronous metastases from colorectal cancer. Dig Liver Dis 2025; 57:83-88. [PMID: 38972790 DOI: 10.1016/j.dld.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/23/2024] [Accepted: 06/19/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Population-based data on the incidence of frequent colorectal metastases are fairly scarce, while that on rare metastatic sites are lacking. AIMS The aim of this study was to provide epidemiological indicators of metastatic sites frequency in patients with colorectal cancer. METHODS Incidence was modelled using Poisson and Joinpoint regressions in a population-based cancer registry study including metastatic colorectal cancers diagnosed between 1991 and 2020 (N = 5,199). Tumor molecular markers were collected for the [2016-2020] period. RESULTS Liver, peritoneum, lung and bone were the most frequent metastatic sites. Among frequent sites, incidence of liver and lung sites decreased in men respectively since 1999 and 2010, whereas in women incidence of liver and peritoneum sites increased steadily throughout the whole period. Each of the other sites concerned less than 3% of metastatic colorectal cancer cases and presented standardized incidence rates between 0.19 and 1.39 per 1,000,000. Among rare sites, incidence of adrenal glands, supraclavicular lymph node, mediastinum and ascites had doubled in [2016-2020] as compared to the 25 previous years. BRAFV600E variant was more frequent in presence of carcinomatosis, and absence of liver and lung metastasis while KRAS variant was more frequent in presence of lung metastasis. CONCLUSION This study provides unprecedented incidence indicators for rare synchronous metastases of colorectal cancer.
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Affiliation(s)
- Valérie Jooste
- Digestive Cancer Registry of Burgundy, Dijon, France; CTM UMR1231 EPICAD, Dijon, France; Department of Digestive Oncology, University Hospital Dijon, France; University of Burgundy, France
| | - Côme Lepage
- CTM UMR1231 EPICAD, Dijon, France; Department of Digestive Oncology, University Hospital Dijon, France; University of Burgundy, France
| | - Sylvain Manfredi
- CTM UMR1231 EPICAD, Dijon, France; Department of Digestive Oncology, University Hospital Dijon, France; University of Burgundy, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, Dijon, France; CTM UMR1231 EPICAD, Dijon, France; Department of Digestive Oncology, University Hospital Dijon, France; University of Burgundy, France.
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Boubaddi M, Marichez A, Adam JP, Lapuyade B, Debordeaux F, Tlili G, Chiche L, Laurent C. Comprehensive Review of Future Liver Remnant (FLR) Assessment and Hypertrophy Techniques Before Major Hepatectomy: How to Assess and Manage the FLR. Ann Surg Oncol 2024; 31:9205-9220. [PMID: 39230854 DOI: 10.1245/s10434-024-16108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/16/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND The regenerative capacities of the liver and improvements in surgical techniques have expanded the possibilities of resectability. Liver resection is often the only curative treatment for primary and secondary malignancies, despite the risk of post-hepatectomy liver failure (PHLF). This serious complication (with a 50% mortality rate) can be avoided by better assessment of liver volume and function of the future liver remnant (FLR). OBJECTIVE The aim of this review was to understand and assess clinical, biological, and imaging predictors of PHLF risk, as well as the various hypertrophy techniques, to achieve an adequate FLR before hepatectomy. METHOD We reviewed the state of the art in liver regeneration and FLR hypertrophy techniques. RESULTS The use of new biological scores (such as the aspartate aminotransferase/platelet ratio index + albumin-bilirubin [APRI+ALBI] score), concurrent utilization of 99mTc-mebrofenin scintigraphy (HBS), or dynamic hepatocyte contrast-enhanced MRI (DHCE-MRI) for liver volumetry helps predict the risk of PHLF. Besides portal vein embolization, there are other FLR optimization techniques that have their indications in case of risk of failure (e.g., associating liver partition and portal vein ligation for staged hepatectomy, liver venous deprivation) or in specific situations (transarterial radioembolization). CONCLUSION There is a need to standardize volumetry and function measurement techniques, as well as FLR hypertrophy techniques, to limit the risk of PHLF.
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Affiliation(s)
- Mehdi Boubaddi
- Hepatobiliary and Pancreatic Surgery Department, Bordeaux University Hospital Center, Bordeaux, France.
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Bordeaux University, Bordeaux, France.
| | - Arthur Marichez
- Hepatobiliary and Pancreatic Surgery Department, Bordeaux University Hospital Center, Bordeaux, France
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Bordeaux University, Bordeaux, France
| | - Jean-Philippe Adam
- Hepatobiliary and Pancreatic Surgery Department, Bordeaux University Hospital Center, Bordeaux, France
| | - Bruno Lapuyade
- Radiology Department, Bordeaux University Hospital Center, Bordeaux, France
| | - Frederic Debordeaux
- Nuclear Medicine Department, Bordeaux University Hospital Center, Bordeaux, France
| | - Ghoufrane Tlili
- Nuclear Medicine Department, Bordeaux University Hospital Center, Bordeaux, France
| | - Laurence Chiche
- Hepatobiliary and Pancreatic Surgery Department, Bordeaux University Hospital Center, Bordeaux, France
| | - Christophe Laurent
- Hepatobiliary and Pancreatic Surgery Department, Bordeaux University Hospital Center, Bordeaux, France
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, Bordeaux University, Bordeaux, France
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Zhao J, Wang F, Wang RF. Nuclear medicine based multimodal molecular imaging facilitates precision medicine for gastrointestinal tumors. Shijie Huaren Xiaohua Zazhi 2024; 32:727-734. [DOI: 10.11569/wcjd.v32.i10.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 09/23/2024] [Accepted: 10/21/2024] [Indexed: 10/28/2024] Open
Abstract
Gastric and colorectal cancers are the most common gastrointestinal malignancies, with high morbidity and mortality rates. Early diagnosis and accurate staging are of great significance for formulating reasonable clinical treatment plans, guiding surgical methods, effectively carrying out individualized comprehensive treatment, and estimating prognosis. As representatives of nuclear medicine based multimodal molecular imaging technologies, positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging allow for obtaining the status of lesions throughout the body in one imaging procedure, and are less likely to miss distant and neighboring metastatic lesions. It is very important to truly achieve accurate disease classification and diagnosis, and develop individualized disease prevention and treatment plans. The emerging multimodal nuclide tracer molecular imaging technology has important clinical value in the diagnosis and treatment of gastric cancer and colorectal cancer. This article reviews the application and progress of the two examination methods in the diagnosis and staging of gastric cancer and colorectal cancer.
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Affiliation(s)
- Jing Zhao
- Department of Nuclear Medicine, Peking University International Hospital, Beijing 102206, China
| | - Fei Wang
- Department of Pharmacy, Peking University First Hospital, Beijing 100034, China
| | - Rong-Fu Wang
- Department of Nuclear Medicine, Peking University International Hospital, Beijing 102206, China
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
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Jia W, Li F, Cui Y, Wang Y, Dai Z, Yan Q, Liu X, Li Y, Chang H, Zeng Q. Deep Learning Radiomics Model of Contrast-Enhanced CT for Differentiating the Primary Source of Liver Metastases. Acad Radiol 2024; 31:4057-4067. [PMID: 38702214 DOI: 10.1016/j.acra.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 05/06/2024]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a deep learning radiomics (DLR) model based on contrast-enhanced computed tomography (CT) to identify the primary source of liver metastases. MATERIALS AND METHODS In total, 657 liver metastatic lesions, including breast cancer (BC), lung cancer (LC), colorectal cancer (CRC), gastric cancer (GC), and pancreatic cancer (PC), from 428 patients were collected at three clinical centers from January 2018 to October 2023 series. The lesions were randomly assigned to the training and validation sets in a 7:3 ratio. An additional 112 lesions from 61 patients at another clinical center served as an external test set. A DLR model based on contrast-enhanced CT of the liver was developed to distinguish the five pathological types of liver metastases. Stepwise classification was performed to improve the classification efficiency of the model. Lesions were first classified as digestive tract cancer (DTC) and non-digestive tract cancer (non-DTC). DTCs were divided into CRC, GC, and PC and non-DTCs were divided into LC and BC. To verify the feasibility of the DLR model, we trained classical machine learning (ML) models as comparison models. Model performance was evaluated using accuracy (ACC) and area under the receiver operating characteristic curve (AUC). RESULTS The classification model constructed by the DLR algorithm showed excellent performance in the classification task compared to ML models. Among the five categories task, highest ACC and average AUC were achieved at 0.563 and 0.796 in the validation set, respectively. In the DTC and non-DTC and the LC and BC classification tasks, AUC was achieved at 0.907 and 0.809 and ACC was achieved at 0.843 and 0.772, respectively. In the CRC, GC, and PC classification task, ACC and average AUC were the highest, at 0.714 and 0.811, respectively. CONCLUSION The DLR model is an effective method for identifying the primary source of liver metastases.
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Affiliation(s)
- Wenjing Jia
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China; Shandong First Medical University, Jinan, China.
| | - Fuyan Li
- Department of Radiology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China.
| | - Yi Cui
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China.
| | - Yong Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
| | - Zhengjun Dai
- Scientific Research Department, Huiying Medical Technology Co., Ltd, Beijing, China.
| | - Qingqing Yan
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Xinhui Liu
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Yuting Li
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Huan Chang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
| | - Qingshi Zeng
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
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13
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Ni X, Wei Y, Li X, Pan J, Fang B, Zhang T, Lu Y, Ye D, Zhu Y. From biology to the clinic - exploring liver metastasis in prostate cancer. Nat Rev Urol 2024; 21:593-614. [PMID: 38671281 DOI: 10.1038/s41585-024-00875-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Liver metastases from prostate cancer are associated with an aggressive disease course and poor prognosis. Results from autopsy studies indicate a liver metastasis prevalence of up to 25% in patients with advanced prostate cancer. Population data estimate that ~3-10% of patients with metastatic castration-resistant prostate cancer harbour liver metastases at the baseline, rising to 20-30% in post-treatment cohorts, suggesting that selective pressure imposed by novel therapies might promote metastatic spread to the liver. Liver metastases are associated with more aggressive tumour biology than lung metastases. Molecular profiling of liver lesions showed an enrichment of low androgen receptor, neuroendocrine phenotypes and high genomic instability. Despite advancements in molecular imaging modalities such as prostate-specific membrane antigen PET-CT, and liquid biopsy markers such as circulating tumour DNA, early detection of liver metastases from prostate cancer remains challenging, as both approaches are hampered by false positive and false negative results, impeding the accurate identification of early liver lesions. Current therapeutic strategies showed limited efficacy in this patient population. Emerging targeted radionuclide therapies, metastasis-directed therapy, and novel systemic agents have shown preliminary activity against liver metastases, but require further validation. Treatment with various novel prostate cancer therapies might lead to an increase in the prevalence of liver metastasis, underscoring the urgent need for coordinated efforts across preclinical and clinical researchers to improve characterization, monitoring, and management of liver metastases from prostate cancer. Elucidating molecular drivers of liver tropism and interactions with the liver microenvironment might ultimately help to identify actionable targets to enhance survival in this high-risk patient group.
