Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Oct 28, 2022; 14(10): 352-366
Published online Oct 28, 2022. doi: 10.4329/wjr.v14.i10.352
Diagnostic performance of abbreviated gadoxetic acid-enhanced magnetic resonance protocols with contrast-enhanced computed tomography for detection of colorectal liver metastases
Kumi Ozaki, Shota Ishida, Shohei Higuchi, Toyohiko Sakai, Ayaki Kitano, Kenji Takata, Kazuyuki Kinoshita, Yuki Matta, Takashi Ohtani, Hirohiko Kimura, Toshifumi Gabata
Kumi Ozaki, Shohei Higuchi, Toyohiko Sakai, Ayaki Kitano, Kenji Takata, Kazuyuki Kinoshita, Yuki Matta, Takashi Ohtani, Hirohiko Kimura, Department of Radiology, University of Fukui, Fukui 9101193, Japan
Shota Ishida, Department of Radiological Technology, Faculty of Medical Science, Kyoto College of Medical Science, Kyoto 6220041, Japan
Toshifumi Gabata, Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa 9208641, Japan
Author contributions: Ozaki K contributed to the methodology and data curation; Ishida S contributed to the conceptualization; Higuchi S, Sakai T, Kitano A, Takata K and Kinoshita K contributed to the investigation; Ozaki K, Matta Y and Ohtani T contributed to the writing-original draft; Kimura H contributed to the methodology, writing-review and editing; Gabata T contributed to the supervision and project administration.
Institutional review board statement: This single-center retrospective study was approved by our institutional review board (No. 20210035).
Informed consent statement: The written informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: The authors share all data.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kumi Ozaki, MD, PhD, Lecturer, Department of Radiology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Fukui 9101193, Japan. ozakik-rad@umin.org
Received: August 14, 2022
Peer-review started: August 14, 2022
First decision: August 29, 2022
Revised: September 5, 2022
Accepted: October 5, 2022
Article in press: October 5, 2022
Published online: October 28, 2022
Processing time: 74 Days and 1.5 Hours
ARTICLE HIGHLIGHTS
Research background

Although contrast-enhanced magnetic resonance imaging (MRI) using gadoxetic acid has been shown to have higher accuracy, sensitivity, and specificity for the detection and characterization of hepatic metastases compared with other modalities, the long examination time would limit the broad indication. Several abbreviated MRI protocols without dynamic phases (Ab-MRI) have been proposed to achieve equivalent diagnostic performance for the detection of colorectal liver metastases. However, an optimal protocol has not been established, and no studies have assessed the diagnostic performance of Ab-MRI combined with contrast-enhanced computed tomography (CE-CT), which is the preoperative imaging of colorectal cancer staging in clinical settings, to determine the best therapeutic strategy.

Research motivation

The long examination time and relatively high cost of the standard MRI protocol with gadoxetic acid limit its use for the routine surveillance of liver metastases in patients with colorectal cancer. In order to further expand use of the MRI examination with gadoxetic acid with maintaining the diagnostic performance of liver metastases in patients with colorectal cancer, the diagnostic performance of Ab-MRI combined with or without CE-CT, which is the preoperative imaging of colorectal cancer should be estimated.

Research objectives

To compare the diagnostic performance of two kinds of Ab-MRI protocol with the standard MRI protocol and a combination of the Ab-MRI protocol and CE-CT for the detection of colorectal liver metastases.

Research methods

Study participants comprised 87 patients (51 males, 36 females; mean age, 67.2 ± 10.8 years) who had undergone gadoxetic acid-enhanced MRI and CE-CT during the initial work-up for colorectal cancer from 2010 to 2021. Each exam was independently reviewed by two readers in three reading sessions: (1) Only single-shot fast spin echo (FSE) T2-weighted or fat-suppressed-FSE-T2-weighted, diffusion-weighted, and hepatobiliary-phase images (Ab-MRI protocol 1 or 2); (2) all acquired MRI sequences (standard protocol); and (3) a combination of an Ab-MRI protocol (1 or 2) and CE-CT. Diagnostic performance was then statistically analyzed.

Research results

A total of 380 Lesions were analyzed, including 195 metastases (51.4%). Results from the two Ab-MRI protocols were similar. The sensitivity, specificity, and positive and negative predictive values from Ab-MRI were non-inferior to those from standard MRI (P > 0.05), while those from the combination of Ab-MRI protocol and CE-CT tended to be higher than those from Ab-MRI alone, although the difference was not significant (P > 0.05), and were quite similar to those from standard MRI (P > 0.05).

Research conclusions

The diagnostic performances of two kinds of Ab-MRI protocol, including SSFSE or FSE T2-weighted images, were non-inferior to that of the standard protocol. The combination of Ab-MRI and CE-CT provided better diagnostic performance than Ab-MRI alone, nearly equivalent to that of the standard protocol.

Research perspectives

The combination of Ab-MRI and CE-CT can provide a sufficient diagnostic performance for the detection of colorectal liver metastases, and enable a reduction in imaging acquisition time.