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. 2024 Mar 18;5(1):e401.
doi: 10.1097/AS9.0000000000000401. eCollection 2024 Mar.

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

Burak Görgec  1   2   3 , Inez M Verpalen  2   3 , Jasper P Sijberden  1   2 , Mohammad Abu Hilal  4 , Shandra Bipat  3 , Cornelis Verhoef  5 , Rutger-Jan Swijnenburg  1   2 , Marc G Besselink  1   2 , Jaap Stoker  2   3
Affiliations

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

Burak Görgec et al. Ann Surg 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.

Keywords: ablation; colorectal cancer; computed tomography; magnetic resonance imaging; resection.

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Figures

FIGURE 1.
FIGURE 1.
PRISMA flow chart of search results.
FIGURE 2.
FIGURE 2.
Risk of bias assessment of the included studies using the QUADAS-2 tool.
FIGURE 3.
FIGURE 3.
Pooled results of change in local treatment plan after MRI liver in patients amenable to local treatment of colorectal liver metastases according to CT scan.
FIGURE 4.
FIGURE 4.
Sensitivity analyses with (A) pooled results of change in local treatment plan of studies including suspected or known CRLM lesions on CT of all sizes. B, Pooled results of change in local treatment plan of studies including monophasic portal venous CT followed by liver MRI (gadoterate meglumine or gadoxetic acid, and DWI or no DWI). C, Pooled results of change in local treatment plan of studies including monophasic portal venous CT followed by gadoxetic acid-enhanced liver MRI with DWI. D, Pooled results of change in local treatment plan of studies including CT (monophasic or multiphasic) followed by gadoxetic acid liver MRI (DWI or no DWI). E, Pooled results of change in local treatment plan of studies including CT (monophasic or multiphasic) followed by gadoxetic acid liver MRI with DWI. F, Pooled results of change in local treatment of studies with 2 independent readers of CT and MRI. G, Pooled results of change in local treatment of studies including contrast-enhanced liver MRI.
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