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Affiliation(s)
- Xudong Ni
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Yu Wei
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Xiaomeng Li
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Jian Pan
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Bangwei Fang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Tingwei Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Ying Lu
- Key Laboratory of Metabolism and Molecular Medicine of the Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Shanghai Medical College of Fudan University, Shanghai, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Genitourinary Cancer Institute, Shanghai, China
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
- Shanghai Genitourinary Cancer Institute, Shanghai, China.
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14
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Dempsey PJ, Farrelly C, Cronin CG, Fenlon HM. Preoperative imaging of colorectal liver metastases: what the radiologist and the multidisciplinary team need to know. Br J Radiol 2024; 97:1602-1618. [PMID: 39078288 PMCID: PMC11417391 DOI: 10.1093/bjr/tqae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/13/2024] [Accepted: 07/29/2024] [Indexed: 07/31/2024] Open
Abstract
The management of patients with colorectal liver metastases (CRLM) has transformed over the past 2 decades. Advances in surgical techniques, systemic therapies, and local treatments have resulted in a paradigm shift. Disease that would once have been considered terminal is now frequently treated aggressively with both a disease-free and overall survival benefit. In line with the expanding range of treatment options, there has been an increase in the volume and complexity of imaging required in the management of these patients to ensure optimal patient selection and outcome. The radiologist plays a pivotal role in interpreting these studies, conveying the relevant information and informing the discussion at multidisciplinary team meetings. The purpose of this review is to provide an update for radiologists on the current surgical management of patients with CRLM highlighting specific imaging information that is required by the multidisciplinary team when assessing resectability and/or the need for additional liver-directed therapies.
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Affiliation(s)
- Philip J Dempsey
- Department of Radiology, Mater Misericordiae University Hospital, Dublin D07, Ireland
| | - Cormac Farrelly
- Department of Radiology, Mater Misericordiae University Hospital, Dublin D07, Ireland
| | - Carmel G Cronin
- Department of Radiology, Mater Misericordiae University Hospital, Dublin D07, Ireland
| | - Helen M Fenlon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin D07, Ireland
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15
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Lund M, Bjerre TA, Grønbæk H, Mortensen FV, Andersen PK. CEUS compared with CECT, MRI, and FDG-PET/CT for diagnosing CRC liver metastases: a diagnostic test accuracy systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2024; 18:541-549. [PMID: 39315472 DOI: 10.1080/17474124.2024.2407973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 08/15/2024] [Accepted: 09/08/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE To determine the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) compared with contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and Fluorine-18-deoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for diagnosing suspected liver metastases in patients with newly diagnosed colorectal cancer (CRC). METHODS The meta-analysis using the bivariate model included studies on patients with newly diagnosed CRC only and excluded patients with non-CRC liver metastases, known liver metastases, patients treated with chemotherapy and local treatments, e.g. hepatic resection or radiofrequency ablation. We used QUADAS-2 to assess the methodological quality of the studies. RESULTS We included 32 studies, 6 studies evaluated the accuracy of CEUS (n = 937 participants), 26 studies evaluated CECT (n = 2,582), 8 studies evaluated MRI (n = 564) and 6 studies evaluated FDG-PET/CT (n = 813). Sensitivity: FDG-PET/CT 94.4% [95% CI: 90.7-98.1%], MRI 92.9% [95% CI: 88.8-97.0%], CEUS 86.1% [95% CI: 78.0-94.3%] and CECT 84.6% [95% CI: 79.3-89.9%]. Specificity FDG-PET/CT 97.9% [95% CI: 95.9-99.9%], CEUS 96.1% [95% CI: 93.6-98.6%], MRI 94.4% [95% CI: 90.5-98.3%], and CECT 94.3% [95% CI: 91.8-96.8%]. CONCLUSION FDG-PET/CT had significantly higher sensitivity and specificity than CECT, and significantly higher sensitivity than CEUS. MRI had a significantly higher sensitivity than CEUS, but a lower non-significant specificity. CECT had the lowest sensitivity and specificity. PROSPERO REGISTRATION DETAILS CRD42017055015 and CRD42017082996.
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Affiliation(s)
- Martin Lund
- Department of Radiology, Randers Regional Hospital, Randers, Denmark
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas A Bjerre
- Department of Radiology, Randers Regional Hospital, Randers, Denmark
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Frank V Mortensen
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Kragh Andersen
- Department of Biostatistics, University of Copenhagen Faculty of Health Sciences, Institute of Public Health, Copenhagen K, Denmark
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16
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Leiphrakpam PD, Newton R, Anaya DA, Are C. Evolution and current trends in the management of colorectal cancer liver metastasis. Minerva Surg 2024; 79:455-469. [PMID: 38953758 DOI: 10.23736/s2724-5691.24.10363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Metastatic colorectal cancer (mCRC) is a major cause of cancer-related death, with a 5-year relative overall survival of up to 20%. The liver is the most common site of distant metastasis in colorectal cancer (CRC), with about 50% of CRC patients metastasizing to their liver over the course of their disease. Complete liver resection is the primary modality of treatment for resectable colorectal cancer liver metastasis (CRLM), with an overall 5-year survival rate of up to 58%. However, only 15% to 20% of patients with CRLM are deemed suitable for resection at presentation. For unresectable diseases, the median survival of patients remains low even with the best chemotherapy. In recent decades, the management of CRLM has continued to evolve with the expansion of resection criteria, novel targeted systemic therapies, and improved locoregional therapies. However, due to the heterogeneity of the CRC patient population, the optimal evaluation of treatment options for CRLM remains complex. Therefore, effective management requires a multidisciplinary team to help define resectability and devise a personalized treatment approach, from the initial diagnosis to the final treatment.
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Affiliation(s)
- Premila D Leiphrakpam
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rachael Newton
- Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Chandrakanth Are
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA -
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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17
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Lahaye MJ, Lambregts DMJ, Aalbers AGJ, Snaebjornsson P, Beets-Tan RGH, Kok NFM. Imaging in the era of risk-adapted treatment in colon cancer. Br J Radiol 2024; 97:1214-1221. [PMID: 38648743 PMCID: PMC11186558 DOI: 10.1093/bjr/tqae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/25/2024] Open
Abstract
The treatment landscape for patients with colon cancer is continuously evolving. Risk-adapted treatment strategies, including neoadjuvant chemotherapy and immunotherapy, are slowly finding their way into clinical practice and guidelines. Radiologists are pivotal in guiding clinicians toward the most optimal treatment for each colon cancer patient. This review provides an overview of recent and upcoming advances in the diagnostic management of colon cancer and the radiologist's role in the multidisciplinary approach to treating colon cancer.
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Affiliation(s)
- Max J Lahaye
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Doenja M J Lambregts
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arend G J Aalbers
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niels F M Kok
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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18
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Emile SH, Horesh N, Garoufalia Z, Gefen R, Zhou P, Wexner SD. Propensity-score matched outcomes of resection of stage IV primary colon cancer with and without simultaneous resection of liver metastases. Updates Surg 2024; 76:845-853. [PMID: 38568358 PMCID: PMC11130067 DOI: 10.1007/s13304-024-01832-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 05/28/2024]
Abstract
There is controversy in the best management of colorectal cancer liver metastasis (CLM). This study aimed to compare short-term and survival outcomes of simultaneous resection of CLM and primary colon cancer compared to resection of only colon cancer. This retrospective matched cohort study included patients from the National Cancer Database (2015-2019) with stage IV colon adenocarcinoma and synchronous liver metastases who underwent colectomy. Patients were divided into two groups: colectomy-only (resection of primary colon cancer only) and colectomy-plus (simultaneous resection of primary colon cancer and liver metastases). The groups were matched using the propensity score method. The primary outcome was short-term mortality and readmission. Secondary outcomes were conversion, hospital stay, surgical margins, and overall survival. 4082 (37.6%) of 10,862 patients underwent simultaneous resection of primary colon cancer and liver metastases. After matching, 2038 patients were included in each group. There were no significant differences between the groups in 30-days mortality (3.1% vs 3.8%, p = 0.301), 90-days (6.6% vs 7.7%, p = 0.205) mortality, 30-days unplanned readmission (7.2% vs 5.3%, p = 0.020), or conversion to open surgery (15.5% vs. 13.8%, p = 0.298). Patients in the colectomy plus group had a higher rate of lower incidence of positive surgical margins (13.2% vs. 17.2%, p = 0.001) and longer overall survival (median: 41.5 vs 28.4 months, p < 0.001). Synchronous resection of CLM did not increase the rates of short-term mortality, readmission, conversion from minimally invasive to open surgery, or hospital stay and was associated with a lower incidence of positive surgical margins.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33179, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33179, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33179, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33179, USA
- Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peige Zhou
- Georgia Colon and Rectal Surgical Associates, Northside Hospital, Atlanta, Georgia
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33179, USA.
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19
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Dilek ON, Arslan Kahraman Dİ, Kahraman G. Carcinoembryonic antigen in the diagnosis, treatment, and follow-up of focal liver lesions. World J Gastrointest Surg 2024; 16:999-1007. [PMID: 38690060 PMCID: PMC11056666 DOI: 10.4240/wjgs.v16.i4.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/02/2024] [Accepted: 03/13/2024] [Indexed: 04/22/2024] Open
Abstract
In this editorial review, we comment on the article published in the recent issue of the World Journal of Gastrointestinal Surgery. Carcinoembryonic antigen (CEA) is a fetal glycoprotein and can be secreted in very small amounts from healthy adults after birth. CEA is widely used not only for diagnostic tumor markers but also importantly for the management of some gastrointestinal tumors. The most common clinical use is surveillance for the monitoring of colorectal carcinoma. However, CEA can become elevated in several malign or benign characterized pathologies. Serum CEA level may vary depending on the location of the lesion, whether it metastasizes or not, and its histopathological characteristics. It has been determined that cases with high preoperative CEA have a more aggressive course and the risk of metastasis to the lymph tissue and liver increases. In this editorial review, we focused on evaluating the role of CEA in clinical practice with a holistic approach, including the diagnostic and prognostic significance of CEA in patients with focal liver lesions, the role of CEA in follow-up after definitive surgery, and also hepatic resection for metastasis, and the management of all patients with raised CEA.
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Affiliation(s)
- Osman Nuri Dilek
- Department of Surgery, İzmir Katip Celebi University, School of Medicine, İzmir 35150, Turkey
| | | | - Gökhan Kahraman
- Department of Radiology, Suluova State Hospital, Amasya 5500, Turkey
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20
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Ebrahimi S, Lundström E, Batasin SJ, Hedlund E, Stålberg K, Ehman EC, Sheth VR, Iranpour N, Loubrie S, Schlein A, Rakow-Penner R. Application of PET/MRI in Gynecologic Malignancies. Cancers (Basel) 2024; 16:1478. [PMID: 38672560 PMCID: PMC11048306 DOI: 10.3390/cancers16081478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
The diagnosis, treatment, and management of gynecologic malignancies benefit from both positron emission tomography/computed tomography (PET/CT) and MRI. PET/CT provides important information on the local extent of disease as well as diffuse metastatic involvement. MRI offers soft tissue delineation and loco-regional disease involvement. The combination of these two technologies is key in diagnosis, treatment planning, and evaluating treatment response in gynecological malignancies. This review aims to assess the performance of PET/MRI in gynecologic cancer patients and outlines the technical challenges and clinical advantages of PET/MR systems when specifically applied to gynecologic malignancies.
