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Review
. 2012 Sep;19(9):2805-13.
doi: 10.1245/s10434-012-2300-z. Epub 2012 Mar 7.

Preoperative imaging of colorectal liver metastases after neoadjuvant chemotherapy: a meta-analysis

Charlotte S van Kessel  1 , Constantinus F M Buckens, Maurice A A J van den Bosch, Maarten S van Leeuwen, Richard van Hillegersberg, Helena M Verkooijen
Affiliations
Review

Preoperative imaging of colorectal liver metastases after neoadjuvant chemotherapy: a meta-analysis

Charlotte S van Kessel et al. Ann Surg Oncol. 2012 Sep.

Abstract

Background: Chemotherapy treatment induces parenchymal changes that potentially affect imaging of CRLM. The purpose of this meta-analysis was to provide values of diagnostic performance of magnetic resonance imaging (MRI), computed tomography (CT), fluorodeoxyglucose positron emission tomography (FDG-PET), and FDG-PET/CT for preoperative detection of colorectal liver metastases (CRLM) in patients treated with neoadjuvant chemotherapy.

Methods: A comprehensive search was performed for original articles published from inception to 2011 assessing diagnostic performance of MRI, CT, FDG-PET, or FDG-PET/CT for preoperative evaluation of CRLM following chemotherapy. Intraoperative findings and/or histology were used as reference standard. For each imaging modality we calculated pooled sensitivities for patients who received neoadjuvant chemotherapy as well as for chemonaive patients, defined as number of malignant lesions detected divided by number of malignant lesions as confirmed by the reference standard.

Results: A total of 11 papers, comprising 223 patients with 906 lesions, were included. Substantial variation in study design, patient characteristics, imaging features, and reference tests was observed. Pooled sensitivity estimates of MRI, CT, FDG-PET, and FDG-PET/CT were 85.7% (69.7-94.0%), 69.9% (65.6-73.9%), 54.5% (46.7-62.1%), and 51.7% (37.8-65.4%), respectively. In chemonaive patients, sensitivity rates were 80.5% (67.0-89.4%) for CT, 81.3% (64.1-91.4%) for FDG-PET, and 71.0% (64.3-76.9%) for FDG-PET/CT. Specificity could not be calculated because of non-reporting of "true negative lesions."

Conclusion: In the neoadjuvant setting, MRI appears to be the most appropriate imaging modality for preoperative assessment of patients with CRLM. CT is the second-best diagnostic modality and should be used in the absence of MRI. Diagnostic accuracy of FDG-PET and PET-CT is strongly affected by chemotherapy.

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Figures

Fig. 1
Fig. 1
Results of critical appraisal
Fig. 2
Fig. 2
Flowchart showing the multistep process of identifying articles that were suitable for this meta-analysis for evaluation of CRLM after neoadjuvant chemotherapy
Fig. 3
Fig. 3
Forest plots showing pooled sensitivities for MRI, CT, FDG-PET, and PET-CT on a lesion level. a Results are displayed for the patients who received neoadjuvant chemotherapy. b Results are displayed for patients without neoadjuvant chemotherapy
See this image and copyright information in PMC

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