Follow-up result afters negative findings on unenhanced hepatic MR imaging for hepatic metastasis from rectal cancer

Abstract

Objective: To assess the follow-up results after negative findings on unenhanced hepatic MR imaging in rectal cancer patients who have undergone locally curative surgery.

Materials and methods: From all pertinent imaging reports and medical records, we selected 255 patients who had negative results on unenhanced hepatic MR imaging. When selecting patients who had undergone curative resection, the following patients were excluded from the study: 1) patients in whom extrahepatic metastases were detected on preoperative staging work-ups, 2) patients in whom the surgery was judged to be non-curative due to peritoneal seeding or local aggressiveness. Cases with follow-up periods of less than 18 months were also excluded, as these cases were considered insufficient to confirm the negative outcomes. Thus, a total of 149 patients were ultimately enrolled in our study. The follow-up results of unenhanced MR imagings were assessed according to the assumption that the newly developed hepatic metastases had been false-negative lesions on preoperative MR image.

Results: During a median follow-up period of 29.3 months, 25 hepatic metastases were detected in 13 patients (8.7%), which indicated a negative predictive value of 91.3%.

Conclusion: Unenhanced hepatic MR imaging provides a high negative predictive value with regard to the detection of hepatic metastasis in the preoperative evaluation of rectal cancer.

Fig. 1

A 43 year-old-woman with rectal cancer. A, B. Preoperative MR images (T2-weighted single shot fast spin-echo image [17020/100] (A) and T1-weighted GRE image [230/4.0, 90° flip angle] (B)) show no evidence of metastasis in the liver. C. Low attenuating subcentimetric lesion (white arrow) can be seen in the lateral segment on the follow-up CT scan, obtained three months postoperatively. D. Growth of the lesion on the lateral segment (white arrow) can be seen on the CT scan at eight months postoperatively, which represents a metastasis.