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Affiliation(s)
- Sheida Ebrahimi
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Elin Lundström
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
- Department of Surgical Sciences, Radiology, Uppsala University, 751 85 Uppsala, Sweden
- Center for Medical Imaging, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Summer J. Batasin
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Elisabeth Hedlund
- Department of Surgical Sciences, Radiology, Uppsala University, 751 85 Uppsala, Sweden
| | - Karin Stålberg
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Eric C. Ehman
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vipul R. Sheth
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA; (V.R.S.)
| | - Negaur Iranpour
- Department of Radiology, Stanford University, Palo Alto, CA 94305, USA; (V.R.S.)
| | - Stephane Loubrie
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Alexandra Schlein
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Rebecca Rakow-Penner
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
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21
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Chlorogiannis DD, Moussa AM, Zhao K, Alexander ES, Sofocleous CT, Sotirchos VS. Imaging Considerations before and after Liver-Directed Locoregional Treatments for Metastatic Colorectal Cancer. Diagnostics (Basel) 2024; 14:772. [PMID: 38611685 PMCID: PMC11011364 DOI: 10.3390/diagnostics14070772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Colorectal cancer is a leading cause of cancer-related death. Liver metastases will develop in over one-third of patients with colorectal cancer and are a major cause of morbidity and mortality. Even though surgical resection has been considered the mainstay of treatment, only approximately 20% of the patients are surgical candidates. Liver-directed locoregional therapies such as thermal ablation, Yttrium-90 transarterial radioembolization, and stereotactic body radiation therapy are pivotal in managing colorectal liver metastatic disease. Comprehensive pre- and post-intervention imaging, encompassing both anatomic and metabolic assessments, is invaluable for precise treatment planning, staging, treatment response assessment, and the prompt identification of local or distant tumor progression. This review outlines the value of imaging for colorectal liver metastatic disease and offers insights into imaging follow-up after locoregional liver-directed therapy.
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Affiliation(s)
| | - Amgad M. Moussa
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ken Zhao
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Erica S. Alexander
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Vlasios S. Sotirchos
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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22
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Görgec B, Sijberden JP, Swijnenburg RJ, Fretland ÅA, Verhoef C, Besselink MG, Stoker J. Optimal imaging before local therapy of colorectal liver metastases - Authors' reply. Lancet Oncol 2024; 25:e101. [PMID: 38423054 DOI: 10.1016/s1470-2045(24)00093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Burak Görgec
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Jasper P Sijberden
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands; Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Åsmund A Fretland
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Cornelis Verhoef
- Department of Surgical Oncology and Erasmus Medical Centre Cancer Institute, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Jaap Stoker
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands.
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Görgec B, Verpalen IM, Sijberden JP, Abu Hilal M, Bipat S, Verhoef C, Swijnenburg RJ, Besselink MG, Stoker J. Added Value of Liver MRI in Patients Eligible for Surgical Resection or Ablation of Colorectal Liver Metastases Based on CT: A Systematic Review and Meta-Analysis. ANNALS OF SURGERY OPEN 2024; 5:e401. [PMID: 38883954 PMCID: PMC11175892 DOI: 10.1097/as9.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 06/18/2024] Open
Abstract
Background Abdominal computed tomography (CT) is the standard imaging modality for detection and staging in patients with colorectal liver metastases (CRLM). Although liver magnetic resonance imaging (MRI) is superior to CT in detecting small lesions, guidelines are ambiguous regarding the added value of an additional liver MRI in the surgical workup of patients with CRLM. Therefore, this systematic review and meta-analysis aimed to evaluate the clinical added value of liver MRI in patients eligible for resection or ablation of CRLM based on CT. Methods A systematic search was performed in the PubMed, Embase, and Cochrane Library databases through June 23, 2023. Studies investigating the impact of additional MRI on local treatment plan following CT in patients with CRLM were included. Risk of bias was assessed using the QUADAS-2 tool. The pooled weighted proportions for the primary outcome were calculated using random effect meta-analysis. Results Overall, 11 studies with 1440 patients were included, of whom 468 patients (32.5%) were assessed for change in local treatment plan. Contrast-enhanced liver MRI was used in 10 studies, including gadoxetic acid in 9 studies. Liver MRI with diffusion-weighted imaging was used in 8 studies. Pooling of data found a 24.12% (95% confidence interval, 15.58%-32.65%) change in the local treatment plan based on the added findings of liver MRI following CT. Sensitivity analysis including 5 studies (268 patients) focusing on monophasic portal venous CT followed by gadoxetic acid-enhanced liver MRI with diffusion-weighted imaging showed a change of local treatment plan of 17.88% (95% confidence interval, 5.14%-30.62%). Conclusions This systematic review and meta-analysis found that liver MRI changed the preinterventional local treatment plan in approximately one-fifth of patients eligible for surgical resection or ablation of CRLM based on CT. These findings suggest a clinically relevant added value of routine liver MRI in the preinterventional workup of CRLM, which should be confirmed by large prospective studies.
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Affiliation(s)
- Burak Görgec
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Inez M. Verpalen
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Jasper P. Sijberden
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Shandra Bipat
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Rutger-Jan Swijnenburg
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marc G. Besselink
- From the Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jaap Stoker
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
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Seow-En I, Koh YX, Zhao Y, Ang BH, Tan IEH, Chok AY, Tan EJKW, Au MKH. Predictive modeling algorithms for liver metastasis in colorectal cancer: A systematic review of the current literature. Ann Hepatobiliary Pancreat Surg 2024; 28:14-24. [PMID: 38129965 PMCID: PMC10896689 DOI: 10.14701/ahbps.23-078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023] Open
Abstract
This study aims to assess the quality and performance of predictive models for colorectal cancer liver metastasis (CRCLM). A systematic review was performed to identify relevant studies from various databases. Studies that described or validated predictive models for CRCLM were included. The methodological quality of the predictive models was assessed. Model performance was evaluated by the reported area under the receiver operating characteristic curve (AUC). Of the 117 articles screened, seven studies comprising 14 predictive models were included. The distribution of included predictive models was as follows: radiomics (n = 3), logistic regression (n = 3), Cox regression (n = 2), nomogram (n = 3), support vector machine (SVM, n = 2), random forest (n = 2), and convolutional neural network (CNN, n = 2). Age, sex, carcinoembryonic antigen, and tumor staging (T and N stage) were the most frequently used clinicopathological predictors for CRCLM. The mean AUCs ranged from 0.697 to 0.870, with 86% of the models demonstrating clear discriminative ability (AUC > 0.70). A hybrid approach combining clinical and radiomic features with SVM provided the best performance, achieving an AUC of 0.870. The overall risk of bias was identified as high in 71% of the included studies. This review highlights the potential of predictive modeling to accurately predict the occurrence of CRCLM. Integrating clinicopathological and radiomic features with machine learning algorithms demonstrates superior predictive capabilities.
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Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
| | - Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore
- Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore
| | - Yun Zhao
- Department of Colorectal Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
- Group Finance Analytics, Singapore Health Services, Singapore
| | - Boon Hwee Ang
- Group Finance Analytics, Singapore Health Services, Singapore
| | | | - Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
| | - Emile John Kwong Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore
| | - Marianne Kit Har Au
- Group Finance Analytics, Singapore Health Services, Singapore
- Finance, SingHealth Community Hospitals, Singapore
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25
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Chandra P, Sacks GD. Contemporary Surgical Management of Colorectal Liver Metastases. Cancers (Basel) 2024; 16:941. [PMID: 38473303 DOI: 10.3390/cancers16050941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death. Approximately 20-30% of patients will develop hepatic metastasis in the form of synchronous or metachronous disease. The treatment of colorectal liver metastasis (CRLM) has evolved into a multidisciplinary approach, with chemotherapy and a variety of locoregional treatments, such as ablation and portal vein embolization, playing a crucial role. However, resection remains a core tenet of management, serving as the gold standard for a curative-intent therapy. As such, the input of a dedicated hepatobiliary surgeon is paramount for appropriate patient selection and choice of surgical approach, as significant advances in the field have made management decisions extremely nuanced and complex. We herein aim to review the contemporary surgical management of colorectal liver metastasis with respect to both perioperative and operative considerations.
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Affiliation(s)
- Pratik Chandra
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Greg D Sacks
- Department of Surgery, NYU Grossman School of Medicine, New York, NY 10016, USA
- VA New York Harbor Healthcare System, New York, NY 10010, USA
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26
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Li J, Zhu J, Zou Y, Zhang G, Zhu P, Wang N, Xie P. Diagnostic CT of colorectal cancer with artificial intelligence iterative reconstruction: A clinical evaluation. Eur J Radiol 2024; 171:111301. [PMID: 38237522 DOI: 10.1016/j.ejrad.2024.111301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/26/2023] [Accepted: 01/07/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES To investigate the clinical value of a novel deep-learning based CT reconstruction algorithm, artificial intelligence iterative reconstruction (AIIR), in diagnostic imaging of colorectal cancer (CRC). METHODS This study retrospectively enrolled 217 patients with pathologically confirmed CRC. CT images were reconstructed with the AIIR algorithm and compared with those originally obtained with hybrid iterative reconstruction (HIR). Objective image quality was evaluated in terms of the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality was graded on the conspicuity of tumor margin and enhancement pattern as well as the certainty in diagnosing organ invasion and regional lymphadenopathy. In patients with surgical pathology (n = 116), the performance of diagnosing visceral peritoneum invasion was characterized using receiver operating characteristic (ROC) analysis. Changes of diagnostic thinking in diagnosing hepatic metastases were assessed through lesion classification confidence. RESULTS The SNRs and CNRs on AIIR images were significantly higher than those on HIR images (all p < 0.001). The AIIR was scored higher for all subjective metrics (all p < 0.001) except for the certainty of diagnosing regional lymphadenopathy (p = 0.467). In diagnosing visceral peritoneum invasion, higher area under curve (AUC) of the ROC was found for AIIR than HIR (0.87 vs 0.77, p = 0.001). In assessing hepatic metastases, AIIR was found capable of correcting the misdiagnosis and improving the diagnostic confidence provided by HIR (p = 0.01). CONCLUSIONS Compared to HIR, AIIR offers better image quality, improves the diagnostic performance regarding CRC, and thus has the potential for application in routine abdominal CT.
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Affiliation(s)
- Jiao Li
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
| | - Junying Zhu
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
| | - Yixuan Zou
- United Imaging Healthcare, Shanghai 201800, China.
| | - Guozhi Zhang
- United Imaging Healthcare, Shanghai 201800, China.
| | - Pan Zhu
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
| | - Ning Wang
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
| | - Peiyi Xie
- Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510655, China.
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27
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Huang XL, Wang XD, Gong ZM, Zheng YF, Mao JX. Effect of magnetic resonance imaging in liver metastases. World J Gastroenterol 2024; 30:112-114. [PMID: 38293328 PMCID: PMC10823902 DOI: 10.3748/wjg.v30.i1.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024] Open
Abstract
This letter to the editor is a commentary on a study titled "Liver metastases: The role of magnetic resonance imaging." Exploring a noninvasive imaging evaluation system for the biological behavior of hepatocellular carcinoma (HCC) is the key to achieving precise diagnosis and treatment and improving prognosis. This review summarizes the role of magnetic resonance imaging in the detection and evaluation of liver metastases, describes its main imaging features, and focuses on the added value of the latest imaging tools (such as T1 weighted in phase imaging, T1 weighted out of phase imaging; diffusion-weighted imaging, T2 weighted imaging). In this study, I investigated the necessity and benefits of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid for HCC diagnostic testing and prognostic evaluation.
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Affiliation(s)
- Xing-Liang Huang
- Department of Science and Education, Dianjiang People's Hospital of Chongqing, Chongqing 408399, China
| | - Xiao-Dong Wang
- Department of Science and Industry, Chongqing Medical and Pharmaceutical College, Chongqing 400030, China
| | - Zhao-Miao Gong
- Department of Science and Industry, Chongqing Medical and Pharmaceutical College, Chongqing 400030, China
| | - Yan-Feng Zheng
- Department of Science and Industry, Chongqing Medical and Pharmaceutical College, Chongqing 400030, China
| | - Jing-Xin Mao
- Department of Science and Industry, Chongqing Medical and Pharmaceutical College, Chongqing 400030, China
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28
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Huang XL, Wang XD, Gong ZM, Zheng YF, Mao JX. Effect of magnetic resonance imaging in liver metastases. World J Gastroenterol 2024; 30:113-115. [DOI: 10.3748/wjg.v30.i1.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/12/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024] Open
Abstract
This letter to the editor is a commentary on a study titled "Liver metastases: The role of magnetic resonance imaging." Exploring a noninvasive imaging evaluation system for the biological behavior of hepatocellular carcinoma (HCC) is the key to achieving precise diagnosis and treatment and improving prognosis. This review summarizes the role of magnetic resonance imaging in the detection and evaluation of liver metastases, describes its main imaging features, and focuses on the added value of the latest imaging tools (such as T1 weighted in phase imaging, T1 weighted out of phase imaging; diffusion-weighted imaging, T2 weighted imaging). In this study, I investigated the necessity and benefits of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid for HCC diagnostic testing and prognostic evaluation.
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Affiliation(s)
- Xing-Liang Huang
- Department of Science and Education, Dianjiang People's Hospital of Chongqing, Chongqing 408399, China
| | - Xiao-Dong Wang
- Department of Science and Industry, Chongqing Medical and Pharmaceutical College, Chongqing 400030, China
| | - Zhao-Miao Gong
- Department of Science and Industry, Chongqing Medical and Pharmaceutical College, Chongqing 400030, China
| | - Yan-Feng Zheng
- Department of Science and Industry, Chongqing Medical and Pharmaceutical College, Chongqing 400030, China
| | - Jing-Xin Mao
- Department of Science and Industry, Chongqing Medical and Pharmaceutical College, Chongqing 400030, China
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29
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Görgec B, Hansen IS, Kemmerich G, Syversveen T, Abu Hilal M, Belt EJT, Bosscha K, Burgmans MC, Cappendijk VC, D'Hondt M, Edwin B, van Erkel AR, Gielkens HAJ, Grünhagen DJ, Gobardhan PD, Hartgrink HH, Horsthuis K, Klompenhouwer EG, Kok NFM, Kint PAM, Kuhlmann K, Leclercq WKG, Lips DJ, Lutin B, Maas M, Marsman HA, Meijerink M, Meyer Y, Morone M, Peringa J, Sijberden JP, van Delden OM, van den Bergh JE, Vanhooymissen IJS, Vermaas M, Willemssen FEJA, Dijkgraaf MGW, Bossuyt PM, Swijnenburg RJ, Fretland ÅA, Verhoef C, Besselink MG, Stoker J. MRI in addition to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): an international, multicentre, prospective, diagnostic accuracy trial. Lancet Oncol 2024; 25:137-146. [PMID: 38081200 DOI: 10.1016/s1470-2045(23)00572-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Guidelines are inconclusive on whether contrast-enhanced MRI using gadoxetic acid and diffusion-weighted imaging should be added routinely to CT in the investigation of patients with colorectal liver metastases who are scheduled for curative liver resection or thermal ablation, or both. Although contrast-enhanced MRI is reportedly superior than contrast-enhanced CT in the detection and characterisation of colorectal liver metastases, its effect on clinical patient management is unknown. We aimed to assess the clinical effect of an additional liver contrast-enhanced MRI on local treatment plan in patients with colorectal liver metastases amenable to local treatment, based on contrast-enhanced CT. METHODS We did an international, multicentre, prospective, incremental diagnostic accuracy trial in 14 liver surgery centres in the Netherlands, Belgium, Norway, and Italy. Participants were aged 18 years or older with histological proof of colorectal cancer, a WHO performance status score of 0-4, and primary or recurrent colorectal liver metastases, who were scheduled for local therapy based on contrast-enhanced CT. All patients had contrast-enhanced CT and liver contrast-enhanced MRI including diffusion-weighted imaging and gadoxetic acid as a contrast agent before undergoing local therapy. The primary outcome was change in the local clinical treatment plan (decided by the individual clinics) on the basis of liver contrast-enhanced MRI findings, analysed in the intention-to-image population. The minimal clinically important difference in the proportion of patients who would have change in their local treatment plan due to an additional liver contrast-enhanced MRI was 10%. This study is closed and registered in the Netherlands Trial Register, NL8039. FINDINGS Between Dec 17, 2019, and July 31, 2021, 325 patients with colorectal liver metastases were assessed for eligibility. 298 patients were enrolled and included in the intention-to-treat population, including 177 males (59%) and 121 females (41%) with planned local therapy based on contrast-enhanced CT. A change in the local treatment plan based on liver contrast-enhanced MRI findings was observed in 92 (31%; 95% CI 26-36) of 298 patients. Changes were made for 40 patients (13%) requiring more extensive local therapy, 11 patients (4%) requiring less extensive local therapy, and 34 patients (11%) in whom the indication for curative-intent local therapy was revoked, including 26 patients (9%) with too extensive disease and eight patients (3%) with benign lesions on liver contrast-enhanced MRI (confirmed by a median follow-up of 21·0 months [IQR 17·5-24·0]). INTERPRETATION Liver contrast-enhanced MRI should be considered in all patients scheduled for local treatment for colorectal liver metastases on the basis of contrast-enhanced CT imaging. FUNDING The Dutch Cancer Society and Bayer AG - Pharmaceuticals.
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Affiliation(s)
- Burak Görgec
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Ingrid S Hansen
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunter Kemmerich
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Mohammed Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Eric J T Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Koop Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Bjørn Edwin
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arian R van Erkel
- Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Hugo A J Gielkens
- Department of Radiology, Medical Spectrum Twente, Enschede, Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus Medical Centre, Rotterdam, Netherlands; Erasmus Medical Centre Cancer Institute, Erasmus Medical Centre, Rotterdam, Netherlands
| | | | - Henk H Hartgrink
- Department of Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Karin Horsthuis
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Niels F M Kok
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Peter A M Kint
- Department of Radiology, Amphia Hospital, Breda, Netherlands
| | - Koert Kuhlmann
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Daan J Lips
- Department of Surgery, Medical Spectrum Twente, Enschede, Netherlands
| | - Bart Lutin
- Department of Radiology, Groeninge Hospital, Kortrijk, Belgium
| | - Monique Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Martijn Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Yannick Meyer
- Department of Surgical Oncology, Erasmus Medical Centre, Rotterdam, Netherlands; Erasmus Medical Centre Cancer Institute, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Mario Morone
- Department of Radiology, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Jan Peringa
- Department of Radiology, OLVG, Amsterdam, Netherlands
| | - Jasper P Sijberden
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Janneke E van den Bergh
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Inge J S Vanhooymissen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Maarten Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, Netherlands
| | | | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Public Health, Methodology, Amsterdam, Netherlands
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Rutger-Jan Swijnenburg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Åsmund A Fretland
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Centre, Rotterdam, Netherlands; Erasmus Medical Centre Cancer Institute, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands.
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30
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Cohen R, Platell CF. Metachronous colorectal cancer metastasis: Who, what, when and what to do about it. J Surg Oncol 2024; 129:71-77. [PMID: 37458102 DOI: 10.1002/jso.27400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
Metachronous colorectal cancer (CRC) metastasis occurs due to micrometastatic disease, in up to 23% of patients who have undergone curative-intent treatment. Metachronous metastasis tends to occur within 2 years of initial treatment. Diagnosis relies on posttreatment surveillance strategies. Care for patients with metachronous CRC metastasis is complex and requires careful multidisciplinary consideration. Those with isolated and technically resectable diseases are recommended to undergo metastasectomy with adjunct chemotherapy, however, survival, even after curative-intent resection, is poor.
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Affiliation(s)
- Ryan Cohen
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Colorectal Cancer Unit, St John of God Subiaco Hospital, Perth, Western Australia, Australia
| | - Cameron F Platell
- Colorectal Cancer Unit, St John of God Subiaco Hospital, Perth, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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31
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Fu Y, Ruan W, Sun X, Hu F, Lan X, Liu F. Added value of regional 18F-FDG PET/MRI-assisted whole-body 18F-FDG PET/CT in malignant ascites with unknown primary origin. Eur J Hybrid Imaging 2023; 7:22. [PMID: 38044389 PMCID: PMC10694118 DOI: 10.1186/s41824-023-00179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/12/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Comparing to PET/CT, integrative PET/MRI imaging provides superior soft tissue resolution. This study aims to evaluate the added value of regional delayed 18F-FDG PET/MRI-assisted whole-body 18F-FDG PET/CT in diagnosing malignant ascites patients. RESULTS The final diagnosis included 22 patients with ovarian cancer (n = 11), peritoneal cancer (n = 3), colon cancer (n = 2), liver cancer (n = 2), pancreatic cancer (n = 2), gastric cancer (n = 1), and fallopian tube cancer (n = 1). The diagnosis of the primary tumor using whole-body PET/CT was correct in 11 cases. Regional PET/MRI-assisted whole-body PET/CT diagnosis was correct in 18 cases, including 6 more cases of ovarian cancer and 1 more case of fallopian tube cancer. Among 4 cases that were not diagnosed correctly, 1 case had the primary tumor outside of the PET/MRI scan area, 2 cases were peritoneal cancer, and 1 case was colon cancer. The diagnostic accuracy of regional PET/MRI-assisted whole-body PET/CT was higher than PET/CT alone (81.8% vs. 50.0%, κ 2 = 5.14, p = 0.023). The primary tumor conspicuity score of PET/MRI was higher than PET/CT (3.67 ± 0.66 vs. 2.76 ± 0.94, P < 0.01). In the same scan area, more metastases were detected in PET/MRI than in PET/CT (156 vs. 86 in total, and 7.43 ± 5.17 vs. 4.10 ± 1.92 per patient, t = 3.89, P < 0.01). Lesion-to-background ratio in PET/MRI was higher than that in PET/CT (10.76 ± 5.16 vs. 6.56 ± 3.45, t = 13.02, P < 0.01). CONCLUSION Comparing to whole-body PET/CT alone, additional delayed regional PET/MRI with high soft tissue resolution is helpful in diagnosing the location of the primary tumor and identifying more metastases in patients with malignant ascites. Yet larger sample size in multicenter and prospective clinical researches is still needed.
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Affiliation(s)
- Yiru Fu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei, China
| | - Weiwei Ruan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei, China
| | - Xun Sun
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei, China
- Key Laboratory of Biological Targeted Therapy of the Ministry of Education, Wuhan, 430022, China
| | - Fan Hu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei, China
- Key Laboratory of Biological Targeted Therapy of the Ministry of Education, Wuhan, 430022, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei, China.
- Key Laboratory of Biological Targeted Therapy of the Ministry of Education, Wuhan, 430022, China.
| | - Fang Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, Hubei, China.
- Key Laboratory of Biological Targeted Therapy of the Ministry of Education, Wuhan, 430022, China.
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Horkaew P, Chansangrat J, Keeratibharat N, Le DC. Recent advances in computerized imaging and its vital roles in liver disease diagnosis, preoperative planning, and interventional liver surgery: A review. World J Gastrointest Surg 2023; 15:2382-2397. [PMID: 38111769 PMCID: PMC10725533 DOI: 10.4240/wjgs.v15.i11.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 11/26/2023] Open
Abstract
The earliest and most accurate detection of the pathological manifestations of hepatic diseases ensures effective treatments and thus positive prognostic outcomes. In clinical settings, screening and determining the extent of a pathology are prominent factors in preparing remedial agents and administering appropriate therapeutic procedures. Moreover, in a patient undergoing liver resection, a realistic preoperative simulation of the subject-specific anatomy and physiology also plays a vital part in conducting initial assessments, making surgical decisions during the procedure, and anticipating postoperative results. Conventionally, various medical imaging modalities, e.g., computed tomography, magnetic resonance imaging, and positron emission tomography, have been employed to assist in these tasks. In fact, several standardized procedures, such as lesion detection and liver segmentation, are also incorporated into prominent commercial software packages. Thus far, most integrated software as a medical device typically involves tedious interactions from the physician, such as manual delineation and empirical adjustments, as per a given patient. With the rapid progress in digital health approaches, especially medical image analysis, a wide range of computer algorithms have been proposed to facilitate those procedures. They include pattern recognition of a liver, its periphery, and lesion, as well as pre- and postoperative simulations. Prior to clinical adoption, however, software must conform to regulatory requirements set by the governing agency, for instance, valid clinical association and analytical and clinical validation. Therefore, this paper provides a detailed account and discussion of the state-of-the-art methods for liver image analyses, visualization, and simulation in the literature. Emphasis is placed upon their concepts, algorithmic classifications, merits, limitations, clinical considerations, and future research trends.
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Affiliation(s)
- Paramate Horkaew
- School of Computer Engineering, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Jirapa Chansangrat
- School of Radiology, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Nattawut Keeratibharat
- School of Surgery, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima 30000, Thailand
| | - Doan Cong Le
- Faculty of Information Technology, An Giang University, Vietnam National University (Ho Chi Minh City), An Giang 90000, Vietnam
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Attiyeh MA, Malhotra GK, Li D, Manoukian SB, Motarjem PM, Singh G. Defining MRI Superiority over CT for Colorectal and Neuroendocrine Liver Metastases. Cancers (Basel) 2023; 15:5109. [PMID: 37894475 PMCID: PMC10605771 DOI: 10.3390/cancers15205109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND We compared CT and MRI for staging metastatic colorectal or neuroendocrine liver metastases (CRLMs and NELMs, respectively) to assess their impact on tumor burden. METHODS A prospectively maintained database was queried for patients who underwent both imaging modalities within 3 months, with two blinded radiologists (R1 and R2) independently assessing the images for liver lesions. To minimize recall bias, studies were grouped by modality, and were randomized and evaluated separately. RESULTS Our query yielded 76 patients (42 CRLMs; 34 NELMs) with low interrater variability (intraclass correlation coefficients: CT = 0.941, MRI = 0.975). For CRLMs, there were no significant differences in lesion number or size between CT and MRI. However, in NELMs, Eovist®-enhanced MRI detected more lesions (R1: 14.3 vs. 12.1, p = 0.02; R2: 14.4 vs. 12.4, p = 0.01) and smaller lesions (R1: 5.7 vs. 4.4, p = 0.03; R2: 4.8 vs. 2.9, p = 0.02) than CT. CONCLUSIONS CT and MRI are equivalent for CRLMs, but for NELMs, MRI outperforms CT in detecting more and smaller lesions, potentially influencing treatment planning and surgery.
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Affiliation(s)
- Marc A. Attiyeh
- Department of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| | - Gautam K. Malhotra
- Department of Surgery, USC, Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Saro B. Manoukian
- Department of Radiology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Pejman M. Motarjem
- Department of Radiology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Gagandeep Singh
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA
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Choi AS, Moon TJ, Abuhashim W, Bhalotia A, Qian H, Paulsen KE, Lorkowski M, Ndamira C, Gopalakrishnan R, Krishnamurthy A, Schiemann WP, Karathanasis E. Can targeted nanoparticles distinguish cancer metastasis from inflammation? J Control Release 2023; 362:812-819. [PMID: 37011838 PMCID: PMC10548349 DOI: 10.1016/j.jconrel.2023.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/11/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
Targeting ligands have been widely used to increase the intratumoral accumulation of nanoparticles and their uptake by cancer cells. However, these ligands aim at targets that are often also upregulated in inflamed tissues. Here, we assessed the ability of targeted nanoparticles to distinguish metastatic cancer from sites of inflammation. Using common targeting ligands and a 60-nm liposome as a representative nanoparticle, we generated three targeted nanoparticle (NP) variants that targeted either fibronectin, folate, or αvβ3 integrin, whose deposition was compared against that of standard untargeted NP. Using fluorescently labeled NPs and ex vivo fluorescence imaging of organs, we assessed the deposition of the NPs into the lungs of mice modeling 4 different biological landscapes, including healthy lungs, aggressive metastasis in lungs, dormant/latent metastasis in lungs, and lungs with general pulmonary inflammation. Among the four NP variants, fibronectin-targeting NP and untargeted NP exhibited the highest deposition in lungs harboring aggressive metastases. However, the deposition of all targeted NP variants in lungs with metastasis was similar to the deposition in lungs with inflammation. Only the untargeted NP was able to exhibit higher deposition in metastasis than inflammation. Moreover, flow-cytometry analysis showed all NP variants accumulated predominantly in immune cells rather than cancer cells. For example, the number of NP+ macrophages and dendritic cells was 16-fold greater than NP+ cancer cells in the case of fibronectin-targeting NP. Overall, targeted NPs were unable to distinguish cancer metastasis from general inflammation, which may have clinical implications to the nanoparticle-mediated delivery of cancer drugs.
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Affiliation(s)
- Andrew S Choi
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Taylor J Moon
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Walid Abuhashim
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Anubhuti Bhalotia
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Huikang Qian
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Kai E Paulsen
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Morgan Lorkowski
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Crystal Ndamira
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Ramamurthy Gopalakrishnan
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Animesha Krishnamurthy
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - William P Schiemann
- Department of Biochemistry, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America
| | - Efstathios Karathanasis
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America; Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States of America.
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Maino C, Vernuccio F, Cannella R, Cortese F, Franco PN, Gaetani C, Giannini V, Inchingolo R, Ippolito D, Defeudis A, Pilato G, Tore D, Faletti R, Gatti M. Liver metastases: The role of magnetic resonance imaging. World J Gastroenterol 2023; 29:5180-5197. [PMID: 37901445 PMCID: PMC10600959 DOI: 10.3748/wjg.v29.i36.5180] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/28/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023] Open
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.
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Affiliation(s)
- Cesare Maino
- 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
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo 90127, Italy
| | - Francesco Cortese
- Unit of Interventional Radiology, F Miulli Hospital, Acquaviva delle Fonti 70021, Italy
| | - Paolo Niccolò Franco
- Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
| | - Clara Gaetani
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Valentina Giannini
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F Miulli Hospital, Acquaviva delle Fonti 70021, Italy
| | - Davide Ippolito
- Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy
- School of Medicine, University of Milano Bicocca, Milano 20100, Italy
| | - Arianna Defeudis
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Giulia Pilato
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo 90127, Italy
| | - Davide Tore
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Riccardo Faletti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
| | - Marco Gatti
- Department of Surgical Sciences, University of Turin, Turin 10126, Italy
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Fernández Montes A, Alonso V, Aranda E, Élez E, García Alfonso P, Grávalos C, Maurel J, Vera R, Vidal R, Aparicio J. SEOM-GEMCAD-TTD clinical guidelines for the systemic treatment of metastatic colorectal cancer (2022). Clin Transl Oncol 2023; 25:2718-2731. [PMID: 37133732 PMCID: PMC10425293 DOI: 10.1007/s12094-023-03199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/04/2023]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer deaths in Spain. Metastatic disease is present in 15-30% of patients at diagnosis and up to 20-50% of those with initially localized disease eventually develop metastases. Recent scientific knowledge acknowledges that this is a clinically and biologically heterogeneous disease. As treatment options increase, prognosis for individuals with metastatic disease has steadily improved over recent decades. Disease management should be discussed among experienced, multidisciplinary teams to select the most appropriate systemic treatment (chemotherapy and targeted agents) and to integrate surgical or ablative procedures, when indicated. Clinical presentation, tumor sidedness, molecular profile, disease extension, comorbidities, and patient preferences are key factors when designing a customized treatment plan. These guidelines seek to provide succinct recommendations for managing metastatic CRC.
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Affiliation(s)
- Ana Fernández Montes
- Medical Oncology Department, Complexo Hospitalario Universitario, Ourense (CHUO), C/ Ramón Puga, 56, 32005, Ourense, Spain.
| | - Vicente Alonso
- Medical Oncology Department, Hospital Universitario Miguel Servet, Saragossa, Spain
| | - Enrique Aranda
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Elena Élez
- Medical Oncology Department, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Pilar García Alfonso
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Grávalos
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Joan Maurel
- Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Ruth Vera
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Rosario Vidal
- Medical Oncology Department, Complejo Asistencial Universitario, Salamanca, Spain
| | - Jorge Aparicio
- Medical Oncology Department, Hospital Universitari I Politècnic la Fe, Valencia, Spain
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Qiu QS, Zhu K, Wang JH, Chen XS, Wang WT, Dong SY, Sun W, Rao SX. Diagnostic Performance of Contrast Enhanced CT Alone or in Combination with (Non-)Enhanced MRI for Colorectal Liver Metastasis. Acad Radiol 2023; 30:1856-1865. [PMID: 36481127 DOI: 10.1016/j.acra.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/02/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES To compare the diagnostic performance of contrast enhanced CT (CE-CT), CE-CT combined with non-enhanced MRI (NE-MRI) or contrast enhanced MRI (CE-MRI) for colorectal liver metastasis (CRLM). MATERIALS AND METHODS Sixty-six colorectal cancer patients with 198 focal liver lesions who underwent preoperative abdominal CE-CT and MRI examinations were included respectively. The images were assessed independently by two readers in three protocols (1: CE-CT, 2: CE-CT+NE-MRI, 3: CE-CT+CE-MRI). The diagnostic performance of each protocol was analyzed by receiver operating characteristic (ROC) curve and the areas under ROC (AUCs) were calculated and compared. RESULTS The detection rates of protocol 2 were 90.9%-92.9% for liver lesions and 86.4%-89.6% for CRLM, and both significantly higher than protocol 1 of 82.8%-85.4% and 76.8%-80.8% (p<0.001-0.001), whereas similar to protocol 3 of 91.9%-94.4% and 87.2%-91.2% (p 0.250-1.000). The AUCs of protocol 2 were greater than protocol 1 for all lesions (0.914-0.934 vs. 0.779-0.799, p<0.001) and lesions < 10mm (0.726-0.776 vs. 0.528-0.561, p<0.001), and were not inferior to that of protocol 3 (0.929-0.949 in all lesions and 0.754-0.821 in lesion < 10mm, p 0.053-0.162). CONCLUSION CE-CT combined with NE-MRI offered superior diagnostic performance for CRLM compared to CE-CT alone and showed comparable performance to CE-CT combined with CE-MRI.
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Affiliation(s)
- Qian-Sai Qiu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, P. R. China; Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong University, Nantong, P. R. China
| | - Kai Zhu
- Department of Liver Surgery, Zhongshan Hospital, Fudan University, Shanghai P. R. China
| | - Jia-Hui Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, P. R. China
| | - Xiao-Shan Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, P. R. China
| | - Wen-Tao Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, P. R. China; Department of Cancer Center, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - San-Yuan Dong
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, P. R. China
| | - Wei Sun
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, P. R. China; Department of Cancer Center, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Sheng-Xiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, P. R. China; Department of Cancer Center, Zhongshan Hospital Fudan University, Shanghai, 200032, China.
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Carney BW, Larson MC, Corwin MT, Lamba R. Imaging of Hepatobiliary Cancer. Curr Probl Cancer 2023:100964. [PMID: 37321910 DOI: 10.1016/j.currproblcancer.2023.100964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/04/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
The liver and biliary tree are common sites of primary and secondary malignancies. MRI followed by CT is the mainstay for the imaging characterization of these malignancies with the dynamically acquired contrast enhanced phases being the most important for diagnosis. The liver imaging reporting and data system classification provides a useful framework for reporting lesions in patents with underlying cirrhosis or who are at high risk for developing hepatocellular carcinoma. Detection of metastases is improved with the use of liver specific MRI contrast agents and diffusion weighted sequences. Aside from hepatocellular carcinoma, which is often diagnosed noninvasively, other primary hepatobiliary tumors may require biopsy for definite diagnosis, especially when presenting with nonclassic imaging findings. In this review, we examine the imaging findings of common and less common hepatobiliary tumors.
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Affiliation(s)
- Benjamin W Carney
- Department of Radiology, University of California, Davis Health System, Sacramento, California.
| | - Michael C Larson
- Department of Radiology, University of California, Davis Health System, Sacramento, California
| | - Michael T Corwin
- Department of Radiology, University of California, Davis Health System, Sacramento, California
| | - Ramit Lamba
- Department of Radiology, University of California, Davis Health System, Sacramento, California
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Yoshino T, Cervantes A, Bando H, Martinelli E, Oki E, Xu RH, Mulansari NA, Govind Babu K, Lee MA, Tan CK, Cornelio G, Chong DQ, Chen LT, Tanasanvimon S, Prasongsook N, Yeh KH, Chua C, Sacdalan MD, Sow Jenson WJ, Kim ST, Chacko RT, Syaiful RA, Zhang SZ, Curigliano G, Mishima S, Nakamura Y, Ebi H, Sunakawa Y, Takahashi M, Baba E, Peters S, Ishioka C, Pentheroudakis G. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with metastatic colorectal cancer. ESMO Open 2023; 8:101558. [PMID: 37236086 PMCID: PMC10220270 DOI: 10.1016/j.esmoop.2023.101558] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/28/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with metastatic colorectal cancer (mCRC), published in late 2022, were adapted in December 2022, according to previously established standard methodology, to produce the Pan-Asian adapted (PAGA) ESMO consensus guidelines for the management of Asian patients with mCRC. The adapted guidelines presented in this manuscript represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with mCRC representing the oncological societies of China (CSCO), Indonesia (ISHMO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO), co-ordinated by ESMO and the Japanese Society of Medical Oncology (JSMO). The voting was based on scientific evidence and was independent of the current treatment practices, drug access restrictions and reimbursement decisions in the different Asian countries. The latter are discussed separately in the manuscript. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with mCRC across the different countries of Asia, drawing on the evidence provided by both Western and Asian trials, whilst respecting the differences in screening practices, molecular profiling and age and stage at presentation, coupled with a disparity in the drug approvals and reimbursement strategies, between the different countries.
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Affiliation(s)
- T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
| | - A Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - H Bando
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - E Martinelli
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania 'L. Vanvitelli', Naples, Italy
| | - E Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - R-H Xu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center and State Key Laboratory of Oncology in South China, Guangzhou, China
| | - N A Mulansari
- Hematology-Medical Oncology Division, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital/Universitas Indonesia, Jakarta, Indonesia
| | - K Govind Babu
- Department of Medical Oncology, HCG Hospital and St. John's Medical College, Bengaluru, India
| | - M A Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - C K Tan
- Department of Oncology and Nuclear Medicine, Thomson Hospital Kota Damansara, Selangor, Malaysia
| | - G Cornelio
- Department of Medical Oncology, University of the Philipppines-Philippine General Hospital, St. Lukes Cancer Institute-Global City, The Philippines
| | - D Q Chong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - L-T Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital and Centre for Cancer Research, Kaohsiung Medical University, Kaohsiung; National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - S Tanasanvimon
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok
| | - N Prasongsook
- Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - K-H Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - C Chua
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - M D Sacdalan
- Department of Surgery, University of the Philippines-College of Medicine and University of the Philippines-Philippine General Hospital, Manila, The Philippines
| | - W J Sow Jenson
- Department of Radiotherapy & Oncology, Aurelius Hospital, Nilai, Malaysia
| | - S T Kim
- Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Centre, Seoul, South Korea
| | - R T Chacko
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - R A Syaiful
- Department of Surgery, Dr Cipto Mangunkusumo National General Hospital, University of Indonesia, Jakarta, Indonesia
| | - S Z Zhang
- Department of Colorectal Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan; Department of Oncology and Haematology, University of Milano, Milan, Italy
| | - S Mishima
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Y Nakamura
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - H Ebi
- Division of Molecular Therapeutics, Aichi Cancer Center Research Institute, Nagoya
| | - Y Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki
| | - M Takahashi
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai
| | - E Baba
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - S Peters
- Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - C Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
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Nakai H, Sakamoto R, Kakigi T, Coeur C, Isoda H, Nakamoto Y. Artificial intelligence-powered software detected more than half of the liver metastases overlooked by radiologists on contrast-enhanced CT. Eur J Radiol 2023; 163:110823. [PMID: 37059006 DOI: 10.1016/j.ejrad.2023.110823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/17/2023] [Accepted: 04/04/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE To evaluate the sensitivity of artificial intelligence (AI)-powered software in detecting liver metastases, especially those overlooked by radiologists. METHODS Records of 746 patients diagnosed with liver metastases (November 2010-September 2017) were reviewed. Images from when radiologists first diagnosed liver metastases were reviewed, and prior contrast-enhanced CT (CECT) images were checked for availability. Two abdominal radiologists classified the lesions into overlooked lesions (all metastases missed by radiologists on prior CECT) and detected lesions (all metastases if any of them were correctly identified and invisible on prior CECT or those with no prior CECT). Finally, images from 137 patients were identified, 68 of which were classified as "overlooked cases." The same radiologists created the ground truth for these lesions and compared them with the software's output at 2-month intervals. The primary endpoint was the sensitivity in detecting all liver lesion types, liver metastases, and liver metastases overlooked by radiologists. RESULTS The software successfully processed images from 135 patients. The per-lesion sensitivity for all liver lesion types, liver metastases, and liver metastases overlooked by radiologists was 70.1%, 70.8%, and 55.0%, respectively. The software detected liver metastases in 92.7% and 53.7% of patients in detected and overlooked cases, respectively. The average number of false positives was 0.48 per patient. CONCLUSION The AI-powered software detected more than half of liver metastases overlooked by radiologists while maintaining a relatively low number of false positives. Our results suggest the potential of AI-powered software in reducing the frequency of overlooked liver metastases when used in conjunction with the radiologists' clinical interpretation.
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Affiliation(s)
- Hirotsugu Nakai
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Preemptive Medicine and Lifestyle Disease Research Center, Kyoto University Hospital, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takahide Kakigi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Christophe Coeur
- AI digital division - Guerbet, 15 Rue des Vanesses, Villepinte 93420, France.
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Preemptive Medicine and Lifestyle Disease Research Center, Kyoto University Hospital, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
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Stage IV Colorectal Cancer Management and Treatment. J Clin Med 2023; 12:jcm12052072. [PMID: 36902858 PMCID: PMC10004676 DOI: 10.3390/jcm12052072] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023] Open
Abstract
(1) Background: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related mortality worldwide. Up to 50% of patients with CRC develop metastatic CRC (mCRC). Surgical and systemic therapy advances can now offer significant survival advantages. Understanding the evolving treatment options is essential for decreasing mCRC mortality. We aim to summarize current evidence and guidelines regarding the management of mCRC to provide utility when making a treatment plan for the heterogenous spectrum of mCRC. (2) Methods: A comprehensive literature search of PubMed and current guidelines written by major cancer and surgical societies were reviewed. The references of the included studies were screened to identify additional studies that were incorporated as appropriate. (3) Results: The standard of care for mCRC primarily consists of surgical resection and systemic therapy. Complete resection of liver, lung, and peritoneal metastases is associated with better disease control and survival. Systemic therapy now includes chemotherapy, targeted therapy, and immunotherapy options that can be tailored by molecular profiling. Differences between colon and rectal metastasis management exist between major guidelines. (4) Conclusions: With the advances in surgical and systemic therapy, as well as a better understanding of tumor biology and the importance of molecular profiling, more patients can anticipate prolonged survival. We provide a summary of available evidence for the management of mCRC, highlighting the similarities and presenting the difference in available literature. Ultimately, a multidisciplinary evaluation of patients with mCRC is crucial to selecting the appropriate pathway.
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Kitasaki N, Abe T, Inoue M, Kohata A, Toyota K. Pathological complete response of multiple liver metastases from colon cancer successfully treated with conversion surgery: A case report. Int J Surg Case Rep 2023; 104:107935. [PMID: 36801767 PMCID: PMC9969276 DOI: 10.1016/j.ijscr.2023.107935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Recently, the successful long-term survival of patients with unresectable distant metastases from colorectal cancer, who underwent conversion surgery after systemic chemotherapy, have been documented. Herein, we present a patient afflicted with ascending colon cancer and multiple unresectable liver metastases, who underwent conversion surgery, resulting in the complete disappearance of the pathological liver metastases. PRESENTATION OF CASE A 70-year-old woman visited our hospital with a chief complaint of weight loss. A diagnosis of ascending colon cancer (cT4aN2aM1a [H3]: TNM classification 8th edition) stage IVa with RAS/BRAF wild-type mutation was made (four liver metastases up to 60 mm in diameter were observed in both lobes). After 2 years and 3 months of systemic chemotherapy (capecitabine, oxaliplatin, and bevacizumab), the tumor marker levels had decreased to normal ranges and all liver metastases showed partial responses with remarkable shrinkage. After confirmation of a liver function and a preserved future liver remnant volume, the patient finally underwent hepatectomy, involving partial resection of S4 and subsegmentectomy of S8, along with a right hemicolectomy. Histopathologic examination revealed that all liver metastases had completely disappeared, while regional lymph node metastases had changed into scar tissue. However, the primary tumor failed to respond to chemotherapy, resulting in ypT3N0M0 ypStage IIA. The patient was discharged from the hospital on the 8th postoperative day without any postoperative complications. She is currently on the 6th month of follow-up without any recurring metastasis. CLINICAL DISCUSSION Curative surgery is recommended for resectable liver metastases of colorectal cancer (CRLM), be it synchronous or heterochronous. Up until now, the efficacy of perioperative chemotherapy for CRLM is limited. Chemotherapy has a double-edged aspect, where some cases have shown successful improvement in the treatment stage. CONCLUSION To obtain the maximum benefit from conversion surgery, it is critical to incorporate the appropriate surgical technique, at the correct stage, in order avoid the progression to chemotherapy-associated steatohepatitis (CASH) in the patient.
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Affiliation(s)
- Nao Kitasaki
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan.
| | - Tomoyuki Abe
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan.
| | - Masashi Inoue
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan.
| | - Akihiro Kohata
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan.
| | - Kazuhiro Toyota
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Hiroshima, Japan.
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Miao Z, Zhao X, Li X. [18F]FDG PET/CT versus [18F]FDG PET/MRI for the diagnosis of colorectal liver metastasis: A systematic review and meta-analysis. Front Oncol 2023; 13:1114059. [PMID: 36860315 PMCID: PMC9969139 DOI: 10.3389/fonc.2023.1114059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
Purpose The purpose of our meta-analysis and systematic review was to compare the diagnostic performance of [18F]FDG PET/CT and [18F]FDG PET/MRI in colorectal liver metastasis. Methods We searched PubMed, Embase, and Web of Science for eligible articles until November 2022. Studies focusing on the diagnostic value of [18F]FDG PET/CT or PET/MRI for colorectal liver metastasis were included. Using a bivariate random-effect model, the pooled sensitivity and specificity for [18F]FDG PET/CT and [18F]FDG PET/MRI were reported as estimates with 95% confidence intervals (CIs). Heterogeneity among pooled studies was assessed using the I2 statistic. The Quality Assessment of Diagnostic Performance Studies (QUADAS-2) method was used to evaluate the quality of the studies that were included. Results There were a total of 2743 publications identified in the initial search, finally, a total of 21 studies comprising 1036 patients were included. The pooled sensitivity, specificity, and AUC of [18F]FDG PET/CT in were 0.86 (95% CI: 0.76-0.92), 0.89 (95% CI: 0.83-0.94), and 0.92(95% CI: 0.90-0.94). [18F]FDG PET/MRI were 0.84 (95% CI: 0.77-0.89), 1.00 (95% CI: 0.32-1.00), and 0.89(95% CI: 0.86-0.92), respectively. Conclusion [18F]FDG PET/CT shows similar performance compared to [18F]FDG PET/MRI in detecting colorectal liver metastasis. However, pathological results were not obtained for all patients in the included studies and PET/MRI results were derived from studies with small sample sizes. There is a need for additional, larger prospective studies on this issue. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier (CRD42023390949).
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Affiliation(s)
- Zhi Miao
- Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin, China,School of Chemical Engineering and Technology, Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin, China,*Correspondence: Zhi Miao,
| | - Xiaomeng Zhao
- Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (Ministry of Education), Tianjin University, Tianjin, China,School of Chemical Engineering and Technology, Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin, China
| | - Xuanwen Li
- Graduate School of Health Science, Suzuka University of Medical Science, Suzuka, Japan
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Yamazaki K, Nishii R, Mizutani Y, Makishima H, Kaneko T, Isobe Y, Terada T, Tamura K, Imabayashi E, Tani T, Kobayashi M, Wakatsuki M, Tsuji H, Higashi T. Estimation of post-therapeutic liver reserve capacity using 99mTc-GSA scintigraphy prior to carbon-ion radiotherapy for liver tumors. Eur J Nucl Med Mol Imaging 2023; 50:581-592. [PMID: 36192469 DOI: 10.1007/s00259-022-05985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is currently no established imaging method for assessing liver reserve capacity prior to carbon-ion radiotherapy (CIRT) for liver tumors. In order to perform safe CIRT, it is essential to estimate the post-therapeutic residual reserve capacity of the liver. PURPOSE To evaluate the ability of pre-treatment 99mTc-galactosyl human serum albumin (99mTc-GSA) scintigraphy to accurately estimate the residual liver reserve capacity in patients treated with CIRT for liver tumors. MATERIALS AND METHODS This retrospective study evaluated patients who were performed CIRT for liver tumors between December 2018 and September 2020 and underwent 99mTc-GSA scintigraphy before and 3 months after CIRT, and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI within 1 month before CIRT were evaluated. The maximal removal rate of 99mTc-GSA (GSA-Rmax) was analyzed for the evaluation of pre-treatment liver reserve capacity. Then, the GSA-Rmax of the estimated residual liver (GSA-RL) was calculated using liver SPECT images fused with the Gd-EOB-DTPA-enhanced MRI. GSA-RL before CIRT and GSA-Rmax at 3 months after CIRT were compared using non-parametric Wilcoxon signed-rank test and linear regression analysis. RESULTS Overall, 50 patients were included (mean age ± standard deviation, 73 years ± 11; range, 29-89 years, 35 men). The median GSA-RL was 0.393 [range, 0.057-0.729] mg/min, and the median GSA-Rmax after CIRT was 0.369 [range, 0.037-0.780] mg/min (P = .40). The linear regression equation representing the relationship between the GSA-RL and GSA-Rmax after CIRT was y = 0.05 + 0.84x (R2 = 0.67, P < .0001). There was a linear relationship between the estimated and actual post-treatment values for all patients, as well as in the group with impaired liver reserve capacity (y = - 0.02 + 1.09x (R2 = 0.62, P = .0005)). CONCLUSIONS 99mTc-GSA scintigraphy has potential clinical utility for estimating the residual liver reserve capacity in patients undergoing carbon-ion radiotherapy for liver tumors. TRIAL REGISTRATION UMIN000038328, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043545 .
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Affiliation(s)
- Kana Yamazaki
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Ryuichi Nishii
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan.
| | - Yoichi Mizutani
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki City, Miyazaki, Japan
| | - Hirokazu Makishima
- Department of Radiation Oncology, University of Tsukuba, Tsukuba City, Ibaraki, Japan
- Proton Medical Research Center, University of Tsukuba, Tsukuba City, Ibaraki, Japan
- Department of Diagnostic Radiology and Radiation Oncology, QST Hospital, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba City, Chiba, Japan
| | - Takashi Kaneko
- Department of Diagnostic Radiology and Radiation Oncology, QST Hospital, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba City, Chiba, Japan
- Department of Radiology, Division of Radiation Oncology, Yamagata University Faculty of Medicine, Yamagata City, Yamagata, Japan
| | - Yoshiharu Isobe
- Department of Medical Technology, QST Hospital, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba City, Chiba, Japan
| | - Tamasa Terada
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki City, Miyazaki, Japan
| | - Kentaro Tamura
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Etsuko Imabayashi
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
| | - Toshiaki Tani
- Department of Medical Technology, QST Hospital, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba City, Chiba, Japan
| | - Masato Kobayashi
- School of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa City, Ishikawa, Japan
| | - Masaru Wakatsuki
- Department of Diagnostic Radiology and Radiation Oncology, QST Hospital, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba City, Chiba, Japan
| | - Hiroshi Tsuji
- Department of Diagnostic Radiology and Radiation Oncology, QST Hospital, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba City, Chiba, Japan
| | - Tatsuya Higashi
- Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan
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Oppenheimer J, Bressem KK, Elsholtz FHJ, Hamm B, Niehues SM. Can optimized model-based iterative reconstruction improve the contrast of liver lesions in CT? Acta Radiol 2023; 64:42-50. [PMID: 34985369 PMCID: PMC9780754 DOI: 10.1177/02841851211070119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Computed tomography is a standard imaging procedure for the detection of liver lesions, such as metastases, which can often be small and poorly contrasted, and therefore hard to detect. Advances in image reconstruction have shown promise in reducing image noise and improving low-contrast detectability. PURPOSE To examine a novel, specialized, model-based iterative reconstruction (MBIR) technique for improved low-contrast liver lesion detection. MATERIAL AND METHODS Patient images with reported poorly contrasted focal liver lesions were retrospectively reconstructed with the low-contrast attenuating algorithm (FIRST-LCD) from primary raw data. Liver-to-lesion contrast, signal-to-noise, and contrast-to-noise ratios for background and liver noise for each lesion were compared for all three FIRST-LCD presets with the established hybrid iterative reconstruction method (AIDR-3D). An additional visual conspicuity score was given by two experienced radiologists for each lesion. RESULTS A total of 82 lesions in 57 examinations were included in the analysis. All three FIRST-LCD algorithms provided statistically significant increases in liver-to-lesion contrast, with FIRSTMILD showing the largest increase (40.47 HU in AIDR-3D; 45.84 HU in FIRSTMILD; P < 0.001). Substantial improvement was shown in contrast-to-noise metrics. Visual analysis of the lesions shows decreased lesion visibility with all FIRST methods in comparison to AIDR-3D, with FIRSTSTR showing the closest results (P < 0.001). CONCLUSION Objective image metrics show promise for MBIR methods in improving the detectability of low-contrast liver lesions; however, subjective image quality may be perceived as inferior. Further improvements are necessary to enhance image quality and lesion detection.
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Affiliation(s)
- Jonas Oppenheimer
- Department of Radiology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,Jonas Oppenheimer, Charité – Universitätsmedizin Berlin, Clinic for Radiology Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Keno Kyrill Bressem
- Department of Radiology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Henry Jürgen Elsholtz
- Department of Radiology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefan Markus Niehues
- Department of Radiology, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Blankenburg M, Elhamamy M, Zhang D, Fujikawa N, Corbin A, Jin G, Harris J, Knobloch G. Evaluation of health economic impact of initial diagnostic modality selection for colorectal cancer liver metastases in suspected patients in China, Japan and the USA. J Med Econ 2023; 26:219-232. [PMID: 36705988 DOI: 10.1080/13696998.2023.2173436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS To compare cost offsets and contributing factors (false-negative rates and confirmatory imaging requirements, potentially leading to longer waiting times for diagnosis) as well as long-term cost effectiveness associated with the diagnostic and treatment pathways for colorectal cancer liver metastases (CRCLM) in the US, Japan, and China according to initial imaging modality used. Gadoxetate disodium (ethoxylbenzyl-diethylenetriaminepentaacetic acid)-enhanced magnetic resonance imaging (EOB-MRI) was compared to multidetector computed tomography (MDCT), extracellular contrast media enhanced-MRI (ECCM-MRI) (the US and China only) and contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS Decision tree models were developed to simulate the clinical pathway, from first diagnostic test to initial treatment decision, based on local clinical guidelines and validated by experts. Input data were derived from the literature (up to 31st December 2020) as well as from interviews with local experts. A Markov model extension was built to evaluate the number of false-negative patients and associated costs, over a lifetime horizon. RESULTS The decision-tree models showed that, increasing proportionate use of initial EOB-MRI resulted in a cost-offset per patient (excluding false-negative patients) in all countries (USD 201 for the US, JPY 6,284 for Japan and CNY 446 for China) driven by reductions in follow-on diagnostic procedures and unnecessary treatment. The use of EOB-MRI was also associated with a shorter average waiting time to a final diagnosis and treatment decision compared to MDCT, ECCM-MRI and CEUS. The Markov model showed that with an increase in EOB-MRI use, there are fewer false-negative diagnoses over a lifetime horizon. In all three countries, the incremental cost-effectivenes ratio (ICER) was below standard willingness-to-pay thresholds. CONCLUSION The findings of these models demonstrate that use of EOB-MRI early in the diagnostic pathway for CRCLM results in short-term cost savings, as well as being cost effective in the long term.
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Cervantes A, Adam R, Roselló S, Arnold D, Normanno N, Taïeb J, Seligmann J, De Baere T, Osterlund P, Yoshino T, Martinelli E. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2023; 34:10-32. [PMID: 36307056 DOI: 10.1016/j.annonc.2022.10.003] [Citation(s) in RCA: 660] [Impact Index Per Article: 330.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- A Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - R Adam
- AP-HP Hôpital Paul Brousse, Université Paris-Saclay, ER "Chronothérapie, Cancers, Transplantation", Villejuif, France
| | - S Roselló
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - D Arnold
- Department of Oncology and Hematology, Asklepios Tumourzentrum Hamburg, AK Altona, Hamburg, Germany
| | - N Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumouri, 'Fondazione G. Pascale'-IRCCS, Naples, Italy
| | - J Taïeb
- Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, Assitance Publique-Hôpitaux de Paris AP-HP Paris Centre, Paris, France; Paris Cancer Institute SIRIC CARPEM, Centre de Recherche des Cordeliers, Université Paris-Cité, Paris, France
| | - J Seligmann
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - T De Baere
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France; University of Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France; Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Villejuif, France
| | - P Osterlund
- Tampere University Hospitals and University, Tampere, Finland; Tema Cancer/GI-oncology, Karolinska Comprehensive Cancer Centre, Karolinska Institute, Solna, Sweden
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - E Martinelli
- Department of Precision Medicine, Oncology Unit, Università della Campania "L. Vanvitelli", Naples, Italy
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Cai Q, Mao Y, Dai S, Gao F, Xiao Q, Hu W, Qin T, Yang Q, Li Z, Cai D, Zhong ME, Ding K, Wu XJ, Zhang R. The growth pattern of liver metastases on MRI predicts early recurrence in patients with colorectal cancer: a multicenter study. Eur Radiol 2022; 32:7872-7882. [PMID: 35420300 DOI: 10.1007/s00330-022-08774-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/22/2022] [Accepted: 03/26/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The multicenter study aimed to explore the relationship between the growth pattern of liver metastases on preoperative MRI and early recurrence in patients with colorectal cancer liver metastases (CRCLM) after surgery. METHODS A total of 348 CRCLM patients from 3 independent centers were enrolled, including 130 patients with 339 liver metastases in the primary cohort and 218 patients in validation cohorts. Referring to the gross classification of hepatocellular carcinoma (HCC), the growth pattern of each liver metastasis on MRI was classified into four types: rough, smooth, focal extranodular protuberant (FEP), and nodular confluent (NC). Disease-free survival (DFS) curve was constructed using the Kaplan-Meier method. RESULTS In primary cohort, 42 (12.4%) of the 339 liver metastases were rough type, 237 (69.9%) were smooth type, 29 (8.6%) were FEP type, and 31 (9.1%) were NC type. Those patients with FEP- and/or NC-type liver metastases had shorter DFS than those without such metastases (p < 0.05). However, there were no significant differences in DFS between patients with rough- and smooth-type liver metastases and those without such metastases. The patients with FEP- and/or NC-type liver metastases also had shorter DFS than those without such metastases in two external validation cohorts. In addition, 40.5% of high-risk-type (FEP and NC) liver metastases converted to low-risk types (rough and smooth) after neoadjuvant chemotherapy. CONCLUSION The FEP- and NC-type liver metastases were associated with early recurrence, which may facilitate the clinical treatment of CRCLM patients. KEY POINTS • In the primary cohort, patients with FEP- and NC-type metastases had shorter disease-free survival (DFS) and a higher intrahepatic recurrence rate than patients without such metastases in the liver. • In the primary cohort, there were no significant differences in DFS or intrahepatic recurrence rate between patients with rough- and smooth-type metastases and those without such metastases in the liver. • High-risk patients had shorter DFS and a higher intrahepatic recurrence rate than low-risk patients in primary and external validation cohorts.
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Affiliation(s)
- Qian Cai
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Radiology, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Yize Mao
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Hepato-biliary-pancreatic Oncology, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Siqi Dai
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
| | - Feng Gao
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, supported by National Key Clinical Discipline, Guangzhou, 510655, China
| | - Qian Xiao
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China
| | - Wanming Hu
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Pathology, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Tao Qin
- Department of Medical Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 East Yanjiang Road, Guangzhou, 510120, China
| | - Qiuxia Yang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.,Department of Radiology, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Zhaozhou Li
- Department of Astronomy, School of Physics and Astronomy, Shanghai Jiao Tong University, No. 800 Dongchuan Road, Shanghai, 200240, China
| | - Du Cai
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, supported by National Key Clinical Discipline, Guangzhou, 510655, China
| | - Min-Er Zhong
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China.,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, supported by National Key Clinical Discipline, Guangzhou, 510655, China
| | - Kefeng Ding
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Zhejiang, 310009, Hangzhou, China. .,Cancer Center, Zhejiang University, Hangzhou, China.
| | - Xiao-Jian Wu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, China. .,Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, supported by National Key Clinical Discipline, Guangzhou, 510655, China.
| | - Rong Zhang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China. .,Department of Radiology, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, China.
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49
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Wang X, Qi R, Xu Y, Lu X, Shi Q, Wang Y, Wang D, Wang C. Clinicopathological characteristics and prognosis of colon cancer with lung metastasis without liver metastasis: A large population-based analysis. Medicine (Baltimore) 2022; 101:e31333. [PMID: 36281166 PMCID: PMC9592286 DOI: 10.1097/md.0000000000031333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Distant metastasis explains the high mortality rate of colon cancer, in which lung metastasis without liver metastasis (LuM) is a rare subtype. This study is aimed to identify risk factors of LuM and LLM (lung metastasis with liver metastasis) from colon cancer, and to analyze the prognosis of patients with LuM by creating a nomogram. Patients' information were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariable logistic regression analysis was used to determine the risk factors for LuM and LLM. Prognostic factors for cancer-specific survival (CSS) and overall survival (OS) were identified by multivariate Cox proportional hazards regression and nomogram models were established to predict CSS and OS. Multivariate logistic regression analysis showed that blacks, splenic flexure of colon tumor, tumor size >5 cm, T4, N3, and higher lymph node positive rate were associated with the occurrence of LuM. Meanwhile, age >65 years old, female, splenic flexure of colon, higher lymph node positive rate, and brain metastasis were independent risk factors for CSS. The C-index of the prediction model for CSS was 0.719 (95% CI: 0.691-0.747). In addition, age, primary site, tumor size, differentiation grade, N stage, and bone metastasis were significantly different between LuM and LLM. The nomograms we created were effective in predicting the survival of individuals. Furthermore, patients with LuM and LLM from colon cancer might require different follow-up intervals and examinations.
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Affiliation(s)
- Xiao Wang
- Department of Colorectal Surgery, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang Province, P. R. China
| | - Ruihua Qi
- Department of Colorectal Surgery, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang Province, P. R. China
| | - Ying Xu
- Department of Colorectal Surgery, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang Province, P. R. China
| | - Xingang Lu
- Department of Colorectal Surgery, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang Province, P. R. China
| | - Qing Shi
- Department of Colorectal Surgery, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang Province, P. R. China
| | - Ya Wang
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Department of Hospital Infection-Control, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Hospital Infection-Control, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, P. R. China
| | - Da Wang
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
- *Correspondence: Chunliang Wang, Department of Colorectal Surgery, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang Province 311499, P. R. China (e-mail: )
| | - Chunliang Wang
- Department of Colorectal Surgery, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang Province, P. R. China
- *Correspondence: Chunliang Wang, Department of Colorectal Surgery, The First People’s Hospital of Fuyang, Hangzhou, Zhejiang Province 311499, P. R. China (e-mail: )
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50
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Li S, Li Z, Huang X, Zhang P, Deng J, Liu X, Xue C, Zhang W, Zhou J. CT, MRI, and radiomics studies of liver metastasis histopathological growth patterns: an up-to-date review. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3494-3506. [PMID: 35895118 DOI: 10.1007/s00261-022-03616-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 02/07/2023]
Abstract
The histopathological growth patterns (HGPs) of liver metastases (LMs) are independently associated with the long-term prognosis of the primary tumor, with different HGPs predicting different patient outcomes and clinical treatment decisions. Non-invasive imaging biomarkers for stratification of HGPs are beneficial for treatment monitoring, evaluation of efficacy, and prognosis prediction of LMs. This review describes the state of research regarding computed tomography (CT), magnetic resonance imaging (MRI), and radiomics imaging biomarkers for LM-HGPs; discusses the advantages of CT, MRI, and radiomics for classification of LM-HGPs; and provides a reference for the stratification of LM-HGPs. Finally, the difficulties and deficiencies of CT, MRI, and radiomics in LM-HGP research are summarized along with the proposed directions for future research.
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Affiliation(s)
- Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Zhengxiao Li
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Xiaoyu Huang
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Peng Zhang
- Department of Pathology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China
| | - Juan Deng
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Xianwang Liu
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Caiqiang Xue
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Wenjuan Zhang
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou, 730030, China. .,Second Clinical School, Lanzhou University, Lanzhou, China. .,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China. .,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
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